288 OF THE BLOOD: ITS VITAL PROPERTIES, 



upon an alteration in the proportion of its normal constituents, as in 

 plethora and simple anaemia, or whether its phenomena imply the presence 

 of some toxic substance in the circulating fluid. If the former be his con- 

 clusion, he has then to endeavor to rectify the excess or the deficiency, by 

 reducing the former, or by supplying the latter; as when he bleeds and 

 prescribes low diet for Plethora, and employs iron and generous living in 

 Ancemia. But it is his duty to take care that his means are appropriate to 

 his ends ; for there can be little doubt that the too copious venesection 

 which was formerly practiced almost indiscriminately in acute inflamma- 

 tions, had a pernicious tendency to postpone the final recovery from them, 

 whilst it had often but a doubtful efficacy in subduing the first violence of the 

 disease. As a general rule, it may be stated that general bloodletting is likely 

 to be rather injurious than beneficial in toxic inflammations, in which the 

 vitality of the blood as a whole is decidedly lowered, and to this rule, the 

 results of careful and extended observation have recently shown that Rheu- 

 matism is seldom to be considered an exception, notwithstanding that this 

 disease was formerly considered to be one of those in which the efficacy of 

 copious depletion was most undoubted. In diseases of toxic origin, the treat- 

 ment must be conducted upon principles exactly the same as those by which 

 the practitioner would be guided in his treatment of a case of ordinary 

 poisoning; but as regards the two classes into which it has been shown that 

 these maladies may be divided, a difference must be made in their applica- 

 tion. 



'226. The "morbid poisons" of our second class ( 224) are distinguished 

 by this, that there is a continual new generation of them within the system ; 

 and the first indication of treatment, therefore, will be to check their forma- 

 tion, so far as this may be possible. This is the rationale of the dietetic 

 and regiminal treatment of the lithic, lactic, and oxalic diathesis, of lepra 

 and psoriasis, of chronic gout and rheumatism, and many other chronic 

 diseases of toxic origin. Secondly, we should endeavor to destroy or neutral- 

 ize the poison, if we have any remedies which possess such an action upon 

 it. Perhaps the curative influence of Ammonia in Australian snakebite, 

 recommended by Prof. Halibrd, if supported by future investigations, 1 would 

 constitute one of the best examples of this kind. Thirdly, where we cannot 

 thus destroy the poison, we must endeavor to moderate its action upon the 

 system ; this is the rationale of palliative treatment of every description, in 

 which the/o/is et orif/o of the malady is left unchanged. But, fourthly, our 

 main object must be to eliminate the poison from the S3'stem as rapidly as 

 possible, by the various channels of excretion ; acting upon these by rem- 

 edies which either increase their activity, or which so alter the condition of 

 the morbific matter as to enable it to be more readily drawn oft'. The judg- 

 ment of the well-informed practitioner, in the treatment of diseases of this 

 class, is more shown in his discriminative selection of the best means of thus 

 aiding the Blood to regain its normal purity, than in any more apparently 

 "heroic measures ;" and a candid review of the most approved systems of 

 treatment, for diseases of the type here alluded to, will show that the ratio 

 of their efficacy is in accordance with that of their harmony with the above 

 indications. 



227. Among the Toxic diseases of the zymotic class, in most of which the 

 poison is introduced from without, the course of the morbid phenomena to 

 which this gives rise is usually more definite, and specific, and its duration 

 more limited. There is no source within the body, whence a new supply of 



1 It lias been t.rii'<l and t'nund inetl'ertual in the ease <>(' hufitin snakebites bv Ilil.-ton, 

 Ind. Med. Gaz., 1873. Fayrer, Proceed. Roy. Soc., Jan. id, 1874. 



