1. inflammations. As an antiphlogistic measure, the loss of blood holds a position far above any other agent; and it is in this capacity, moreover, that it exercises the most beneficial therapeutic influence. it may be said to be always indicated in the earlier stages of inflammation, and, indeed, to a greater or less extent, throughout the process, so long as it is attended with an excess of vascular action; and should be abstained from only upon the grounds, that the affection may be so mild as not to require it, or that there may be a coexisting state of system which may afford indications against it, stronger than those of the inflammation itself in its favour.

In inflammation there is an excess of blood in the affected part, sustaining and augmenting the irritation which first called it thither; there is an exalted or irritated state of the nervous constituent of the tissue; and there is frequently an abnormally excitant condition of the blood itself. To lessen the quantity of blood in the part, to diminish the stimulant quality of that blood, and to lower the nervous exaltation of the inflamed tissue, are the obvious indications. Nothing meets these so efficaciously as bleeding. in relation to the first indication, not only does it lessen the whole mass, and consequently thus far proportionably the quantity entering the inflamed part, but it diminishes the force with which the heart propels the blood, and thus meets the same end by lessening the rapidity of the current. As before explained, it has a powerful agency in diluting the blood, and consequently diminishing its stimulant properties, thus fulfilling the second of the indications mentioned. Lastly, by its direct sedative influence on the nervous centres, it lessens nervous irritation of the part, and meets the third and only remaining indication. No substance is equally efficient for all these purposes; and experience constantly offers its results in proof of the correctness of the reasoning.

But so powerful an agent must not be used indiscriminately. Many cases of inflammation are so slight as not to require this or any other remedy; and many yield to milder measures, as to saline purgatives, low diet, etc., so that it may with propriety be dispensed with. But it should be omitted in no case, not offering some decided contraindication, in which the disease is so severe as to threaten serious consequences, or so situated as to occasion reasonable apprehensions of danger on this score. Thus, we may omit bleeding in inflammation of the tonsils of a degree of violence in which it would be all - important to employ it, were the affection seated in the meninges of the brain, or in the peritoneum.

It is commonly within the first three days after an attack of inflammation that general bleeding should be used. if the case has been under our care from the commencement, we can generally, within that time, do all that is required in this way. One single full bleeding, pushed until the pulse begins to flag, or the lips to look pale, will very often be all that is required. But not unfrequently a second may be demanded, and sometimes, though rarely, a third. if called to the patient at a somewhat advanced period of the disease, there are few points in practice, upon which it is more difficult to come to a satisfactory conclusion, than in reference to the propriety of general bleeding. The safest rule, I believe, is still to bleed, if the pulse has strength enough to allow it, provided the inflammation has not begun to abate, or suppuration has not taken place. if suppuration has set in, it will seldom be proper to take blood from the arm. The same may be said of that condition in which the patient sweats profusely whenever he sleeps, without showing any special tendency to perspiration when awake. This indicates a degree of debility which forbids depletion by the lancet.

There is a state of inflammation to which it is highly important that attention should be called, in reference to the use of bleeding. in consequence of the extent and extreme violence of the affection, occupying some interior organ or tissue, as the lungs or peritoneum, for example, the blood and nervous force appear to be so concentrated in the diseased part, that all other parts of the system are actually depressed; and, instead of high fever, with a full strong pulse and a hot skin, the patient is often apparently prostrate, with a small pulse, a pale and cool surface, and general collapse. it is of the utmost consequence that this apparent prostration be not mistaken for real debility. The use of stimulant measures instead of the lancet would probably prove fatal; and it is only from the latter remedy that, in some cases, safety can be hoped for. The condition can generally be recognized, if it be remembered that it occurs in the early stage and greatest violence of the inflammation, and is attended with unmistakable signs of a high degree of this affection. When a vein is opened, the blood may at first flow slowly and reluctantly; but the current soon increases, and at length becomes quite as rapid as under ordinary circumstances; while the pulse, instead of being further depressed, is developed under the operation, and often becomes full and strong. The bleeding should be continued until the pulse again begins to flag, not now under oppression, but from real weakness. in some cases of the kind, the pulse does not rise, and the blood withdrawn seems still further to weaken it. in such a condition, efforts should be made, by means of the hot bath and rubefacients, to call the blood to the surface, and in some measure unload the inflamed part; after which the lancet, if again tried, may be found to succeed most happily. Somewhat analogous is that state of depression of pulse and skin which often attends inflammation of the cerebral substance, and sometimes mucous gastritis; in the former case, depending on a failure of the normal influence from the diseased nervous centre upon the circulation, and in the latter on the depressing influence of the nausea so common in inflammation of the stomach. in both, the lancet should be used irrespective of the pulse, which will generally be found to rise under it.