INFLAMMATIONS. 91 



CCCCLXIII. Upon the same principle (CCCCLXIL), 



at least with perhaps the same exception as above, blood-letting 

 is the chief remedy of acute rheumatism. The blood ought to 

 be drawn in large quantity, and the bleeding is to be repeated 

 in proportion to the frequency, fullness, and hardness of the 

 pulse, and to the violence of the pain. For the most part, large 

 and repeated bleedings, during the first days of the disease, 

 seem to be necessary, and accordingly have been very much 

 employed : but to this some bounds are to be set ; for very pro- 

 fuse bleedings occasion a slow recovery, and, if not absolutely 

 effectual, are ready to produce a chronic rheumatism. 



" Sir John Pringle is one of those who inculcate plentiful 

 venesection ; and he adds, that it is found, that persons, not 

 only from their constitution and time of life, but merely from 

 their being attacked with this disease, will bear bleeding to a 

 greater degree than in any other case. The observation is cer- 

 tainly just, that while the body is under the phlogistic diathesis, 

 while there is an extraordinary tension and tone induced in the 

 whole arterial system, it will bear very large bleedings without 

 immediately showing any of the effects of great debility ; but 

 there is a fallacy in this : when we have overcome the disease 

 and taken away the tone, the debility is remarkable. Then we 

 find Dr. Sydenham's observation just, where he argues the dan- 

 ger from excessive venesection : He considered the disease as 

 autumnal ; and I have observed, as he has done, that the pa- 

 tients did not recover their strength during the whole course of 

 winter ; that they were not only liable to relapses, but to other 

 diseases, and to anasarca, the most certain proof of excessive 

 venesection. I imagine that the disease is not by any means 

 to be overcome without taking a certain quantity of blood ; but 

 I would inculcate Dr SydenhanVs method, of finding some me- 

 thod of shortening the disease if possible without the great ex- 

 pense of bleeding. Dr Sydenham, in his practice, set out with 

 curing rheumatism by bleeding, which he practised pretty free- 

 ly ; but he thought that this, upon many occasions, had bad 

 consequences, which he points out ; and, therefore, he wished' 

 to find another remedy which might be substituted without that 

 expense to the constitution : he finds none, and recommends no- 

 thing more than an extremely low diet of whey alone ; and gives 



