When the system is affected, in consequence of inflammation of vital
parts, the general action is greater than when other parts are
affected, and, therefore, bleeding must be used earlier, and with more
freedom. Mr. Hunter observes, that when these parts are inflamed, the
patient bears bleeding worse than when parts are affected which are
not vital; but this observation must not be admitted indefinitely.
When these parts are affected, the action is so violent, that the power
cannot long support it; and, therefore, we must have early recourse
to the lancet, and allow the blood to flow until the pain diminishes,
and ceases to abate any more, and until the pulse becomes softer,
and perhaps fuller. This is the time to stop; but, whenever the pain
returns, or the pulse becomes hard, the orifice should be again opened,
although we had bled only half an hour before. The system, in this way,
is not weakened, nor the action sunk so low as to injure the power of
recovery, which might be the case, were we to bleed too copiously at
once. This remark applies, in a particular degree, to inflammation of
the bowels; but it may also be extended to pulmonic inflammation; only,
in this case, we can detract more blood at a time than in the other
instance; because the system sympathises less strongly with the lungs,
and, therefore, general evacuation will be longer of operating on the
local disease. The same cause, however, makes the danger less; because
the general action is not raised so high, and the part itself not being
so delicate, can support the action longer, and, consequently, the
danger is less. It is an established point, that no action can subside,
or be destroyed suddenly, and the patient become free from disease.
All morbid actions must subside, more or less slowly, and, therefore,
bleeding ought not at once to be pushed so far as to produce fainting,
unless the patient be very liable to faint. This sudden cessation of
general action does not destroy the specific nature of the action
which is going on when it is induced, but rather leaves the parts
stationary, the tendency to morbid action still continuing, although
the capability to act be suspended for a moment[3]. In place, then,
of bleeding so as to exhaust the strength quickly, and endeavour, as
it were, by the quantity of the discharge, to destroy the disease by
one bleeding, it will be much better to bleed just until we produce
the feeling of weakness to a moderate extent, and abate, to a certain
degree, the pain and hardness of the pulse; stopping, whenever we
find that we are not abating it farther, distinguishing, however,
betwixt real abatement and syncope, or want of power to act and feel.
We then repeat the evacuation, whenever the hardness of the pulse and
pain return; and thus, perhaps in one day, and with infinitely more
benefit, bleed much more frequently, and, perhaps, to a greater extent
than is sometimes done in a week, by those who bleed more copiously at
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