Successful Treatment of a Case of Hydropholia. 201 
alteration whatever will be made in the disease ; but yet.the 
general strength shall be so dimjnished, that death may 
ensue. On the other hand, had the same quantity of blood 
been taken from a large brifice, that then the disease would 
have felt the remedy, and respiration would bave gone on 
with less exertion of we remaining general strength, in 
consequence of the lungs being relieved by this sudden de- 
pletion. 
‘< The great consequence, therefore, attached to the mode 
in which blood is drawn (as on this life or death may often 
depend), imperiously demands of every physician to im- 
press upon the mind of his patient the importance of the 
operation, and the absolute necessity of having it performed 
by a person fully skilled in his profession. 
**T should not omit to mention, that there may now and 
then occur a case, where the vein may uot only be particu- 
larly small, but likewise be deeply seated, and covered with 
fat. Here, although the orifice may be sufficiently large, 
yet a portion of fat may obtrude so as to interrupt the 
stream of blood. I would in such case recommend the 
surgeon to dilate the external orifice, or even make a fresh 
orifice, rather than persist in his endeavours to obtain the 
guantity required in this gradual way.” 
It has repeatedly happened to the writer to meet with 
those diseases, wherein it seemed unavoidably neces+ 
sary to call to his aid the above strong and competent 
measures ; and when he has been closely observing the 
state of the pulse during the operation, he has found that 
perhaps for about thirty or more pulsations (varying ac- 
cording to the strength and constitution of the patient) be- - 
fore the faintness supervenes, there is a perceptible i increase 
of power, and great throbbing in the action of the heart,— 
the heart seeming to strugele against being reduced to a 
state of subjection: this particular action of the heart is 
penerally succeeded by diminished power in the circulation, 
and by which he is assured the disease ‘ has felt the Te= 
medy.” He likewise wishes to add, that when the in- 
creased action of the heart begins to take place, the patient 
is generally very urgent that the bleeding might be discon- 
tinued ; but it is absolutely necessary, in the writer’s opi- 
nion, in extreme cases, to proceed the one step further, 
namely, until faintness is produced. He prefers any other 
position for ‘the patient to be placed in during the operation 
to one that is recumbent. 
Before these obseryations are concluded, it might be 
well 
