486 Observations on the medical effects 



hasten the accession of the warm stage, but are much less 

 effectual than the plan of obstructing the circulation. Dr. 

 Macintosh, of Edinburgh, recommended blood-letting in the 

 cold stage, on the principle of diminishing its duration, and 

 hastening on the hot stage, while at the same time its violence 

 is decreased. This effect it produced, by lessening the mass 

 of the blood, and dispersing morbid local congestions. The 

 same method was energetically employed by the late Dr. 

 Twining, who proved that such a loss of blood had the effect 

 of favourably modifying, and even of checking intermittent 

 fevers. But it had the great disadvantage of weakening the 

 system ; and thus increasing the tendency to relapse, an event 

 so common, as in many cases to render it necessary for the 

 patients to proceed to a more congenial climate, in order to 

 restore the vigour of the constitution. The general results 

 of the numerous cases in which I have stopped the circula- 

 tion for the cure of ague were, that when the tourniquet 

 was applied to one of the extremities, previous to the acces- 

 sion of the paroxysm of ague, known by the premonitory 

 symptoms, the cold stage was entirely prevented, and a slight 

 attack of synocha followed ; and that when applied at any 

 time during the cold fit of an ague, in two or three minutes 

 after, a modified warm stage was induced, which was render- 

 ed milder and shorter in its duration, and more easily 

 brought under the influence of medicine ; and when the attack 

 was accompanied with pain in the back or headache, these 

 symptoms were speedily removed. The following cases are 

 given as favourable examples of the usual effects of the tourni- 

 quet in cases of simple ague. 



Case I. — Bisto Sunder Bhutacharge, aged 40, has had a quo- 

 tidian fever for seven days. The tourniquet was applied on the 

 morning of the 4th August, when he had no fever. He felt 

 faint after it was removed, and this feeling was succeeded by 



