Transcriber’s Note:
The cover image was created by the transcriber and is placed in the public domain.
THE
American Practitioner and News.
“NEC TENUI PENNÂ.”
Vol. XXV. Louisville, Ky., February 1, 1898. No. 3
Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.—Ruskin.
Original Articles.
SOMETHING ON THE DISUSE OF PHLEBOTOMY.
BY RUFUS W. GRISWOLD, M. D.
When I began looking into medical books preparatory to practice, fifty years ago, the standard authors given us to read were not backward in recommending blood-letting in the acute diseases; and a little later, when an attendant at lectures at the College of Physicians and Surgeons at New York, the professors were not lacking with the like advice. But there has come a change, and so much of a change that, in this section of country at least, the lancet has mostly gone out of use. That the frequent use to which it was put seventy-five or a hundred years ago was not at all times wise is likely; but the extent to which it has been given up is also not wise. Rather more to notice some of the reasons why it has so largely been abandoned than to argue for a reintroduction of that ready and efficient instrument is the purpose of this paper.
A prominent point in the consideration of this comparative abandonment of the lancet is presented in the question: Has there been such a change in the type of the acute inflammatory diseases from three or four generations ago as to render the abstraction of blood less necessary and less useful? There are plenty of sound, hard-headed old doctors who will give a negative reply to this query; and occasionally we may notice some of them putting themselves in print to that effect. A Baltimore practitioner not so very long ago said: “The necessity for the use of the lancet is as great at the present time as it ever was in the past; the type of the disease has undergone no such changes as to render the abstraction of blood unnecessary or improper in the successful management of all cases attended with a full, tense, and quick pulse.” Others speak the like; but the majority of opinion is not pronounced in that direction, but rather adverse. Conversations during a forty-four years’ practice with men who began their professional calling sixty years ago, when the lancet was in often call, is to the import that there has been such a change in diseases as renders the frequent resort to blood-letting less important than formerly; that there is less of the sthenic type in even inflammatory fevers, a more general disposition to take on what we call typhoid forms, and thus depletion, either by the evacuation of blood or the exhibition of reducing drugs, is not so beneficial in even the acute inflammatory diseases as formerly. This is the view that has been entertained by a large part of those who began practice half a century or more ago, and this view has been sustained by a large amount of written authority; but it does not go to the extent of justifying that degree of abandonment of bleeding that has prevailed for the last forty years. The general opinion of to-day is, that while positions like that taken in the quotation given are too positive, on the other hand our practice is quite too lax; for while we still believe in blood-letting to some extent, we but seldom make use of it. Now as to the why.
Perhaps the first reason why the lancet is less used than formerly is found in the fact, or rather in the belief, of the change indicated. It is largely accepted as true by the older men in the profession that patients do not bear blood-letting as well as three generations ago. Accepting this as correct, it rationally follows that we should bleed less. But this is only one of the factors in the account, and not the largest one. The opinion that the physicians of the early part of this century used the lancet too often is beyond doubt correct. The doctrine of the purely symptomatic nature of fever put prominently forward by Brousais, and earnestly championed by active and pushing minds a century ago, and which was generally received in Europe and in this country, gave such an unfortunate impetus to the use of the lancet as finally led to its abuse. Patients were bled for almost every thing; not only for the fevers of acknowledged inflammatory type, such as acute pleurisy and the like, were bled for, but also cases of typhus, typhoid, etc., upon the ground that the fever in the case was only a symptom of the inflammatory action and was to be subdued or lessened by antiphlogistic remedies, chief of which was the abstraction of blood. The theory of the essentiality of fever became lost sight of, and the doctor treated for an inflammation rather than for a fever.