INFLAMMATIONS. 59 



the disease, its solution is not to be trusted to the expectoration 

 alone. It is in a more advanced stage only, when the proper 

 remedies have been before employed, and when the symptoms 

 have suffered a considerable remission, that the entire cure may 

 be trusted to a copious and free expectoration. 



CCCLXVII. During the first days of the disease, I have 

 not found that bleeding stops expectoration. On the contrary, 

 I have often observed bleeding promote it ; and it is in a more 

 advanced stage of the disease only, when the patient, by large 

 evacuations, and the continuance of the disease, has been al- 

 ready exhausted, that bleeding seems to stop expectoration. It 

 appears to me, that even then bleeding does not stop expectora- 

 tion, so much by weakening the powers of expectoration as by 

 favouring the serous effusion into the bronchise (CCCXLVIII.) 

 and thereby preventing it. 



" An important question in the management of peripneumo- 

 ny and pleurisy, is to determine what influence the consideration 

 of the expectoration is to have upon our blood-letting. That 

 such a doubt occurs, appears from the words of Sir John Prin- 

 gle. He says that the question often is, whether we are not in 

 danger of allowing the lungs to be overpowered by too copious 

 effusion, the consequence of neglected venesection ; or, upon the 

 other hand, whether we may not, by copious venesection, sup- 

 press the evacuation by expectoration, by which nature com- 

 monly relieves the disease. But Sir John Pringle has not told 

 us how we are to judge of the one and of the other tendency ; 

 he refers to Huxham and Van Swieten, but neither of them 

 have assisted me in determining the question which often occurs. 



" I have not met with any instances where I thought that 

 expectoration was suppressed by too copious venesection ; but, 

 on the contrary, I have seen cases of peripneumony and pleu- 

 risy, which from the beginning were attended with a copious ex- 

 pectoration, and yet for want of bleeding proved fatal. The ef- 

 fects of bleeding on the expectoration may be viewed in two 

 different lights : 



" First, In as far as bleeding may occasion debility, and there- 

 by disable the lungs from throwing off the considerable quantity 

 of water which was poured into their cavities. This case, Mor- 

 gagni alleges to have frequently existed, particularly in old 



