The first opportunity I had of applying a blifter with this intention, was in the cafe of Captain Stokes,' a gentleman between forty and fifty years of age, whom I was defired to vifit, in confultation with Dr. Rush, in January 1803. After an inflammation about the anus, which had been supposed for several days by the patient, an attack of piles, a mortification was observed to have commenced in the perineum, and on the fide of the fcrotum. At my firft vifit I proposed the application of a blifter, to extend from the edge of the mortification in the perineum, backwards over the buttocks; this being agreed to, was immediately applied; the following day, when the blister was dreffed, we were both well fatisfied with its effect, as it had prevented the mortification from spreading backwards; but fo extenfive was the mortification of the fkin and anterior part of the scrotum, which appeared to extend upwards in the course of the fpermatic chords towards the abdomen, that his recovery was not to be expected. After a few days he died.

Dr. Rush being struck with the good effect of the blifter in the preceding inftance, has lately employed the remedy in a cafe of mortification, the history of which is contained in the following letter:

DEAR SIR,

I WAS called upon by Dr. Bleight, on the 29th of laft July, to vifit with him, Captain R. A. who, in confequence of applying a handful of the polygonum perficaria, instead of paper, to a common ufe, after going to ftool, was affected with an inflammation in the extremity of the rectum, which extended around the adjoining parts, and along the perineum, fo as to affect the integuments of the fcrotum. Bleeding and other depleting remedies had been used to no purpose, in order to cure

partial mortification had taken place. I concurred with Dr. Bleight in advifing leeches to the found parts; and recolJecting the high terms in which you fpoke of the efficacy of

blifters in preventing the progress of mortifications, in our confultation, in the cafe of Captain Stokes, in January 1803, I advised their application to all the diseased parts which had not put on a gangrenous appearance. They had the wifhedfor effect; the mortified parts were afterwards cut away, or gradually floughed off; and, under the faithful and patient fubfequent attendance of Dr. Bleight, the Captain happily recovered, and now enjoys his ufual health.

In the most dangerous ftate of his difeafe, we gave him. bark; but its diftreffing effects upon his fyftem obliged us to lay it afide.

On the 24th October 1804, I was defired to meet Doctors S. P. Griffitts, Wiftar, and Strattan, in confultation, concerning the cafe of Mr. Charles French, who was afflicted with a mortification of the foot, which was advancing daily upwards, unchecked by the liberal use of the bark. On the 27th October, I proposed the application of a large blister round the leg, below the knee; this being agreed to, was applied in the evening; when dreffed the next morning, it was obferv ed that the mortification had not increased :--encouraged by the benefit derived from it, I proposed on the 29th, the application of a fecond blifter, to cover all the living parts below the edge of the first. This blifter alfo rofe well;-in a few days a distinct line of feparation between the living and dead parts was observed; the blifters were dreffed with a mixture of bafilicon and fpirit of turpentine. I avoid relating further particulars of this cafe, as Dr. Griffitts proposes to publish a circumftantial detail of it.

Since writing the above, I have been favoured with the fol lowing history of a cafe from Dr. Church, containing addi

tional testimony in favour of the use of blifters in arresting the progrefs of gangrene.

"ON Monday, of November, I was defired to vifit Mrs. Y. in the country, about fixty years of age, of a fair complexion, and delicate constitution; has had feveral children, and heretofore enjoyed good health.

"She had been taken on Saturday with frequent chills, with irregular febrile flufhings, pain in the limbs and head, which continued increasing for nearly thirty-fix hours before I faw her, when fhe was delirious, with flushed countenance, irregularly frequent and tenfe pulfe, tongue furred, respiration frequent, with great general uneasiness.

