1. It is forbidden in that state of fever, as well as in other diseases, in which there is reason to believe the brain or viscera are engorged with blood, and the whole system prostrated below the point of re-action. I have suggested this caution in another place[62]. The pulse in these cases is feeble, and sometimes scarcely perceptible, occasioned by the quantity of blood in the blood-vessels being reduced, in consequence of the stagnation of large portions of it in the viscera. By bleeding in these cases, we deprive the blood-vessels of the feeble remains of the stimulus which keep up their action, and thus precipitate death. The remedies here should be frictions, and stimulating applications to the extremities, and gentle stimuli taken by the mouth, or injected into the bowels. As soon as the system is a little excited by these remedies, blood may be drawn, but in small quantities at a time, and perhaps only by means of cups or leaches applied to the seats of the congestions of the blood. After the vessels are excited by the equable diffusion of the blood through all their parts, it may with safety be drawn from the arm, provided it be indicated by the pulse. [62] Vol. iii. 2. It is seldom proper beyond the third day, in a malignant fever, if it has not been used on the days previous to it, and for the same reason that has been given under the former head. Even the tension of the pulse is not always a sufficient warrant to bleed, for in three days, in a fever which runs its course in five days, the disorganization of the viscera is so complete, that a recovery is scarcely to be expected from the lancet. The remedies which give the only chance of relief in this case, are purges, blisters, and a salivation. 3. Where fevers are attended with paroxysms, bleeding should be omitted, or used with great caution, in the close of those paroxysms. The debility which accompanies the intermission of the fever is often so much increased by the recent loss of blood, as sometimes to endanger life. 4. Bleeding is forbidden, or should be used cautiously in that malignant state of fever, in which a weak morbid action, or what Dr. Darwin calls a tendency to inirritability, takes place in the blood-vessels. It is known by a weak and frequent pulse, such as occurs in the typhus fever, and in the plague in warm climates. I have often met with it in the malignant sore throat, and occasionally in the pleurisy and yellow fever. The remedies here should be gentle vomits or purges, and afterwards cordials. Should the pulse be too much excited by them, bleeding may be used to reduce it.