much of the cotton may be removed as can be done without disturbing the loose epidermis beneath, and the whole again covered with a dry layer of cotton. This is all the dressing which in general is requisite. The cotton is allowed to stick to the skin of the blistered part, and when a fresh layer of epidermis is formed, which takes place very readily, the old epidermis and cotton come off together, leaving a smooth whole surface below.

The advantages of the above mode, according to Dr. M., are first, "that it renders the blister much less painful and annoying to the patient than when unguents are used. The tenderness in fact is comparatively so trifling, and the protection by the cotton so good," he says, "that I have been enabled without annoyance to the patient to percuss freely, and apply the stethoscope firmly over blistered parts, which had been dressed for the first time only an hour or two previously; secondly, the blisters heal faster under it than under dressings with cerate for although the cotton may remain adhering for some days, I have generally found, that within twelve hours the patient ceases to feel the blister a source of annoyance. Lastly, it dispenses with the greasy applications so disagreeable to patients of cleanly habits."*

4. To obtain the good and avoid the evils of blisters, it is evident that a nicer discrimination of the conditions of the system is necessary in the use of this class of agents in children than in adults. Long experience has established the fact that it is only under certain states of the system, that blisters can be used with any prospect of advantage. If this be true in the adult, it is doubly so in the young subject, and any mistake in this respect is much more likely to be followed by injurious consequences in the latter than in the former. Now the conditions which influence the effects of these agents, are the state of the skin, and the state of the nervous and vascular systems. With regard to the skin, it may be laid down as a general rule, that when blisters are used as revulsives, the part to which they are applied should be as nearly as possible in a state of perfect health. In this state, the irritation of blistering may be established even in a child with comparative safety. On the contrary, when the skin is in a morbid state, alceration and gangrene are by no means unusual occurrences. All this is occasionally illustrated in scarlatina and measles. Mr. Pereira mentions that he has seen "two instances of death from the gangrene caused by applying a blister after measles." My friend Prof. Dunglison, in his valuable work on Materia Medica, states that he has seen "several cases of death manifestly caused by the use of blisters in scarlatina and measles." Other facts of a similar character might be adduced, but the preceding are sufficient to show the tendency which there exists in this state of the skin to take on unhealthy inflammation. And the reason is to be sought for in the changed condition of the skin. During the febrile stage of these diseases the skin is preternaturally injected and excited. As soon as the fever subsides and the eruption recedes, the skin is left in a state of debility-a state in which, as we all know, inflammation is very likely to terminate unfavorably. I hope it may not

* Edinburg Monthly Journal of Medical Science, May 1847, p. 83 1. + Materia Medica, Vol. II., p. 775. American Edition.

Vol. II., p. 219.

be inferred from the preceding, that I mean to express the opinion that blisters ought never to be used in such cases as measles and scarlatina-but the possible occurrence of such consequences ought to make us exceedingly cautious about the manner of using them, and indeed ought to deter us from using them at all, unless under a manifest necessity. In every case, therefore, before applying blisters to young children, the condition of the skin ought to be attended to.

With regard to the state of the system, this is even still more necessary to be inquired into. Indeed this is all important, if we hope to realize any of the expected benefits from these agents. Now there are two states of the system almost equally unpropitious to their useand these just the reverse of each other. The first is that in which high inflammatory excitement is present. That this is unfavorable to the legitimate operation of a blister as a revulsive, is obvious, if we reflect for a moment upon the effects of this agent. These are, local irritation and general excitement. Now in all cases where an internal inflammation exists, the difficulty of resolving it by any means will be proportioned to the degree of general excitement accompanying it. If a blister be applied where this general excitement is already very great, one of the necessary consequences will be to augment this so greatly as to counteract, in a greater or less degree, according to circumstances, the beneficial effects of the blister as a revulsive. Under this condition of things, the internal inflammation will be aggravated instead of abated, in consequence of the increase of general exciteHence the fact has been generally observed, that if blisters are applied in the early periods of inflammatory complaints, or before suitable evacuations have been resorted to, they frequently do more harm than good. They merely add fuel to the fire.

ment.

