1. For ordinary cases, the veins at the bend of the elbow, the basilic or median-basilic, are generally preferred; but the jugular vein in children, and the temporal artery in adul3ts, are preferable in some cerebral affections, and the veins of the foot in apoplexy, &c.

2. The very young, the old, and the feeble do not bear bloodletting so well as those in youth or middle life.

3. Inhabitants of large cities bear blood-letting badly, compared with country people whose occupations are chiefly outdoor.

4. Persons predisposed to Phthisis, Scrofula, and Scurvy, bear the abstraction of blood badly.

5. Very fat persons will seldom bear any great loss of blood; fatal syncope has followed the abstraction of even small quantities in these cases.

6. In persons affected with chronic disease of the heart, valves, or large vessels, the sudden abstraction of a large quantity of blood has been followed by fatal consequences.

7. Except Under Pressing Circumstances, Never Bleed A Woman Whilst Menstruating

8. Never bleed an hysterical woman, however severe the attack may appear, until antispasmodics, opium, the cold douche, &c., have been previously employed.

9. Bleed cautiously an habitual drunkard, or a person habituated to much spirituous or vinous liquors; delirium tremens, and other serious nervous affections, have followed a full and rapid abstraction of blood in such cases.

* Outlines of Pathology, p. 231. On Diseases of the Heart, p. 532.

10. Bleed Cautiously A Long Resident In A Tropical Country

11. Repeated blood-lettings are highly objectionable, inasmuch as they tend to produce disease of the heart, and great nervous derangement.

12. In chronic diseases, blood should be drawn chronically; that is, in small quantities, whilst the patient is in the recumbent posture. Topical blood-letting is generally preferable in these cases.

13. Larger bleedings are required in inflammation of serous membranes than in that of mucous surfaces, or in that of the parenchyma or substance of an organ.

14. A Moderate Loss Of Blood At The Commencement Of An inflammation is more effectual than a much larger one at an advanced period of the disease. When inflammation clearly exists, you cannot bleed too early. This particularly applies to tropical diseases.

15. Never bleed in anticipation of an attack of inflammation; wait till it manifests itself. (Travers.)

16. Never continue the use of the lancet until the blood ceases to exhibit signs of inflammation. Remember that there is a line beyond which the practice becomes destructive instead of remedial. (Travers.)

17. Make the character of the pulse, its hardness or softness, your guide, in preference to its quickness, which is a most fallacious guide. The pulse in Phrenitis is slower than natural, and rises under the abstraction of blood; the small contracted wiry pulse of Peritonitis becomes stronger and fuller; and the pulse of parenchymatous inflammation becomes, under the same circumstances, lower and weaker.

18. The feelings of the patient are a good guide for the regulation of the quantity to be abstracted. Relief of pain, and a feeling of faintness, are indications that sufficient has been drawn.

19. If the blood flows slowly, and in a small stream at first, and afterwards more freely and abundantly, it is an indication for allowing the blood to flow on.

20. In acute inflammation abstract blood from a large orifice, the patient being placed in an upright position. A few ounces thus taken are more effectual than three times the quantity taken slowly, whilst the patient is in a recumbent posture.

21. Place but little reliance on the cupped and buffed appearance of the blood, as a sign of inflammation; extraneous circumstances often induce this appearance.

22. If the quantity of crassamentum be very small compared with that of the serum, it may, in the majority of cases, be looked upon as a contra-indication to further blood-letting.

23. In very acute inflammation of important viscera, it is advisable to join topical with general bleeding.

24. In any case of acute inflammation, if we place the patient upright, and bleed to incipient syncope, we abstract precisely the quantity of blood which the patient will bear, and which the disease requires to be drawn. (Marshall Hall.)

25. The colour of the blood should be carefully observed: if it present the proper venous hue, or, if previously livid, it become less so during its abstraction, and assume a natural colour, it is indicative of the propriety of blood-letting in that case.

26. Blood-letting should not be adopted in any disease when a tendency to typhus evidences itself.

27. The tolerance of blood-letting varies remarkably in certain diseases; so much so, that Dr. Marshall Hall suggests a scale, showing those in which this tolerance is either augmented or diminished, compared with the system in health. "It would begin," he says, "with congestion of the head or tendency to apoplexy; inflammation of serous membranes, and of the parenchymatous substance of various organs, would follow; then acute anasarca, and, lastly, inflammation of the mucous membranes. This part of the scale would be divided from the next by the condition of the system in health. Below this would be arranged fever, the effects of intestinal irritation, some cases of delirium, reaction from loss of blood, and disorders of the same class with Dyspepsia, Chlorosis, and Cholera Morbus." He assumes the degree of tolerance of blood-letting in health to be 15 oz.

Contra-indications. 1. Advanced stages of typhus and typhoid fevers. 2. Anaemia. 3. Chlorosis. 4. Phagedenic ulceration and gangrene. 5. Some forms of atonic Dyspepsia.