PRACTICE OF PHYSIC. 



same time, will appear in fevers which are to turn out with con- 

 siderable symptoms of debility : therefore, that alone, though it 

 will have its weight, is but a fallacious mark, and I would be 

 more influenced by the effect of the former venesection. We 

 will be determined to repeat the venesection, if the pulse has 

 been considerably relaxed, and rendered fuller, softer, and 

 even less frequent by the former venesection, but relapses into 

 the same circumstances, becomes again full, contracted and 

 hard. 



" I have thus stated a variety of cases in which the question 

 whether we are to blood or not, is to be put : and I now go on 

 to touch another question which occurs at the same period of 

 the disease ; viz. when the symptoms express an excess of sti- 

 mulant power, whether evacuations which may be supposed to 

 take off that excess are always to be practised, particularly 

 purging ; to what length or degree it is to be employed in the 

 beginning of fevers, particularly in the case of synocha, and in 

 the case of synochus, where the excess of stimulant power is 

 considerable. With regard to this I observe first, that I know 

 of no practitioner who has proposed to make large evacuations 

 by stool ; I have formerly mentioned the uncertainty of the 

 effect ; I have said that purgatives may weaken the system in 

 greater proportion than they affect the heart and arteries 

 (C XL VI I.), and when they do make considerable evacuations 

 they change the determination of the system, deriving too much 

 from the surface of the body (CXLVIIL). Where this has 

 taken place, I have more frequently observed it of bad than of 

 good consequences ; and, as I concluded before, I must repeat 

 now, that if it is the excess of stimulant power that gives the 

 indication, this will be answered more effectually by venesection. 

 The matter, I think, is properly digested by Sir John Pringle ; 

 he says that, in the beginning of inflammatory fevers, after the 

 first venesection, he opens the belly with some lenient laxative ; 

 but he adds farther, that through the course of the fever he finds 

 it sufficient to prevent costiveness by daily glysters ; that he has 

 observed a motion or two procured daily in this way to be one 

 of the best and most general remedies in fever. But that is 

 far from the indication of taking off the excess of stimu- 

 lant power by it. As I marked (CXLIX.) the necessity of 



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