660 PRACTICE OF PHYSIC. 



confusion of the head. These are the circumstances that occur 

 early, and with these there are marks of considerable debility ; 

 the person perhaps is incapable of bearing any degree of the 

 erect posture, the mind is affected with great fear and des- 

 pondency, and with this, upon attempting any motion, tremor 

 appears. I observe here, that I am putting a case of the second 

 day ; but it is extremely difficult, nay impossible, where a dis- 

 ease comes on so gradually, to fix this to the case of a second 

 day ; the consideration applies to several of the first days. Now 

 where the above combination of circumstances occurs, I say 

 this is a case which more certainly than any does not admit of 

 venesection. I own that some practitioners have such a prac- 

 tice of universal venesection upon the approach of fever, that 

 they use it even in the circumstances I have mentioned. Ac- 

 cordingly, Sir John Pringle allows, that in such circumstances 

 as I have described one venesection may be practised ; but it is 

 certainly in view of the particular circumstance of a constitution 

 that is remarkably full and vigorous. A second venesection is 

 always hurtful, and where that is the case, the first must be very 

 doubtful, and be considered as an exception from the general 

 rule, arising from a combination of some degree of inflammatory 

 symptoms, and more especially with respect to the constitution 

 or habits of the patient. Such a combination of inflammatory 

 symptoms may concur ; and just now we have a fever prevail- 

 ing which is certainly of the nervous kind, but which has been 

 very frequently accompanied with catarrhal symptoms, nay with 

 some more pointed rheumatic affections ; yet even in these, 

 when we consider them as not belonging so much to the disease 

 as they are to be imputed to accidental circumstances of the 

 season, venesection is not proper, it has rather been of preju- 

 dice ; and in several instances I have found, that even where 

 otherwise the time of life, &c. would seem to admit of it, the 

 patients did not really bear it tolerably. 



" Now, when I have stated these several cases, with respect 

 to the second (6.), where the inflammatory symptoms are 

 stronger, I have no doubt that sweating is not to be proposed ; 

 but in the other three (a. c. d.), where the symptoms are mode- 

 rate on the second day, and even where the symptoms are more 

 considerable, but still, where the circumstances that seem to 



