Advice to the people in general, with regard to their health

by S. A. D. Tissot

Of Bleeding.

§ 539. Bleeding is necessary only in these four Cases. 1, When there is too great a Quantity of Blood in the Body. 2, When there is any Inflammation, or an inflammatory Disease. 3, When some Cause supervenes, or is about to supervene, in the Constitution, which would speedily produce an Inflammation, or some other dangerous Symptom, if the Vessels were not relaxed by Bleeding. It is upon this Principle that Patients are bled after Wounds, and after Bruises; that Bleeding is directed for a pregnant Woman, if she has a violent Cough; and that Bleeding is performed, by Way of Precaution, in several other Cases. 4, We also advise Bleeding sometimes to asswage an excessive Pain, though such Pain is not owing to Excess of Blood, nor arises from an inflamed Blood; but in Order to appease and moderate the Pain by Bleeding; and thereby to obtain Time for destroying the Cause of it by other Remedies. But as these two last Reasons are in Effect involved or implied in the two first; it may be very generally concluded, that an Excess of Blood, and an inflamed State of it, are the only two necessary Motives for Bleeding.

§ 540. An Inflammation of the Blood is known by the Symptoms accompanying those Diseases, which that Cause produces. Of these I have already spoken, and I have at the same time regulated the Practice of Bleeding in such Cases. Here I shall point out those Symptoms and Circumstances, which manifest an Excess of Blood.

The first, then, is the general Course and Manner of the Patient's living, while in Health. If he is a great Eater, and indulges in juicy nutritious Food, and especially on much Flesh-meat; if he drinks rich and nourishing Wine, or other strong Drink, and at the same time enjoys a good Digestion; if he takes but little Exercise, sleeps much, and has not been subject to any very considerable Evacuation, he may well be supposed to abound in Blood. It is very obvious that all these Causes rarely occur in Country People; if we except only the Abatement of their Exercise, during some Weeks in Winter, which indeed may contribute to their generating more Blood than they commonly do.

The labouring Country-man, for much the greater part of his Time, lives only on Bread, Water and Vegetables; Materials but very moderately nourishing, as one Pound of Bread probably does not make, in the same Body, more Blood than one Ounce of Flesh; though a general Prejudice seems to have established a contrary Opinion. 2, The total Stopping or long Interruption of some involuntary Bleeding or Hæmorrhage, to which he had been accustomed. 3, A full and strong Pulse, and Veins visibly filled with Blood, in a Body that is not lean and thin, and when he is not heated. 4, A florid lively Ruddiness. 5, A considerable and unusual Numbness; Sleep more profound, of more Duration, and yet less tranquil and calm, than at other times; a greater Propensity than ordinary to be fatigued after moderate Exercise or Work; and a little Oppression and Heaviness from walking. 6, Palpitations, accompanied sometimes with very great Dejection, and even with a slight fainting Fit; especially on being in any hot Place, or after moving about considerably. 7, Vertigos, or Swimmings of the Head, especially on bowing down and raising it up at once, and after sleeping. 8, Frequent Pains of the Head, to which the Person was not formerly subject; and which seem not to arise from any Defect in the Digestions. 9, An evident Sensation of Heat, pretty generally diffused over the whole Body. 10, A smarting Sort of Itching all over, from a very little more Heat than usual. And lastly, frequent Hæmorrhages, and these attended with manifest Relief, and more Vivacity.

People should, notwithstanding, be cautious of supposing an unhealthy Excess of Blood, from any one of these Symptoms only. Many of them must concur; and they should endeavour to be certain that even such a Concurrence of them does not result from a very different Cause, and wholly opposite in Effect to that of an Excess of Blood.

But when it is certain, from the whole Appearance, that such an Excess doth really exist, then a single, or even a second Bleeding is attended with very good Effects. Nor is it material, in such Cases, from what Part the Blood is taken.

§ 541. On the other Hand, when these Circumstances do not exist, Bleeding is in no wise necessary: nor should it ever be practised in these following Conditions and Circumstances; except for some particular and very strong Reasons; of the due Force of which none but Physicians can judge.

First, when the Person is in a very advanced Age, or in very early Infancy. 2, When he is either naturally of a weakly Constitution, or it has been rendered such by Sickness, or by some other Accident. 3, When the Pulse is small, soft, feeble, and intermits, and the Skin is manifestly pale. 4, When the Limbs, the Extremities of the Body, are often cold, puffed up and soft. 5, When their Appetite has been very small for a long time; their Food but little nourishing, and their Perspiration too plentiful, from great Exercise. 6, When the Stomach has long been disordered, and the Digestion bad, whence very little Blood could be generated. 7, When the Patient has been considerably emptied, whether by Hæmorrhages, a Looseness, profuse Urine or Sweat: or when the Crisis of some Distemper has been effected by any one of these Evacuations. 8, When the Patient has long been afflicted with some depressing Disease; and troubled with many such Obstructions as prevent the Formation of Blood. 9, Whenever a Person is exhausted, from whatever Cause. 10, When the Blood is in a thin, pale, and dissolved State.

§ 542, In all these Cases, and in some others less frequent, a single Bleeding often precipitates the Patient into an absolutely incurable State, an irreparable Train of Evils. Many dismal Examples of it are but too obvious.