In the highest stage of vascular fulness and activity, local bleeding is of little benefit. The blood abstracted is so rapidly supplied, and the distending force of the forward movement so great, that the capillary vessels have not the opportunity for contracting. Under such circumstances, the measure should always be preceded by general bleeding. But, after the fulness of the vessels, and the moving forces of the blood have been thus reduced, or in cases in which there is no considerable general excitement, the loss of blood locally is of very great importance, and will often eradicate an inflammation which has refused to yield entirely to the lancet. in many cases of disease, the indications and the contraindications for bleeding may be so nicely balanced, that it may be difficult to decide between them; as, for example, in low fevers attended with inflammation. Here local bleeding is an invaluable remedy; and I have repeatedly seen the loss of two or three ounces of blood apparently turn the scale favourably between life and death. it happens, fortunately, in such cases, that the loss of a little blood has much greater effect than in sthenic states of the system. I have often found it necessary to take a little blood from the chest in the pneumonia of typhoid fevers, when active stimulation has been necessary to support the cerebral centres; and I have myself been sometimes astonished at the relief thus obtained. it has been before incidentally stated that blood may be withdrawn locally from infants, with advantage, in reference to effects on the system at large; the whole quantity to be taken being so small that it can be abstracted with sufficient rapidity; and the danger being less of over-bleeding than when the lancet is used.

Local bleeding is effected by simple scarification, or by means of cups or leeches. Scarification is not often used, and only under peculiar circumstances; as in conjunctivitis, tonsillitis, sometimes in laryngitis, and in glossitis with great enlargement of the tongue, in which deep incisions are recommended when the swelling threatens suffocation. The two latter methods are those commonly resorted to.

As a general rule, it is better, when cups and leeches are used, to take blood from the immediate neighbourhood of the inflamed part, than from the inflamed vessels themselves; as the wounds sometimes superadd their own inflammation to that pre-existing, and thus endanger some aggravation of the latter. The quantity of blood to be taken by cups or leeches must depend on the circumstances of each case. in the adult, from three to six ounces are usually drawn; but the quantity may be as small as a fluidounce, or may amount to twelve or fourteen ounces. in severe meningeal or peritoneal inflammation, I have repeatedly directed one hundred American leeches, which ought to abstract about a pint, if of good quality and well applied.

Cupping. For the method of performing this process, and an account of the instruments employed, the reader will consult works on minor surgery. it is a very efficient process in many cases of disease, sometimes almost indispensable; and no physician, who cannot command the services of a cupper in his neighbourhood, should be without a set of the instruments, or the skill requisite for using them efficiently. Should this happen, however, and a strong emergency call for the use of them, he may substitute an extemporaneous process, by means of a sharp knife and a few wineglasses or tumblers.

Cupping has the advantage over leeching that it can be more quickly effected; can be more conveniently diffused over an extensive surface, as that of the chest or abdomen for example; affords the means of more precisely measuring the quantity of blood withdrawn; and superadds to the depletion the revulsive influence of the subsequent inflammation. it should be preferred, therefore, when no special indication for the choice of leeches may exist.

Dry cupping is a sort of depletory method, which is admirably adapted to inflammation attending very low states of system. it withdraws the blood temporarily from the circulation, and leaves it to reenter the vessels, when the local object has been accomplished. its revulsive influence is also not without its advantages. it may be used very freely in thoracic and abdominal inflammation, when the state of the circulation does not admit of any other mode of depletion; and, conjointly with a few wet cups, operates most happily in many instances.

Leeching. This is preferable to cupping when the pain of the operation is a matter of consequence, as in children and delicate or nervous women; when the parts to be operated on are tender to the touch, as in phlegmonous tumours and glandular swellings; when it is desirable to concentrate the bleeding within as small a space as possible, as the end of a finger; when the tissue is loose, as in the eyelids, the scrotum, etc.; and when the parts from which it is wished to abstract blood, are inac-cessible to cups, as the tongue, the uterus, the vulva, the anus, etc. it should almost always be employed preferably in infants.

Two kinds of leeches are used in this country, the European and the American; and it is important to discriminate properly between them; as the amount of blood they draw is very different, and disagreeable effects sometimes result from the one, which are much less incident to the other. Without intending to give a description of these animals, for which the reader is referred to the U. S. Dispensatory, I will merely state that the two species may be distinguished by the colour of the belly, which, in the European, is greenish, or greenish-yellow with black spots, in the American, so far as I have ever seen, is reddish-brown.

The European leech makes a deeper incision than the American, draws more blood directly, and causes the loss of a much larger quantity from the bite. in consequence of this tendency to hemorrhage, it is impossible to regulate, with an approach to precision, the amount of blood that will be lost. Sometimes, too, it is difficult to check the hemorrhage; and, in several instances, infants have perished from this cause. The average quantity of blood drawn by the leeches imported into this country exceeds, as I have been informed, half an ounce for each leech, including the subsequent bleeding. The American leeches are less liable to these disadvantages. Secondary hemorrhage is seldom considerable; the quantity of blood they are likely to take can, therefore, be more accurately estimated; and they are very seldom if ever dangerous. Each animal draws somewhat more than a fluidrachm of blood on the average, and leechers generally estimate two fluidounces to the dozen. Both kinds, however, are uncertain; as the quantity taken varies not only with the state of the worms, but also with that of the part to which they are applied; highly vascular tissues, and those in which the vessels are congested through irritation or inflammation, bleeding much more freely than those in the opposite condition. On the whole, I generally prefer the American leech, and always for infants. The bleeding from the bites of these animals may almost always be arrested by pressure. When this cannot be conveniently applied with any considerable force, I have found the bleeding invariably checked by a small piece of raw cotton, thoroughly wetted with a saturated solution of alum in hot water, just before the solution has begun to crystallize on cooling, and then pressed upon the wound, so that some of the liquid may enter it. The officinal solution of subsulphate of iron (Monsel's solution) is also an efficient haemostatic in such cases.