GENERAL BLOODLETTING. 
649 
matory, but dependent on want of blood and strength, the 
recognised power of calomel and antimony to control inflam- 
mation, and other causes, have removed this error in practice? 
but seem likely to lead us to an absurdly opposite extreme. 
Unfortunately, it is too true that even well-educated members 
of our profession are too apt to neglect or misuse a good 
remedy from the powerful influence of mere fashion. No 
sooner was cod-liver oil asserted to have some power in 
checking or soothing phthisis than it was crammed down the 
throats of a vast proportion of patients as eagerly as if the 
elixir vitae had at last been really discovered. At the present 
time there seems to be a prevailing prejudice against general 
bloodletting among practitioners of medicine; forsooth, 
because their are epidemics which are characterised by 
marked debility, and because many slight inflammations will 
get well without it, (and indeed without any treatment at all,) 
they relinquish a most valuable means of controlling disease, 
— one which, used within proper limits with care and discretion 
may prove of the highest service. Severe acute inflamma- 
tions of internal organs, especially of the parenchyma, and 
serous coverings, are the cases in which bleeding is chiefly 
needed. There are, of course, many exceptions; many causes 
may render bloodletting inapplicable: a constitution broken 
down by drinking, starvation, or excessive exercise of body 
or mind, — the powers of the system reduced by the continu- 
ance of the disease, the case in its own nature being authentic, 
— all these may render bleeding unnecessary or hurtful, but 
do not interfere with the general rule, that an acute inflam- 
mation in a good subject requires active depletion- at the 
outset. By its adoption life will probably be saved, or serious 
irreparable damage avoided. It is after the activity of the 
disease and the force of the general circulation and tone of 
the system have been reduced by bleeding, that other reme- 
dies, as antimony and calomel, are so useful in rendering its 
repetition unnecessary, and completing the restoration of the 
affected part to its natural state. 
There are one oi two points in the diagnosis of inflamma- 
tion of great importance. If I take up an ordinary treatise 
on medicine, I find that an acute inflammation is distin- 
guished by the presence of acute fever accompanying the 
pain, and other local signs; a pleurisy, for instance, is distin- 
guished from pleurodynia by the presence of fever in the 
former. Now, it frequently happens that a patient is seen 
in private practice at the very onset of the attack, w hen the 
pain is very severe, but there is no fever at all. It is ex- 
tremely necessary to bear this in mind in respect to the 
xxvi. - 84 
