658 PRACTICE OF PHYSIC. 



dent during the night, when the sleep is extremely disturbed, 

 much thirst, a more considerable degree of headach, the pulse 

 more frequent, to 100 and upwards, and full, with some degree 

 of hardness. In this case, after prescribing the antiphlogistic 

 regimen in general, there is no doubt that venesection is the 

 next remedy, and that without regard to the nature of the disease 

 which may follow afterwards. This case, therefore, is to be con- 

 sidered as inflammatory or a synochus ; but even supposing it 

 to be known from the epidemic prevailing, that it is to be a 

 typhus, there is no hesitation about a venesection, and a large 

 venesection too, which, accordingly, is the first measure to be 

 pursued. 



" c. We put a third case, which is somewhat of a middle 

 kind between the two former, where the symptoms are more 

 violent than in the first (a), and at the same time somewhat 

 more moderate than in the last (6), and therefore not so decisive 

 with respect to the practice I am speaking of. I say that in 

 such cases it may be often very doubtful whether we ought to 

 blood or not, and particularly to what degree we should do it ; 

 and it is not to be determined alone from the circumstances 

 which we may call proper to the disease, as I have just now put 

 them, but commonly from some other collateral circumstances 

 with respect to the remote cause, the constitution of the patient, 

 and some other accidental circumstances. With that view 

 I would say, if such a fever as I speak of happens at a time 

 when a common contagion is not known, or where there is none 

 remarkably powerful ; if, on the other hand, we can perceive 

 that the application of cold had a considerable share in bring- 

 ing it on ; if we have more reason to suspect this from the sea- 

 son of the year, either in the winter or spring, and if the attack 

 of the disease was without those symptoms of approach that I 

 first described, but was more sudden and sufficiently marked ; 

 if this happens in a young, full, and vigorous constitution, and 

 which perhaps has been formerly liable to inflammatory dis- 

 orders, and in consequence of this accustomed to venesection ; 

 if, to these several circumstances, there are farther joined ca- 

 tarrhal symptoms, rheumatic affections, or especially some topi- 

 cal determination, then there is no sort of doubt that venesec- 

 tion is the most proper remedy. 



