FEVERS. 667 



there too we may apply blisters. And in short, at any period 

 of the disease where we have a topical affection, blisters near 

 the affected part are proper ; but without any topical affection, 

 merely considering the general course of the fever, where there 

 are symptoms of increased action, and danger from every stimu- 

 lus, they are to be employed with a great deal of caution. But 

 if the disease from the beginning puts on the form of a nervous 

 fever or typhus, I am of opinion that we may begin blistering 

 at any period of the disease without any hesitation. The case 

 that gives difficulty is this ; where the disease is a synochus, a 

 general fever without topical determinations, but with marks 

 of increased impetus, frequency of pulse, and some degree of 

 fulness in it., with considerable heat and thirst, whether, when 

 the other remedies are exhausted, we should have recourse to 

 blistering ? I am disposed to think that we should not. I do 

 not say that the chief effect of blistering is by its stimulus ; but 

 it is a stimulus, and even the temporary stimulus may have ef- 

 fect in the case of a general phlogistic diathesis ; and I see that 

 Dr. Lind, who is so remarkable an advocate for blistering in con- 

 tagious fevers, observes that he has known them to have done a 

 great deal of harm in those fevers which approach near to the 

 inflammatory form ; and Sir John Pringle also, who is certainly 

 an advocate for their use, acknowledges his doubts with regard 

 to them in such cases. I therefore say that their use is doubt- 

 ful, at least so long as the fever keeps the form of the synochus ; 

 and it is agreed upon by all practitioners, that their most certain 

 use in general fever is when the Diathesis phlogistica is very 

 nearly gone, when only the febrile spasm properly remains, and 

 when blisters maybe of service even by their stimulus. But 

 there is another consideration that weighs with me upon this 

 subject. I have said that the duration of fevers is not absolute- 

 ly determined, yet it commonly is by several circumstances very 

 much so ; and if it is so, if we cannot hope immediately to 

 cut short the course of fevers by blisters, it would be desirable 

 to put off their use till they become more necessary. There are 

 not many places to which they can be well applied, and it is not 

 proper to pre-occupy these, lest if a topical determination should 

 occur, it might prevent their more convenient use in the time of 

 the greatest need. 



3A2 



