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diate cause of the difeafe. This is far from a proper view of the fubject. The lofs of half a pound of blood, a quantity often fufficient for the cure of inflammation, can have no calculable effect in diminishing the tenfion of the vascular fyftem, mechanically fpeaking. The veffels throughout the body are liable to far greater viciffitudes of diftenfion and contraction upon every partial change in the distribution of the fluids. is in fome other way, therefore, and not fimply by unloading the veffels, that bloodletting produces its good effects in the cure of inflammation. Nor is it by weakening the fyftem generally; for there are many inflammations that are best treated by means the reverse of this; by remedies that give vigour to the fyftem, and increase its activity.

Inflammation occurs as readily, generally fpeaking, in weak as in ftrong habits: there appears even reason to believe that the former are in fome refpects more difpofed to it than the robuft and vigourous. It seems to be a general law of the animal œconomy, that in proportion as the powers of the body are diminished, the excitability with regard to impreffions, and confequently the disposition to be thrown into irregular action, are

increased. Hence weakness, though never of itself a disease, may predispose to it. But the diseases which arife under fuch circumstances are characterized by lefs activity, and go on more flowly to diforganization; and they commonly also require a lefs active mode of cure.

When inflammation arifes in debilitated habits, it is often not only not curable by general bloodletting and other evacuations, if employed to any confiderable extent, but may be even rendered thereby more difficult of removal; and that, probably, for the reafon above stated, namely, that weakening the fyftem increases the difpofition to irregular action, or predisposes to disease. The rule, however, is by no means conftant, that bloodletting is improper as a remedy for inflammation in debilitated habits. On many of thefe occafions, it is found to be scarcely lefs effectual than in a state of vigour. To determine in different cafes when it may be proper or otherwise, is a very difficult task, and requires much judgment and experience on the part of the practitioner. From my own obfervation, I am inclined to believe, that, when properly adjusted to the actual ftrength of the fyftem (a point of the firft magnitude, but which has been too much

overlooked*), there are few cafes of inflammation that are not capable of being relieved by it, and that it may form a valuable auxiliary to other means, even to those of a tonic and ftimulant nature.

This, I know, is in oppofition to received opinions, and will be fuppofed to involve an inconsistency, namely, the recommending at once bloodletting and the use of tonic and ftimulant remedies. The inconfiftency, however, in this cafe is more apparent than real. If disease do not confift effentially in weaknefs fimply (as has, I think, been clearly fhewn), but in some unknown deviation from the natural and healthy mode of acting; then it is clear that it may be obviated, and health restored, by remedies of either the ftimulating

I believe that blood is often drawn in too large quantities from the fick, without fufficient attention being paid to their state of weakness at the time. When bloodletting is thought advifable, in adults, the quantity of blood taken away is generally between fix and twelve ounces. But I have obferved a manifeft reduction of the ftrength, and a feeling of weaknefs, continuing for feveral days, induced by the lofs of not more than from two to three ounces, and yet with evident relief to the disease. In fuch a cafe, it is probable that the lofs of fix or eight ounces, which is in general not confidered as a large quantity, would do harm. The remedy itfelf is not always fo much to be blamed, as the error in its administration.

or debilitating claffes, which have no right therefore to be fet in oppofition to one another on this occafion. In fact, whatever is capable of producing any confiderable impreffion on the fyftem, or of changing its mode of acting, may become a remedy for its diforders and hence means apparently the most opposite are often found to remove one and the fame disease. Difeafes accompanied with great debility have often been cured by lofs of blood and other evacuations, while thofe of an oppofite character have in many inftances yielded to the most active ftimulants. A flight acquaintance with the hiftory of phyfic will ferve to convince us of this. The practice of Sydenham was in many respects in direct oppofition to that of Morton; the one employed bleeding, where the other gave the most active ftimulants: yet there can be no doubt that they both frequently fucceeded in curing their patients.

Of late a divifion of inflammation has been made into two fpecies, the active and the paffive: the latter being fuppofed to confift in a weakened action of the inflamed part. If this be meant in relation merely to the more active form of the disease, it may be well founded; but if in refpect to

the state of health, I believe it to be far otherwife. There is no inflammation in which there are not unequivocal marks of increased exertion in the part itself, however different the general state of the system. The phenomena are the fame effentially, both in the active and the indolent forms of the disease, and differ only in degree. But a difference in degree merely has never been allowed to constitute a diverfity of fpecies.

Let us take the fcrophulous ophthalmia as an example. This has been called a cafe of paffive inflammation depending on debility; not of the conftitution only, but of the inflamed part itfelf. The phenomena are, however, quite irreconcileable with this idea. The vascular action and the fenfibility of the part are evidently increased. Hence the tumour, the enlargement of vesfels and confequent rednefs of the membranes. That these effects are not owing to ftagnation of the fluids, and want of power in the veffels to tranfmit their contents, is fhewn by the presence of all the marks of increafed circulation, as a florid hue, augmented fecretions, heightened fenfibility rendering the impreffion of light painful, and increafed evolution of heat; and still more by the growth of new parts, as fungous excre