2. Vascular irritation or Active Congestion. The same indications exist here as in positive inflammation, of which, indeed, active congestion is often the immediate antecedent, and may be considered as the forming stage. in most cases of this kind, however, the affection is so slight as not to require the loss of blood, yielding either spontaneously, or to abstinence and a saline cathartic. But there are cases attended with great danger, which require the most prompt and efficient interference; and in such cases bleeding is the most effectual remedy. it often, indeed, affords immediate relief, operating more rapidly than even in established inflammation; as, from its nature, the affection is less fixed and more readily curable. The condition calling for the use of the lancet is such an amount of active congestion as to threaten injury to the organ from pressure, or to endanger hemorrhage; especially in important organs, as the liver, lungs, or brain. in active congestion of the brain, either attended with apoplectic symptoms, or threatening apoplectic effusion, prompt bleeding is very important, carried to any extent which may be required to reduce the force of the pulse. The quantity which it is often necessary to abstract is very large, in consequence of the abnormal pressure made on the cerebral centres. in active congestion of the lungs, moreover, the danger is sometimes imminent of immediate suffocation from effusion of serous fluid or of blood; and the remedy scarcely less imperiously called for. A similar condition of the liver is less dangerous, as the organ admits of great distension without fatal results; and the remark is still more applicable to the spleen; but, in either, there is sometimes a call for the use of the lancet.

Hemorrhages are often nothing more than a result of vascular irritation or active congestion of the bleeding tissue; and, in all such cases, the lancet is indicated when the checking of the hemorrhage is strongly called for, and the state of the pulse permits. in milder cases of the same kind, cupping over the affected organ is all that may be required.

Fevers afford examples of high vascular excitement; but simply for the state of fever bleeding is seldom indicated. The affection when idiopathic is generally a result of some agency which the loss of blood has no power to remove or control, and will continue steadily onward, no matter what amount of blood may be withdrawn, short of a fatal result. The pulse may be diminished in fulness and force, and the general strength may be prostrated; but the fever continues with no abatement of its real violence, though some of its phenomena may be partially suppressed. There are, however, two circumstances which, in febrile affections, render the lancet advisable or necessary. When the fever is symptomatic of a special inflammation or vascular irritation, bleeding is often called for in reference to the local disease; upon the cessation or abatement of which the fever also ceases or abates. Very often, too, the febrile movement causes, or is attended with local inflammations or determinations of blood, Which endanger the safety of some important organ, while, by reacting on the system, they may tend to increase the fever.

Here venesection is indicated, precisely as it is in similar affections occurring independently of the fever. Local determinations of the kind referred to are extremely common in fevers, especially to the head, lungs, and stomach; and, when general bleeding may not seem to be required, the application of cups or leeches to the organ affected is often extremely useful. This, then, is the general rule for the employment of bleeding in fevers; namely, that it is to be resorted to not directly for the relief of the fever itself, but for the abatement or cure of any local inflammation, or vascular irritation, which may be either the cause of the fever, an incidental attendant upon it, or an effect.

3. Nervous irritation. When this is dependent on an abnormal vascular excitement of the nervous centres, or is connected with active congestion or inflammation of the part in which the nervous disorder is exhibited, bleeding may generally be employed with good effect; though, as in the conditions before referred to, the violence of the affection may not be such as to require it. All convulsive diseases and painful spasms may be ranked in this category, under the circumstances mentioned. in eclampsia, bleeding is often extremely serviceable, and sometimes necessary to save life by controlling cerebral excitement. in spasm of the rima glottidis, with irritation of the laryngeal membrane, constituting croup in children, it is often necessary. Spasms of the heart, stomach, bowels, biliary passages, ureter, bladder, and uterus, call for it when associated with a similar state of the tissues, in which they are respectively situated. The same may be said of mania, and all other nervous disorders. But great care must be taken not to confound these affections with the very similar ones proceeding from pure nervous irritation, without active congestion or inflammation, or from positive debility or depression of the nervous centres; in which cases tonics and stimulants are required, and not the lancet.

4. To Awaken Susceptibility in the Cerebral Centres. in cases of poisoning by one of the stimulating narcotics, as opium or belladonna, the brain is rendered so insensible by the poison, that it cannot duly feel impressions made upon other organs. it is highly important to evacuate the poison, and sometimes emetics are the only means to which we can have recourse. But, in the state of insensibility referred to, these medicines will often fail to operate. Bleeding is here indicated, if the pulse permit, to diminish the cerebral congestion, and thus for a time restore such a degree of susceptibility, as may enable the brain to feel the impression of the medicine, and send the requisite influence to the parts concerned in the act of vomiting.