612 PRACTICE OF PHYSIC. 



toms taken altogether, or the most part of them are present, 

 venesection is strongly indicated." 



5. The period of the disease. " I have sufficiently explain- 

 ed why the synochus is the most common form of fever in this 

 and in many other countries, that is to say, why our fever has 

 more or less of the inflammatory nature in the beginning, so 

 that venesection may be employed, but afterwards assumes 

 more of the nervous character, with more of debility, when 

 venesection is employed with more danger. The ancients 

 were very nice in this matter, and in general they seldom ad- 

 mitted of venesection after the fourth day. A late writer in 

 a treatise de vence sectione in acutis, &c. shows that indeed 

 such was the general rule, but at the same time attempts to 

 show, very properly, that it is not to be limited by the number 

 of days, and that we are rather to be guided by other circum- 

 stances, and particularly by the state of the symptoms. The 

 ancients, even in inflammatory cases, as in peripneumony and 

 pleurisy, did not bleed after the fourth day ; and we say that 

 venesection during the three or four first days, is especially ef- 

 fectual ; but there are circumstances in which without all doubt 

 venesection may be continued, while there are not evident symp- 

 toms of a tendency to suppuration or gangrene. But where we 

 have no topical phlegmasise present, the difficulty is greater, 

 and, in general, I have no doubt in agreeing with the ancients 

 that venesection is only safe in the beginning, and that the dan- 

 ger is greater as the disease advances. But there is a great 

 difference in the duration of the inflammatory state in the syno- 

 chus, and there are instances of the good effects of venesection 

 in the more advanced stages. The inflammatory symptoms 

 which for some time, perhaps, were not very considerable, from 

 certain accidents, sometimes come on with fresh vigour, when 

 venesection may be the only remedy. It would therefore be 

 extremely dangerous to establish any general rule ; only we are 

 sure that, as the disease advances, venesection is to be employed 

 with more caution, and may be attended with more danger ; but 

 from several instances which I have met with, where we were 

 obliged to swerve from the general rule, when inflammatory 

 symptoms happened to recur with a hardness and tension of the 