On the other hand, a state of great constitutional exhaustion and emaciation is also unfavorable to their operation. The reason here, however, is entirely different from that in the preceding case. The danger here is that from the impaired state of the vital energies, the local inflammation of the blister may be followed by ulceration, gangrene and death. In the use of blisters, therefore, both these extremes should be carefully avoided. With regard to the condition most propitious to their use, it is that in which the general excitement is rather below than above the natural standard. When this is the case, there is less danger from any increase of excitement, while the system is in the state most favorable to the transfer of irritations from one part to another. Now all this is applicable to the adult, and we can easily see how much more so it must be in the case of the irritable and sensitive infant.

5. In the use of blisters in children, especial reference should be had to the peculiarities of their temperament and constitution. This is more important perhaps than it may at first sight appear. Every practitioner must have observed the extreme suffering which adults sometimes undergo from the irritation of blisters. In nervous and irri. table habits I have myself seen a state of things thus induced, little short of phrenzy. In children of nervous temperaments all this is much more likely to happen, and accordingly greater caution should be exercised.

If the foregoing conclusions be founded in truth, they would seem at

once to expose the impropriety of the practice of resorting to the use of blisters on every trifling occasion, in the management of the diseases of children. There is an opinion prevalent-how it has originated I know not, that blisters are innocent remedies-if they do no good, they can do no harm. Now this is unquestionably a great error, and has been productive of vast mischief. Independently of the unnecessary suffering which they may occasion, they sometimes produce death by the manifest causes of ulceration and gangrene, while in others they insidiously aggravate the disease they were intended to relieve.

ART. II.-Proceedings of the Brooklyn Medical Association.—(Prepared by Drs. MITCHELL, CRANE and TRASK, a committee appointed for the purpose.)

FIRST REGULAR MEETING, December, 1847.

DR. HENRY read a paper of which the following is an abstract: During the month of September, C. D., a girl aged 10 years, while convalescing from a severe attack of remittent fever, was seized suddenly with pain in the gastrocnemius muscle of the left leg, occupying all the fleshy portion, with loss of motion and extreme pain on any attempt at moving the limb. There was great irritability and night sweats, for which 1 gr. sulph. quinine was prescribed every 4 hours. The amendment of the symptoms was thenceforth rapid, all the functions were properly performed, and the leg which had hitherto been immovable, could be drawn up to the abdomen with ease.

After several days, (Nov. 26), all the symptoms returned in an aggravated degree. There was so exquisite a tenderness to the touch as to cause a dread of the approach of any person to the bedside; the sensitiveness not being confined to the seat of original attack, but involving the whole limb from the hip to the toes, and also the inguinal glands, which were slightly enlarged and excessively tender; the pain much increased on any disturbance of the limb. The whole limb was much enlarged, the skin natural in appearance and temperature; appetite good, bowels regular, tongue slightly red and smooth, pulse 100, no thirst.

November 27. Limb enlarged to double the size of the other, al. though the pain and tenderness are confined to no particular portion of the limb, yet she points to the glands of the groin as the part at which motion produces excruciating torture; the color of the affected limb was perhaps a little whiter than that of the sound one, and there was not the slightest redness at any point; no oedema. She complained of some pain in the right hip-joint on motion, and on examining the spine some tenderness was detected in the lumbar region, due perhaps to long confinement to the recumbent posture; pulse 112; in other respects same as day before. Up to this date, frictions with camphorated oil, when they could be borne, had been freely employed; and opiates freely administered. Ung. hydrar. was then directed to be rubbed into the limb.

November 28. Comparatively comfortable; no pains except when

moved.

December 1, Limb still tender to touch, and in other respects remains as before; passed a restless night; pulse 140, soft and regular. From the constantly progressive increase of irritability the prognosis was considered at this date rather unfavorable. Two grains of quinine were directed every four hours, and a nutritious diet ordered. At no time had the movements of the limb been voluntary.

From this period the amendment was slow but uninterrupted; the power of motion returning so slowly that the patient was unable to walk without support before the beginning of March.

At the present date, 16 months from the attack, the leg has recovered its natural size, but there is diminished freedom of motion from partial anchylosis of the hip-joint; the general health is good.

The father of this patient, who had an attack of remittent fever about the same time, suffered during his convalescence from a similar swelling of the left lower extremity, the pain commencing in the gastrocnemius muscle. This yielded in a few days to simple treatment and the recovery was complete.

The symptoms corresponded in both these cases with those of phlegmasia dolens of puerperal females, and Dr. Henry is of the opinion that they were genuine examples of that affection.

