190 DISEASES OF THE PARENCHYMA OF THE LUNG. 



regarded as one of the most efficient antiphlogistics in inflammation of 

 external organs. Its action is directly tonic upon the relaxed tissues 

 and dilated capillaries. It is harder to comprehend its mode of action 

 upon inflammation of parts separated from the point of application, by 

 skin, muscle, and bone. However, the contraction of the uterus and 

 intestinal muscles, when cold is applied to the abdomen, proves the pos- 

 sibility of its operation upon the interior, and ice compresses have long 

 and justly been held in repute for meningitis, as have also the cold com- 

 presses in peritonitis, by IZiewisch. I have no experience of the effect 

 upon pneumonia of the repeated envelopment of the entire body in cold 

 wrappings, as has been practised often by hydropaths ; although it may 

 be assumed that it would reduce the temperature of the body, and tem- 

 porarily moderate the fever, even if it were unattended by any great 

 direct influence upon the local phenomena. At all events, I am able to 

 testify that, in the infectious diseases, active cooling treatment has such 

 an effect upon the elevated temperature of the body in a large number 

 of cases. All other modes of treatment recommended for pneumonia 

 cannot be regarded as addressed directly to the disease, but, like blood- 

 letting, belong to the indicatio symptomatica being required only 

 when special symptoms arise. 10 



Venesection ought to be resorted to in the following three con- 

 ditions only : 1st. When the pneumonia has attacked a vigorous and 

 hitherto healthy subject, is of recent occurrence, the temperature being 

 higher than 105 F., and the frequence of the pulse rating at more than 

 one hundred and twenty beats a minute. Here danger threatens from 

 the violence of the fever ; and free venesection will reduce the tempera- 

 ture, and lessen the frequence of the pulse. In those who are already 

 debilitated and anaemic, bleeding increases the danger of exhaustion. 

 Should the fever be moderate, blood-letting is not indicated, even in 

 healthy and vigorous individuals. It cannot cut the fever short, and 

 indeed the fever is more apt to persist, although in a somewhat more 

 moderate degree, so that the enfeebled patient is thrown into greater 

 danger than if he had had to pass through a more violent fever, but with 

 unreduced strength. 



2d. When collateral oedema in the portions of the lung unaffected 

 by pneumonia is causing danger to life, the pressure of the blood is re- 

 duced by bleeding ; and, by prevention of further transudation of serum 

 into the vesicles, insufficience of the lung and carbonic-acid poisoning 

 are averted. Whenever the great frequence of respiration in the com 

 mencement of a pneumonia cannot be traced to fever, pain, and to the 

 extent of the pneumonic process alone, as soon as a serous foamy 

 expectoration appears, together with a respiration of forty or fifty 

 breaths a minute, and when the rattle in the chest does not cease for a 



