INFLUENZA. 213 



" 2dly. Is the blood the seat of the disease ? 



" In my opinion, certainly not; for I have found this fluid in 

 two very opposite conditions, — one slow in coagulating, and 

 presenting a thick and firm buffy coat ; the other dark -coloured, 

 quick in coagulating, and with no buffy surface. The former 

 appearance I have invariably found connected with a strong and 

 full pulse, the latter attended by a weak soft pulse ; but quick 

 in both instances. Under the last- mentioned circumstances, I 

 bled in very few instances, and then only in small quantities ; 

 but I have no doubt the appearance of the blood would have 

 been the same in every case in which I abstained from general 

 bleeding. The appearance of the blood, and the state of the 

 pulse, are, probably, rather to be attributed to the idiosyncrasy 

 of the patient, and the diet to which he had been accustomed, 

 than to the effect of the disease. I coincide with your pre- 

 sident's opinion, that the state of the blood ought to have little or 

 no influence over our treatment of disease ; but I cannot go so 

 far as to discard it altogether from consideration. I must confess 

 that I almost always examine its appearance after venesection, 

 which, however, can be ascertained as well in a few minutes as 

 in as many hours ; and in an inflammatory disease I am always 

 pleased to find a buffy coat, for it assures me that, at any rate, 

 my patient can endure bloodletting. In a case in wdiich I may 

 be in doubt as to the propriety of repeating the withdrawal of 

 blood — being, perhaps, influenced, pro and con, by equally 

 weighty reasons — I should incline to the performance of the act 

 if the blood, at the previous abstraction, had presented a fibrous 

 coat. This, however, is a digression for which I must apologise, 

 and return to another query. 



" 3dly. Where, then, is the seat of the disease ? or in what does 

 it consist ? 



" Surely not in the presence of any symptoms that, however 

 frequent, are yet in some cases wanting. And it is a curious 

 fact, respecting the quick pulse, the tumefaction of the extremi- 

 ties and the eyelids, the loss of appetite, the affection of the 

 throat or the lungs, that, however frequent these appearances may 

 be, yet there are some instances in which one or more of them 

 are absent. The only symi^toms universally present are fever 

 and prostration of strength. We must, therefore, regard it as a 

 fever siii generis, in which the mucous membranes are consider- 

 ably affected, and the nervous system greatly deranged. It will 

 run its course. ■ — There is no knocking it down. — All that we 

 can do is to regulate its progress, to moderate its fury, and to 

 assist Nature in her own operations. We may, indeed, conquer 

 by a siege, but not by an assault. 



" 4thly. Is bleeding desirable in this complaint ? 



p 3 



