FEVERS. 615 



gravating the symptoms ; and when, from the redness of the 

 eye, the delirium, and other circumstances, these topical de- 

 terminations are to be apprehended. It is a question of great 

 difficulty also when such determinations appear to be in the 

 lungs or other viscera ; and the difficulty arises very much 

 from hence, that these topical determinations do not appear dis- 

 tinctly marked, because though they have all the effects of in- 

 flammation in the particular part, yet the irritation is not com- 

 municated to the rest of the system, which renders the obser- 

 vation difficult ; the general venesection has very little effect in 

 removing these symptoms, and by having recourse to it, we in- 

 crease the general debility without affecting the particular part. 

 All this leads to the conclusion, that, while perhaps there is no 

 other certain remedy but blood-letting, topical blood-lettings, 

 which can act on the particular part affected, are the only ones 

 admissible. Thus, a little scarification of the vessels of the eyes 

 themselves, or a leech or two applied near them will have more 

 effect than two pounds of blood taken from the arm in the ge- 

 neral way. 



" But even these topical venesections, if they are large, may 

 produce considerable effects upon the whole system, so that even 

 these are not to be admitted but with moderation, and where 

 they can be directed so as to influence the vessels of the part 

 affected ; so topical blood-lettings are more useful in cases of 

 topical determinations to the brain, than in the case of such a 

 determination to the lungs or abdominal viscera. At the same 

 time I would not neglect it, or exclude it in these last cases, 

 especially as they are seldom accompanied with the same symp- 

 toms of debility, so that our cupping and scarifying may be 

 practised with safety and advantage." 



CXLIII. When, after the consideration of these circum- 

 stances, blood-letting is determined to be necessary, it should 

 be observed, that it is more effectual according as the blood is 

 more suddenly drawn off, and as the body is, at the same time, 

 more free from all irritation, and, consequently, when in a pos- 

 ture in which the fewest of the muscles are in action. 



" Before I dismiss this subject, I must advert to a difficulty 

 which arises with respect to the practice of blood-letting at dif- 

 ferent times of the paroxysms- of both intermittent and continued 



