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but quick and full, and does not become softer or slower upon the flowing of the blood, and that the effusion is profuse, and threatens to continue so, it appears to me, that blood-letting may be necessary, and I have often found it useful. It seems probable also, that the particular circumstances of venesection may render it more powerful for taking off the tension and inflammatory irritation of the system, than any gradual flow from an artery.

795. That a spasm of the extreme vessels has a share in supporting hemorrhagy, appears to me probable from hence, that blistering has been often found useful in moderating and suppressing the disease.

796. Do emetics and vomiting contribute to the cure of haemorrhagy ?—See Dr. Bryan Robinson on the virtues and power of medicines.

797. When an haemorrhagy is very profuse, and seems to endanger life, or even threaten to induce a dangerous infirmity, it is agreed on all hands, that it is to be immediately suppressed by every means in our power; and, particularly, that» besides the means above mentioned for moderating the disease, astringents, internal or external, where the latter can be applied are to be employed for suppressing it,

798. The internal astringents are either vegetable or fossil.

The vegetable astringents are seldom very powerful in the cure of any haemorrhagies, except those of the alimentary canal.

The fossil astringents are more powerful; but some choice amongst the different kinds may be proper.

The chalybeates, so frequently employed, do not appear to me to be very powerful.

The preparations of lead are certainly more so, but are otherwise of stf pernicious a quality, that they should not be employed except in cases of the utmost danger. The Tinctura Saturnina, or Antiphthisica, as it has been called, appears to be of little efficacy; but whether from the small portion of lead which it contains, or from the state in which the lead is in it, I am uncertain.

The fossil astringent that appears to me the most powerful, and at the same time the most safe, is alum.

799. External astringents, when they can be applied, are more effectual than the internal. The choice of these is left to the surgeons.

800. The most powerful of all astringents appears to me to be cold, which may be employed, cither by applying cold water to the surface of the body, or by throwing it into the internal parts.

801. For suppressing haemorrhagies, many superstitious remedies and charms have been recommended, and pretended to have been employed with success. The seeming success of these, however, has been generally owing to the by-standers mistaking a spontaneous ceasing of the haemorrhagy for the effect of the remedy. At the same time, I believe, that those remedies may have been sometimes useful, by impressing the mind with horror, awe, or dread.

802. Upon occasion of profuse hzemorrhagies, opiates have been employed with advantage; and, when the fulness and inflammatory diathesis of the system have been previously taken off by the haemorrhagy itself, or by blood-letting, I think opiates may be employed with safety.

803. For restraining haemorrhagy, ligatures have been applied upon the limbs, in the view of retarding the return of the venous blood from the extremities; but they appear to me to be of uncertain and ambiguous use.

804. In the case of profuse haemorrhagies, no pains are to be taken to prevent a Deliquium Animi, or fainting, as the happening of this is often the most certain means of stopping the haemorrhagy.'

805. Having thus delivered the general doctrine of hsemorrhagy, I proceed to consider the particular cases of it. It may perhaps be remarked, that I have marked fewer of these than are commonly enumerated by the nosologists; but my reasons for dijfering from these authors, must be left to a nosological discussion, to be entered into elsewhere more properly than here.

CHAP, II.

OV THE EPISTAXIS OB HiEMORItHAGY OF THE NOSE.

806. X He state of the vessels upon the internal surface of the nose, being such as already mentioned (757), renders an haemorrhagy from that more frequent than from any other part of the body.

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807. The blood commonly flows from one nostril only, and probably because an haemorrhagy from one vessel relieves the congestion in all the neighbouring vessels.

The blood flowing from both nostrils at the same time, shews commonly a more considerable dis? ease.

808. This haemorrhagy happens to persons of every constitution and temperament, but most frer quently to those of a plethoric habit and sanguine temperament. It happens to both sexes, but most frequently to the male.

809. This haemorrhagy may occur at any time of life; but most commonly happens to young persons, owing to the state of the balance of the system peculiar to that age, as mentioned in 756,

810. Although generally it happens to persons before they have arrived at their full growth, and more rarely afterwards; yet sometimes it happens to persons after their acme, and during the state of manhood: and it must then be imputed to an unusually plethoric state of the system; to an habitual determination of the blood to the vessels of the nose; or to the particular weakness of these.

811. In all these cases, the disease may be considered as an haemorrhagy purely arterial, and depending upon an arterial plethora; but it sometimes occurs in the decline of life, when probably it depends upon and may be considered as a mark of a venous plethora of the vessels of the head. See 772.

812. This haemorthagy happens also at any period of life, in certain febrile diseases, which are altogether or partly of an inflammatory nature,

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