"The lofs of ten or twelve ounces of blood, with a faline cathartic, abated in fome degree the febrile symptoms. The delirium ftill continuing, in the evening, blifters to the wrifts, with a continuation of the faline mixture, produced an alleviation of all the fymptoms, fo that towards morning she had a few hours fleep. When the awoke, fhe was perfectly collected, complaining of great forenefs in her body and limbs, particularly in one ankle, which she said was painful; her skin was cool, and her pulfe frequent but foft, easily yielding to the least pressure. The family informed me that the ankle she complained of, had had an ulcer on it for fourteen years, which had been brought on by a flight injury after one of her deliveries; that it had within the laft two weeks been healed. On examination, the ulcer appeared to have been of the fize of a dollar, above the internal ankle, which was now quite livid, with fome fwelling around the edges, having the appearance of a vefication, and a deep purple blush, extending an inch or two beyond it, attended with a distreffing burning fenfation. The leg at this time was quite cool and fomewhat fwelled.

"The medicines fhe had been taking were omitted, and the tonic cordial plan fubftituted: the bark, wine, and opium were administered freely, and cataplafms of bark with yeaft, were applied to the part and changed frequently.

"This treatment was followed until Thursday, with an increase of the lividity and vefications on different parts of the ankle, filled with a bloody-coloured fluid.

"On Thursday the appearances were indeed unpleasant; the lividity of the ankle had extended, and the deep purple colour of the skin was near the middle of the leg, with very great tumefaction. The pulfe was frequent, fkin cool, tongue dry, and much apparent infenfibility of the limb. The bark was still continued internally, and the fermenting cataplasm of powdered carbone, with meal, honey, and yeaft, was applied in large quantities over the part affected, and was repeated or changed very frequently. This plan was rigidly adhered to all Thursday and Friday, changing the bark (which now had been taken in fuch quantities as to ficken the ftomach), for fome other tonic.

"The deep and burning redness, ftill, however, progreffed towards the knee, with an increase of thofe unpleasant vefications; the pulfe on Saturday was much more frequent; the skin cool; tongue dry, and covered with a dark-coloured crust; very great restleffness, with conftant incoherent muttering.

"In this fituation I recollected a converfation I had had fome time fince with Dr. Phyfick, in which he mentioned the good effects he had experienced from bliftering, in a cafe of gangrene. The critical and dangerous ftate of the patient required fomething to be promptly done. The blifter was propofed with confiderable hesitation, as I could not recollect in what stage or what species of gangrene Dr. Phyfick had used it.

"A large blifter was, however, applied on the infide of the leg below the knee, one part on the healthy portion of the leg, and the remainder immediately on the difeafed part. After twelve hours it rofe very well, and, contrary to what I dreaded, affumed a very pleafing afpect, and without the leaft increase of disease. The pulfe ftill continued frequent and the skin cool, although the patient in every other refpect was much more compofed.

"On Sunday, the leg was much more favourable; the lividity and vefication had not increafed, and the tumefaction which was very confiderable, had fubfided much. The foot, VOL. I.

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though much fwelled before, did not, until this period, shew the leaft difpofition to take on diseased action. It now be came covered with the deep purple fhining appearance, with a: diftreffing burning fenfation, which, together with the increased tumefaction, occafioned much uneafinefs. The bark, with elixir of vitriol, was perfevered in freely, and from the pleafing effects of the blifter, in arrefting the rapid progress. of the disease in the leg, I applied a large one covering all the upper part of the foot, including that part of the ankle where the disease first began. The effects were equally as pleafing as in the first inftance, producing an almost immediate ceffation of the progrefs of the disease.

"The parts of the ulcer where the disease first began, feparated to fome depth; the cuticle from below the knee separated, and in fome places on the leg; and the feparation extended even through the cutis and adipose membrane.

"The tumefaction of the leg gradually diminished, and the patient, is completely free from every danger."

Impressed with an idea that blifters will be often found ufeful in preventing the progrefs of mortifications, I have been induced to publish the preceding cafes as early as possible.

PHILIP SYNG PHYSICK.

Philadelphia, 24th November, 1804.

An Account of the Effects of LABOR in the Cure of Pulmonary Confumption. In a Letter from the Rev. DR. SAMUEL K. JENNINGS, of Bedford County, Virginia, to DR. Benjamin RUSH.

Dear Sir,

THAT

HAT theory only is to be confidered a rational one, which is fupported by facts, and will admit of the most extensive practical utility. If the following facts can be of any service to you, it will afford me fingular fatisfaction to have communicated them.