Medical Inquiries and Observations, Vol. 4: The Second Edition, Revised and Enlarged by the AuthorRush, Benjamin
History
Medical Inquiries and Observations, Vol. 4: The Second Edition, Revised and Enlarged by the Author
Rush, Benjamin
Medicine; Yellow fever -- Pennsylvania -- Philadelphia
16. Bleeding is forbidden after the fifth or seventh day in a pleurisy.
This prohibition was introduced into medicine at a time when a fear was
entertained of arresting the progress of nature in preparing and
expelling morbific matter from the system. From repeated experience I can
assert, that bleeding is safe in every stage of pleurisy in which there
is pain, and a tense and oppressed pulse; and that it has, when used for
the first time after the fifth and seventh days, saved many lives.
Bleeding has likewise been limited to a certain number of ounces in
several states of fever. Were the force of the remote cause of a fever,
its degrees of violence, and the habits of the subject of it, always the
same, this rule would be a proper one; but, this not being the case, we
must be governed wholly by the condition of the system, manifested
chiefly by the state of the pulse. To admit of copious bleeding in one
state of fever, and not in another, under equal circumstances of morbid
excitement, is to prescribe for its name, and to forget the changes which
climate, season, and previous habits create in all its different states.
17. The loss of a sufficient quantity of blood is often prevented by
patients being apparently _worse_, after the first or second bleeding.
This change for the worse, shows itself in some one or more of the
following symptoms, viz. increase of heat, chills, delirium, hæmorrhages,
convulsions, nausea, vomiting, faintness, coma, great weakness, pain, a
tense, after a soft pulse, and a reduction of it in force and frequency.
They are all occasioned by the system rising suddenly from a state of
extreme depression, in consequence of the abstraction of the pressure of
the blood to a state of vigour and activity, so great, in some instances,
as to reproduce a depression below what existed in the system before a
vein was opened; or it is occasioned by a translation of morbid action
from one part of the body to another.
The chills which follow bleeding are the effects of a change in the
fever, from an uncommon to a common state of malignity. They occur
chiefly in those violent cases of fever which come on without a chilly
fit.
The hæmorrhages produced by bleeding are chiefly from the nose,
hæmorrhoidal vessels, or uterus, and of course are, for the most part,
safe.
Uncommon weakness, succeeding blood-letting, is the effect of sudden
depression induced upon the whole system, by the cause before-mentioned,
or of a sudden translation of the excitement of the muscles into the
blood-vessels, or some other part of the body. These symptoms, together
with all the others which have been mentioned, are so far from
forbidding, that they all most forcibly indicate a repetition of
blood-letting.
I shall briefly illustrate, by the recital of three cases, the good
effects of bleeding, in removing pain, and the preternatural slowness and
weakness of the pulse, when produced by the use of that remedy.
Public-domain text, read in full here on John Shaqi.
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