once, and repeat it seldomer.
[3] When we are obliged to stop our bleeding, on account of fainting,
before we would otherwise do it, we will find it necessary to repeat
the venesection sooner than if this did not happen.
Concerning the exact quantity of blood, which ought, in the different
varieties of inflammation, to be detracted, I hold it, from the above
principle, to be ridiculous to give any direction; because no general
rule can be given, by which we may, a priori, determine the quantity.
We are to bleed until we procure an abatement of the action; and to
stop whenever this abatement ceases to be really progressive[4]. We are
to renew the bleeding, whenever the action again increases, and stop,
as before, whenever it is abated, remembering, that, after some time,
a more sparing detraction will produce a greater effect, than a more
copious one would do, in the commencement of the disease. It must also
be attended to, that, owing to the weakness induced by the disease, and
by the bleedings, we must, toward the end, bleed at longer intervals;
for, if we continue to bleed in the same way as formerly, we would
either kill the patient, or at least prevent the act of restoration
from taking place; because we would thus diminish the power, or vital
energy, which was to perform this act. Those, then, who order a certain
number of ounces to be taken away, must reason upon probability, and
prescribe less efficaciously, than those who direct no determinate
quantity, but regulate their practice by the effects. It is equally
foolish in those who order bleeding, pro viribus, and are satisfied
with this until their next stated visit; because bleeding until
fainting takes place, and not repeating it for some time afterwards,
may be doing a great deal too little.
[4] We must distinguish, as has been already mentioned, betwixt a real
abatement of the inflammatory action, and a mere temporary suspension
of action, or syncope.
As there is a proper time for stopping each individual evacuation, so
also is there a period at which we ought to stop the general plan of
cure by bleeding, or at least to intermit it. And to determine when
this period is come, is sometimes a pretty nice point, and one of much
importance; because, if we stop too soon, we allow the action still
to go on, and, perhaps, to terminate fatally. On the other hand, if
we bleed too long, we sink the parts below the state necessary for
recovery, and even accelerate the unfavourable termination. When, for
instance, from the state of the pulse, and other circumstances, we
apprehend the accession of gangrene, bleeding will not abate pain, but
will bring on the mortification sooner, and make it spread farther, as
will be afterwards mentioned.
Public-domain text, read in full here on John Shaqi.
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