92 PRACTICE OF PHYSIC. 



particular instances of the cure of obstinate cases by these 

 means. I seldom find that the impatience of our patients will 

 allow us to proceed in this way, except in a very few instances. 

 Every day's experience, however, shews that we can hardly take 

 down the diet too much in the case of rheumatism, and that, 

 without this, scarcely any bleeding or any other evacuation will 

 answer the purpose. Huxham approves of a spare use of this 

 evacuation ; and the French (though we at first seem to have 

 learned the practice of large bleeding from them) are of the 

 same mind. Thus, Lieutaud approves of little bleeding, and 

 adduces the experience of Marquet, who, having at first prac- 

 tised profuse phlebotomy, found that it protracted the com- 

 plaints of the patients for years ; and that, by becoming after- 

 wards more sparing, he had often cured the disease in eight or 

 ten days. 



" To give my opinion on this matter, though I allow that 

 blood is very easily repaired, (a common argument adduced by 

 the advocates for the copious use of phlebotomy,) yet in some 

 cases I have seen that even this was the case when much blood- 

 letting and haemorrhagy were joined, and that it induced weakness 

 of tedious and dangerous consequences ; so that I can confirm 

 M. Marquet's observations, by observing that I have seen, by 

 such a practice, the acute converted into the chronic rheu- 

 matism, which is a kind of torpor, or even almost palsy. 

 For this reason I would recommend bleeding, not in such quan- 

 tity as to weaken the system, but only to remove the irritation." 



CCCCLXIV. To avoid that debility of the system, which 

 general bleedings are ready to occasion, the urgent symptom of 

 pain may be often relieved by topical bleedings ; and especially 

 when any swelling and redness have come upon a joint, the 

 pain of it may be very certainly relieved by such bleedings ; 

 but as the continuance of the disease seems to depend more up- 

 on the phlogistic diathesis of the whole system than upon the 

 affection of particular parts, so topical bleedings will not always 

 supply the place of the general bleedings proposed above. 



" I was formerly fond of using much topical bleeding, and I 

 have had much occasion to see that it almost constantly relieves 

 the pain of the part in which it is practised, with this condition, 

 which Sir John Pringle remarks, that the part is previously af- 



