Many of the older writers, proceeding upon the humoural theories,
began their treatment of gangrene by bleeding and purging, after which
they prescribed theriaca, and other stimulating applications. Some
modern authors still adhere, in part, to this practice, and consider
the loss of blood to be advantageous in cases of incipient gangrene.
Mr. Bell, who is one of the latest writers on this subject, informs
us, that, when the “general symptoms of inflammation, particularly a
quick, full, or hard pulse, still continue violent, and especially
when the patient is young and plethoric, it then becomes absolutely
necessary, even although mortification may have commenced, to empty
the vessels a little by one general blood-letting,” which, “in such
cases, may in reality be considered as an antiseptic; and it does often
indeed, in this particular situation of mortification, prove more
powerfully so, than all the different articles in general enumerated
as such.” If, however, we consider the nature of mortification, and
the circumstances under which it is most likely to occur, we must
look upon this practice as dangerous, and must be permitted to doubt
whether the full hard pulse is to be met with after the commencement of
inflammation, or whether the symptoms of the inflammatio valida, (in
which alone bleeding is admissible) still continue violent, after one
portion of the inflamed part is evidently gangrenous. Is it reasonable
to suppose that one portion of the inflamed part shall be already dead,
or dying, and that yet the rest shall not have begun to suffer? or
that the action shall not have become converted into the inflammatio
debilis, (if it were not originally this)? This surely is not the time
for bleeding, purging, and debilitating remedies; but the part must be
considered as possessing the low inflammatory action, and the patient
as requiring suitable remedies. It may indeed be said by some, in
favour of bleeding, that the bark, in some instances, does not check
the progress of the disease; but it surely does not thence follow, that
it does positive injury, and that remedies of an opposite nature are
useful.
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