than violence or intensity. All this every body knows. It seems nearly as certain that there is nothing peculiar, nor very much to be apprehended in the debility that attends fevers; that the cases of bad success from bloodletting are no where to be met with detailed by authors, nor at any rate so numerous as to countenance the important consequences deduced from them; that a most disproportionate and almost superstitious attention has been paid to it by the scholars of Cullen, who have thereby done serious mischief to humanity. "As putting debility in the place "of putrescence, they rendered it almost the "universal watch-word of medicine, and anni"hilated for a time a great part of the benefit of experience." (Researches on Fever, Beddoes, p. 165.).

66

It next becomes part of our task to demonstrate how decidedly averse to this remedy the best modern authors, whose works are in most general use, have declared themselves. Bloodletting," says Cullen, (139.), " is one of the most powerful "means of diminishing the activity of the whole ແ body, especially of the sanguiferous system; "and it must therefore be the most effectual "means of moderating the violence of reaction in "fevers. Taking this as a fact, I omit inquiring "into its mode of operation, and shall only con

66

"sider in what circumstances of fevers it may "most properly be employed."-" When the "violence of reaction," he proceeds," and its "constant attendant, a phlogistic diathesis, are sufficiently manifest; when these constitute the "principal part of the disease, and may be expected to continue throughout the whole of it, "as in the cases of synocha, then bloodletting is "the principal remedy, and may be employed "as far as the symptoms of the disease may seem "to require, and the constitution of the patient "will bear. It is however to be attended to, "that a greater evacuation than is necessary may "occasion a slower recovery, may render the person more liable to a relapse, or may bring on "other diseases." The practical utility to be derived from this precept may be sufficiently judged of by considering that synocha is an affection which is scarcely ever seen as an idiopathic disease, and which therefore can scarcely ever be supposed to call for the use of the lancet.

66

In proof of this assumption we may quote the following short note, taken at Dr Gregory's Lectures, April 18. 1815. ·

* Bloodletting, according to this, only counteracts the violence of reaction, but has no general independent effect upon the system; a doctrine which the Doctor first assumes, and then compliments himself for not asking the reason of it.

« For 23 years, in which Dr Gregory gave cli"nical lectures, always three months, and often "six months in the year, he never saw ONE EX

"" AMPLE OF PURE SYNOCHA.' Dr Bateman, alluding to the same thing, says, " My own subsequent experience entirely coincides with that "assertion."

Dr Cullen continues, "In the case of synocha, "therefore, there is little doubt about the pro"priety of bloodletting. But there are other spe"cies of fever, as the synochus, in which a vio"lent reaction and phlogistic diathesis appear, "and prevail during some part of the course of the "disease, while at the same time these circumstan"ces do not constitute the principal part of the "disease, nor are to be expected to continue du"ring the whole course of it; and it is well known, "that in many cases the state of violent reaction "is to be succeeded, sooner or later, by a state "of debility, from the excess of which the danger of the disease is chiefly to arise. It is there66 fore necessary, that in many cases bloodletting "should be avoided; and even although during "the inflammatory state of the disease it may be proper, it will be necessary to take care that "the evacuation be not so large as to increase the state of debility which is to follow.”

We must again pause to consider this passage;

the words printed in Italics sufficiently shew, that he did not even wish venesection to be employed in synochus. For as to the expression, that in many cases debility succeeds the violent reaction, every body that has read Cullen's own definition, knows that this always takes place; and hence the " many "cases in which it should necessarily be avoid"ed," will include every possible example of the disease. The precept of accommodating the quantity of the evacuation to the state of the debility which is to follow, is equally cogent, and can only be of use in those happy instances where medical practitioners, like their patron Deity, are gifted with a knowledge of futurity. He concludes as follows: "From all this, it must ap

pear, that the employing of bloodletting in "certain fevers requires much discernment and skill, and is to be governed by the considera"tion of the following circumstances :

66

"1st, The nature of the prevailing epidemic. "2d, The nature of the remote cause.

"3d, The season and climate in which the dis

ease occurs.

"4th, The degree of phlogistic diathesis pre❝sent.

"5th, The period of the disease.

"6th, The age, vigour, and plethoric state of "the patient.

"7th, The patient's former diseases and habits of bloodletting.

8th, The appearance of the blood'drawn out. "9th, The effects of the bloodletting that may "have been already practised."

These circumstances may, no doubt, occasionally be so prominent as to require consideration; but we much suspect, that what Dr Johnson has remarked of marriage, mutatis mutandis may be well applied here: That if all the difficulties connected with bleeding were to be fully considered before inserting the lancet, no man would ever bleed.

Dr Fordyce declares himself hostile to bloodletting in fevers. The following are his opinions on the subject,

"If the disease which the author has endea, "voured to define as fever be only meant, the taking of blood from any large vein, in any part of the body indiscriminately, never dimi"nished, shortened, nor carried off a fever in

66

66

any case he has seen, nor has he found any on "record in which it had this effect. Taking a(6 way blood from the arm or from any large vein "neither increases nor diminishes a fever, nor al "ters its course as far as he has seen."

"The further debility arising from emptying the "vessels by taking away a quantity of blood is of"ten such as to destroy the patient in the remain

I