Dr. MITCHELL reported the following case as another example of phlegmasia dolens after fever:

A lady, convalescent from typhus fever, was attacked with acute pain in the calf of the left leg, attended with considerable heat of skin and acceleration of pulse. The part became hot, swollen and hard without change of colour. The hardness resembled that of lead, and occupied the whole bulk of the gastrocnemius muscles. There was tenderness in the popliteal space, and in the left iliac region. Partly from the pain caused by motion, and partly from want of power over the muscles the use of the limb was lost. After five days these symp toms began to abate, but lameness continued for several weeks afterwards.

Dr. TRASK reported the following:

A. T., æt. 6 months, was healthy for the first two months after birth, after which time it began to lose its appetite and flesh, neither of which it regained. About July 15th it had an attack of vomiting and diarhea which yielded to simple remedies. At this time the mother observed a red spot like a pimple just below the right clavicle, and also dark-colored, ecchymozed patches, feeling hard under the finger, on the back between the shoulders, and on the left elbow and a few upon the lower extremities. The appearance of these spots remained unchanged until July 30th, when the diarrhoea returned, accompanied by frequent green discharges and tenesmus, but no vomiting.

Coincident with this relapse, the spot below the clavicle began to increase rapidly in size and by August 1st, it formed a tense, insensible globular swelling of a dark blue color reaching about an inch and a half above and below the clavicle, and encroaching upon the region of the trachea, with an abrasion of the cuticle in the centre of the size of a half dime. The tumors on the back, some eight or ten in number, varied in size from a pea to a nut, were slightly, if at all ele

vated above the surrounding skin, feeling under the finger like inflamed lymphatic glands. Similar spots, of the same blue colour, and others of a greenish-yellow, were seen on the trunk and extremities. The pa tient was at that time exceedingly prostrated, with the pulse 160.

The swelling upon the neck appearing to be gangrenous, a yeast poultice was ordered; also hydrarg. c. creta and pulv. dov., cum sesqui carb. ammon.

Aug. 2. The tumor was discharging pretty freely a sanious offensive fluid from the opening in the apex. The discharge continued offensive until death, which took place next day; the whole tumor had become much softened and would probably have entirely sloughed off had the patient survived sufficiently long.

"The spots of purpura," says Wilson, "are usually seated in the superficial layer of the dermis, more rarely the extravasation takes place beneath the epidermis, and in some cases ecchymoses are found in the subcutaneous cellular tissue." No post mortem examination could be obtained; but it is evident that from the age of two months, some source of irritation existed, probably intestinal, by which the system was debilitated, and that the morbid state of the capillary system thus induced, was made manifest by the extravasation of blood into the subcutaneous cellular tissue.

Dr. McMELLEN reported a case of hæmatocele, occurring in a U.S. soldier several years since, which yielded very happily to treatment. Dr. MORSE reported a case of placenta prævia.

Dr. BETTS read a communication upon the employment of blisters in erysipelas. When applied to the margin of the inflamed surface the further extension of the disease is prevented, and when applied to the inflamed surface itself, he has in every case found the cure very speedy. In one instance, as an experiment, he applied strips of blistering plaster around a limb with intervening spaces uncovered; the blistered portions were cured, and the unblistered surface being subsequently vesicated, yielded with equal promptness. Dr. Betts has observed two circumstances connected with blisters in erysipelas; 1st. There is little or no pain. 2d. The surface heals with rapidity.

REGULAR MEETING, February.

Dr. TRASK exhibited the stomach of a man who committed suicide by taking arsenic. About one o'clock in the morning of January 25th 1846, Dr. Morse was called to J. I., whom he found in the following condition the extremities cold, the face livid, eyes turned upward with lids half closed, jaws firmly locked, respiration becoming rapidly feeble. He had a few moments before confessed that he had taken poison.

Autopsy 57 hours after death. The whole muscular system in a state of great rigidity, the parietes of the abdomen tense and unyielding as a board. Expression of countenance placid, omentum healthy,

no appearance of inflammation of peritoneal surface of the stomach, veins about the greater curvature fully distended, stomach contained three pints of water mixed with gray, stringy mucus. Its villous coat was

generally injected and considerably corrugated, and in many places very much softened. There were three or four irregular bands nearly parallel, inch in width running in the course of the curvature of the stomach looking like wheals, caused by a very considerable thicken