60 PRACTICE OF PHYSIC. 



persons. I am very ready to admit of it, but I take it to be li- 

 mited to very copious catarrhal effusions in old persons. 



" Secondly, In as far as it may by revulsion diminish the se- 

 cretion, which has been supposed to take place when there was 

 no matter poured out into the bronchiae. We must distinguish 

 between the secretion and the expectoration. Now, the question 

 is, how far bleeding diminishes the secretion, the exhalation 

 from the exhalant arteries, and the secretion from the mucous 

 follicles, I am very adverse to admit this theory, from the con- 

 sideration that venesection is not very powerful in the way of 

 revulsion ; and when I consider that the quantity of blood com- 

 monly drawn from a vein, in the arm for instance, is divided 

 among the extreme arteries of the whole system, it appears to 

 me that it can have no sensible effects upon each of them, till it 

 induces such a debility on the whole system, as to diminish 

 every kind of secretion : this case is possible, but can hardly 

 occur from any bleeding which we practice in this case, and 

 which is alleged to have affected the lungs. 



" But I will give another view of this matter. That state of 

 the lungs in peripneumony and pleurisy, in which no secretion 

 takes place, depends, I think, on the same circumstances which 

 support the inflammation in general, the extreme vessels of the 

 lungs being affected with a spasm. And bleeding is the remedy 

 which takes off the spasm on which the inflammation depends, 

 and which, therefore, also promotes the diminished secretion ; 

 so that where no secretion exists, bleeding is the most likely 

 means to bring it on. I have observed, in many cases where 

 the disease began with a dry cough without any expectoration, 

 that the venesection relieved the dyspnoea and pain, and brought 

 on an expectoration : I am of opinion, therefore, that it is more 

 frequently a means of bringing on than of diminishing expector- 

 ation. 



" But to bring the matter nearer to a particular case : the 

 expectoration which sometimes occurs in the beginning of the 

 disease, is to be considered as an effect of the violence of the 

 disease ; as an effect, I would say, of the increased impetus, 

 which forces the exhalant vessels on the surface of the lungs, 

 and so often produces an effusion into the cellular texture. 

 Such an expectoration, however large and free, is rather to be 



