The abstraction of blood must be carried to the extent of subduing the
inflammation: there is no other limit to the quantity to be taken but
that which is adequate to subdue the inflammation. To attempt to measure
the quantity by drachms or ounces is wholly vain; because, if the remedy
be properly employed, the quantity will vary in every individual case.
To take an ounce more than the subdual of the inflammation requires is
injurious; to take an ounce less is still more pernicious; to take the
quantity necessary to accomplish the object, and no more, is to use the
lancet—that powerful instrument, so dangerous in rash hands, and no less
dangerous in weak, with the discernment and decision of a master. He who
with a knowledge which gives and which justifies boldness and decision,
is able thus to employ this great remedy, is a skilful physician, who
has derived from study and experience the best fruit they can yield: he
who has not yet reached this perfection of his art, (and who among us
can pretend to the attainment?) must still go on to observe and to
learn.
The object to be accomplished then is clear; that means of obtaining it
are known; and when these means are promptly, boldly, and effectually
employed, what is the result of experience? That after all, the quantity
of blood it is necessary to abstract is not large. The tendency of the
preceding observations is not to countenance frequent and large
abstractions of blood in fever, but to save the blood of the patient, by
taking the due quantity at the proper time. Smaller bleedings will
subdue febrile than pure inflammation. Febrile inflammation, as has been
so often stated, is a modified inflammation, the modification consisting
in less activity in the vascular system and greater depression in the
nervous. Whence a moderate bleeding will make an impression upon febrile
inflammation which can be equalled in pure inflammation only by a large
bleeding. He who takes away sixteen ounces of blood in fever adopts a
bolder and more decisive practice, and brings more effectual relief to
his patient, than he who abstracts thirty ounces of blood in some other
forms of inflammation; and he who takes away six ounces of blood in one
febrile case, does more than he who takes away sixteen in another. But
the question never can be whether the bleeding should be small or large:
that is nothing. The thing to be considered is the condition of the
organs, the state of the system; not the ounces of blood to be taken,
nor the number of periods at which it is to be removed. Abstract blood
to the subdual of the inflammation—that is the rule; abstract blood at
the very commencement of the inflammatory action; if you are in time to
do it, at the very commencement of the febrile excitement. Then little
blood will be lost, and the patient will be safe. And when this is done,
nothing of importance remains to be done. The practitioner who has been
thus active in the commencement will be idle during the future progress
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