OF BLEEDING.
No operation of surgery is so frequently necessary as bleeding; it ought therefore to be very generally understood. But though practised by midwives, gardeners, blacksmiths, we have reason to believe that very few know when it is proper. Even physicians themselves have been so much the dupes of theory in this article, as to render it the subject of ridicule. It is however an operation of great importance, and must, when seasonably and properly performed, be of singular service to those in distress.
Bleeding is proper at the beginning of all inflammatory fevers, as pleurisies, peripneumonies, &c. It is likewise proper in all topical inflammations, as those of the intestines, womb, bladder, stomach, kidnies, throat, eyes, &c. as also in the asthma, sciatic pains, coughs, head-achs, rheumatisms, the apoplexy, epilepsy, and bloody flux. After falls, blows, bruises, or any violent hurt received either externally or internally, bleeding is necessary. It is likewise necessary for persons who have had the misfortune to be strangled, drowned, suffocated with foul air, the fumes of metal, or the like. In a word, whenever the vital motions have been suddenly stopt from any cause whatever, except in swoonings occasioned by mere weakness or hysteric affections, it is proper to open a vein. But in all disorders proceeding from a relaxation of the solids, and an impoverished state of the blood, as dropsies, cacochymies, &c. bleeding is improper.
Bleeding for topical inflammations ought always to be performed as near the part affected as possible. When this can be done with a lancet, it is to be preferred to any other method; but where a vein cannot be found, recourse must be had to leeches or cupping.
The quantity of blood to be let must always be regulated by the strength, age, constitution, manner of life, and other circumstances relating to the patient. It would be ridiculous to suppose that a child could bear to lose as much blood as a grown person, or that a delicate lady should be bled to the same extent as a robust man.
From whatever part of the body blood is to be let, a bandage must be applied between that part and the heart. As it is often necessary, in order to raise the vein, to make the bandage pretty tight, it will be proper in such cases, as soon as the blood begins to flow, to slacken it a little. The bandage ought to be applied at least an inch, or an inch and half from the place where the wound is intended to be made.
Persons not skilled in anatomy ought never to bleed in a vein that lies over an artery or a tendon, if they can avoid it. The former may easily be known from its pulsation or beating, and the latter from its feeling hard or tight like a whipcord under the finger.
It was formerly a rule, even among those who had the character of being regular practitioners, to bleed their patients in certain diseases till they fainted. Surely a more ridiculous rule could not be proposed. One person will faint at the very sight of a lancet, while another will lose almost the whole blood of his body before he faints. Swooning depends more upon the state of the mind than of the body; besides, it may often be occasioned or prevented by the manner in which the operation is performed.
Children are generally bled with leeches. This, though sometimes necessary, is a very troublesome and uncertain practice. It is impossible to know what quantity of blood is taken away by leeches; besides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those who practice bleeding take a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine.
Certain hurtful prejudices with regard to bleeding still prevail among the country people. They talk, for instance, of head-veins, heart-veins, breast-veins, &c. and believe that bleeding in these will certainly cure all diseases of the parts from whence they are supposed to come, without considering that all the blood-vessels arise from the heart, and return to it again; for which reason, unless in topical inflammations, it signifies very little from what part of the body blood is taken. But this, though a foolish prejudice, is not near so hurtful as the vulgar notion that the first bleeding will perform wonders. This belief makes them often postpone the operation when necessary, in order to reserve it for some more important occasion, and, when they think themselves in extreme danger, they fly to it for relief, whether it be proper or not. Bleeding at certain dated periods or seasons has likewise bad effects.