Now, by means of the stethoscope, I distinguished to a considerable extent at the upper part of the left side of the chest, a mixed rattle, composed of sounds rather deep than acute, and a gurgling noise, as if a large quantity of mucus was floating in the cells. At the shoulder blade, the instrument furnished the same signs. In addition to the repetition of bleeding from the arm, twenty ounces of blood were removed by cupping, part from the breast and part from the shoulder blade. Great and immediate relief was afforded. The general fever, of which, both now and before, occasional delirium was one symptom, was checked. The medicine consisted of tartarized antimony and nitre in a saline draught, with the addition of syrup of poppy, in order to quiet cough and irritation. On the following day, blood was again taken from the arm freely; but, notwithstanding the blood exhibited the same signs as before in a great degree, no further depletion was required. We are much instructed as to the degree of inflammatory action of the vessels by the appearance of the blood, which, when possessing these characters, is commonly, but inaccurately called inflamed. And we must not consider that continued bleeding is the indispensable remedy for restoring the circulation to a healthy state, and the blood to its natural condition. My view of the nature of blood of this description is, that it simply contains a larger proportion than usual of one of its constituent parts, termed the fibrin; and hence, a firmer clot and the buffy coat. It is important as being an attendant on inflammatory action[1], and an indication, therefore, to our treatment. Although we rightly attach all possible importance to the use of the lancet, and of local bleeding, we must not forget that we have other means of reducing the circulation; as, for example, the use of medicines, repose, and general regimen. To return to the case, I have to add, that when heat of the skin and general fever were abated, the peculiar sounds just now mentioned, had also nearly disappeared. In this state of improvement, a large blister was applied over the affected side of the chest. As it seemed probable that further general bleeding might be avoided, digitalis was added to the medicine. This becomes a valuable agent at the period when we may hope to have laid aside the use of the lancet. If employed during the height of inflammation, most probably it will not render the pulse slower; and even if it does have this effect, it rather masks than cures the disease, leaving us in doubt whether the abatement of the pulse be fairly due to the diminution of inflammatory action, or to the influence of the digitalis. This gentleman recovered gradually, but in the most favourable manner. The latest morbid indication by the stethoscope, was simply the mucous rattle.