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BLEEDING IN IN EL AMMATION. 
Dr. Markham, in a letter addressed to the editor of the 
Medical Times and Gazette , gives the following summary 
of the conclusions arrived at in two papers by him, lately 
printed in that journal, on the above subject : 
c: 1 . There is no proof that venesection has any directly 
beneficial influence over the course of inflammations, either 
external or internal. Surgeons never bleed now in external 
inflammations ; and physicians have given up all argument 
in favour of the proceeding, except in the case of pneumonia, 
and perhaps also of peritonitis. At all periods of medical 
history, moreover, it has been especially in pneumonia, that 
the benefits of venesection have been most firmly extolled. 
“ 2. But the direct abstraction of blood by leeches, &c., from 
an inflamed part, during the early stages of the inflam- 
mation, modifies its course, and materially reduces the most 
characteristic phenomena of it, viz. the pain, the heat, the red- 
ness, and the swelling ; and the abstraction of blood does this, 
whether the inflammation be traumatic or specific, as we 
observe, for instance, in the application of leeches to a sprained 
ankle or to an inflamed joint. There is therefore a marked 
distinction to be made between venesection and local abstrac- 
tion of blood. 
“3. Local abstraction of blood, however, cannot produce 
the same beneficial results in the case of internal inflamma- 
tions, except in those instances in wdiich we are thereby able 
to draw blood directly from the inflamed part. Leeches 
applied to the thorax cannot draw blood directly from the 
inflamed lungs. When they appear to be of service in pleuro- 
pneumonia, they are so by drawing blood from, and so 
reducing the inflammation of, the parietal pleura. In endo- 
carditis, again, direct bleeding (over the cardiac region) is 
useless ; in pericarditis it is of great service, because thereby 
blood can be drawn directly from the inflamed pericardium 
and pleura. 
“ 4. Venesection, where properly used, is of great service, 
incidentally, in pneumonia. There is a peculiarity in the 
circumstances attending this inflammation, which causes it to 
differ from all other internal inflammations ; and this pecu- 
liarity consists in the mechanical effects — the congestion of 
blood in the heart — produced by the inflammation. The 
bleeding relieves this congestion, it has no directly benefi- 
cial influence over the inflammatory process. It serves ex- 
actly the same end in pneumonia, as it does in the conges- 
