6. It has been forbidden after the suppurative process has begun in local inflammation. It constantly retards the suppuration, when begun, in the angina tonsillaris, and thus protracts that disease. To this rule there are frequent exceptions.
7. It should be omitted in pneumony, after copious expectoration has taken place. This discharge is local depletion, and, though slow in its effects compared with bleeding, it serves the same purpose in relieving the lungs. The lancet can only be required where great pain in coughing, and a tense pulse, attend this stage of the disease.
8. It may be omitted (except when the blood-vessels are insulated) in those diseases in which there is time to wait, without danger to life, or future health, for the circuitous operation of purging medicines, or abstemious diet.
9. It should be avoided, when it can be done without great danger to life, where there is a great and constitutional dread of the operation. In such cases, it has sometimes done harm to the patient, and injured the credit of the lancet.
10. There are cases in which sizy blood should not warrant a repetition of blood-letting. Mr. White informs us, in the History of the Bilious Fever which has lately prevailed at Bath, that bleeding, in many cases in which this appearance of the blood took place, was useless or hurtful. In some of the fevers of our own country, we sometimes see sizy blood followed by symptoms which forbid the repeated use of the lancet, but which yield to other depleting remedies, or to such as are of a cordial nature. I have seen the same kind of blood, a few hours before death, in a pulmonary consumption, and three days after a discharge of a gallon and a half of blood from the stomach by vomiting.
11. Even a tense pulse does not always call for the repeated use of the lancet. I have mentioned one case, viz. on the third or fourth days of a malignant fever, in which it is improper. There are instances of incurable consumptions from tubercles and ulcers in the lungs, in which the pulse cannot be made to feel the least diminution of tension by either copious or frequent bleedings. There are likewise cases of hepatic fever, in which the pulse cannot be subdued by this remedy. This tense state of the pulse is the effect of a suppurative process in the liver. If a sufficient quantity of blood has been drawn in the first stage of this disease, there is little danger from leaving the pulse to reduce or wear itself down by a sudden or gradual discharge of the hepatic congestion. The recovery in this case is slow, but it is for the most part certain. I have once known a dropsy and death induced by the contrary practice.
12. and lastly. There is sometimes a tension in the pulse in hæmorrhages, that will not yield to the lancet. The man whose blood was sizy, three days after losing a gallon and a half of it from his stomach, had a tense pulse the day before he died; and I once perceived its last strokes to be tense, in a patient whom I lost in a yellow fever by a hæmorrhage from the nose. The only circumstance that can justify bleeding in these cases is extreme pain, in which case, the loss of a few ounces of blood is a more safe and effectual remedy than opium.
I shall now add a few remarks upon the efficacy of blood-letting, in diseases which are not supposed to belong to the class of fevers, and which have not been included in the preceding volumes.
I. The philosophers, in describing the humble origin of man, say that he is formed “inter stercus et urinam.” The divines say that he is “conceived in sin, and shapen in iniquity.” I believe it to be equally true, and alike humiliating, that he is conceived and brought forth in disease.
This disease appears in pregnancy and parturition. I shall first endeavour to prove this to be the case, and afterwards mention the benefits of blood-letting in relieving it, in both cases.