INFLAMMATIONS. 57 



inferred from there being a considerable remission of the pain 

 which had before subsisted, while, along with this, the cough, 

 and especially the dyspnoea, continue, and are rather augmented. 

 At the same time, the frequency of the pulse is rather in- 

 creased ; the feverish state suffers considerable exacerbations 

 every evening, and by degrees a hectic, in all its circumstances, 

 comes to be formed. 



CCCLX. The termination of Pneumonia by gangrene, is 

 much more rare than has been imagined ; and, when it does 

 occur, it is usually joined with the termination by effusion 

 (CCCXLVL) ; and the symptoms of the one are hardly to be 

 distinguished from those of the other. 



CCCLXI. The cure of pneumonic inflammation must pro- 

 ceed upon the general plan (CCXLIV.) ; but the importance 

 of the part affected, and the danger to which it is exposed, re- 

 quire that the remedies be fully, as well as early employed. 



CCCLXII. The remedy chiefly to be depended upon, is 

 that of bleeding at the arm, which will be performed with most 

 advantage in the arm of the side affected, but may be done in 

 either arm, as may be most convenient for the patient or the 

 surgeon. The quantity drawn must be suited to the violence 

 of the disease, and to the vigour of the patient ; and generally 

 ought to be as large as this last circumstance will allow. The 

 remission of pain, and the relief of respiration, during the flow- 

 ing of the blood, may limit the quantity to be then drawn ; but if 

 these symptoms of relief do not appear, the bleeding should be 

 continued till the symptoms of a beginning syncope come on. 

 It is seldom that one bleeding, however large, will prove a cure 

 of this disease ; and although the pain and difficulty of breath- 

 ing may be much relieved by the first bleeding, these symptoms 

 commonly, and after no long interval, recur, often with as 

 much violence as before. In the event of such recurrence, the 

 bleeding is to be repeated, even in the course of the same day, 

 and perhaps to the same quantity as before. 



Sometimes the second bleeding may be larger than the first. 

 There are persons who, by their constitution, are ready to faint, 

 even upon a small bleeding ; and in such persons this may pre- 

 vent the drawing so much blood at first as a pneumonic inflam- 

 mation might require ; but as the same persons are often found 



