From the time of Sydenham, who was a strong advocate for blood-letting in this disease, up to a recent period, it has been considered not only a rational, but a necessary and successful mode of treating Acute Rheumatism, to abstract blood at the outset of the attack, and even to repeat it when the pain was great, and the inflammatory symptoms of a severe character. Drs. Barlow,* Budd, Hope. Watson,§ &c, have employed and recommended its use. Dr. R. B. Todd,* however, was one of the first who raised objections to its employment. He stated that it was fraught with the most dangerous consequences, that it was most uncertain in its effects, that it increased the danger of internal effusions, that it predisposed to Endocarditis and Pericarditis, that violent delirium more frequently attended its employment, and that it very much increased the tendency to the chronic state. Although, it appears to me, the ill effects attributed by Dr. Todd to the practice of bloodletting in Acute Rheumatism are too highly coloured, yet it is certain that its indiscriminate use, as formerly in vogue, has been the cause of much mischief in certain cases. As in other instances, much discretion is necessary in the selection of cases in which it is applicable.

* Cyc. Pract. Med , vol. iii. Lib. of Med., vol. v. p. 200.

On Diseases of the Heart, 3rd Ed., p. 179. § Lectures, vol. ii. p. 678.

3018. In Hydrophobia, blood-letting has been extensively employed, but with very doubtful success. It is recommended by Mead, Boerhaave, Fothergill, Nugent, Ferriar, Innes, Shoolbred, and others; but cases in which it was fairly tried and signally failed, are related by Rutherford, Troillet, Parry, and Bosquillon. Although occasionally useful, no dependence should be placed upon it as a remedy. Dr. Bennett,t however, observes, that from the published results of this plan of treatment, when employed at an early stage of this disease, it appears to be more beneficial than any other; and in certain cases, where the vascular excitement is much increased and the constitution robust, it may be adopted with every hope of success.

3019. In Tetanus, in the earliest stage, when the patient is of a full habit, the wound swollen, inflamed, and painful, Dr. Dickson recommends a full blood-letting, with purgatives and other antiphlogistic remedies, as the means the best calculated to allay the general and local irritation. During the Peninsular War it was extensively employed, and Sir James M'Grigor§; states that, in some cases, it was productive of decidedly good effect. Bleeding, however, should not be carried to any great extent, more relief having been derived from cupping along the course of the spine. It is more useful in idiopathic than in traumatic Tetanus; but even in these, it is only applicable in the earliest stage. Sir Astley Cooper|| regarded it as hurtful. It appears to be in every respect inferior to Chloroform or Cannabis. Cases successfully treated by copious blood-letting are recorded by Pelletier, ¶ Lisfranc,** Larrey. and others.

* Med. Gaz., Oct. 4, 1848.

Lib. of Med., vol. ii. p. 260.

* Med.-Chir. Trans, vol. vii. part ii. § Ibid., vol. vi. p. 455.

|| Surgical Essays, part ii p. 190, et seq.

¶ Revue Med., 1827. ** Dict, de Med. et Chir. Pract.,

Mem. de Med. et Chir. Militaire, t. xxxiv.

3020. Cataplasms, or Poultices, are external applications of a soft pap-like consistence, and are rendered anodyne, emollient, stimulant, or antiseptic, according to the ingredients employed in their formation. A simple poultice acts chiefly by virtue of its warmth and moisture. The various kinds of poultices have been considered in the first part of this work, under the headings of the respective articles which form the principal or active ingredients. They prove of great service in promoting the suppurative process in abscesses and ulcerations, and in wounds and inflamed surfaces generally.

3021. Cathartics, or Purgatives, are medicines which increase the quantity or number of the alvine evacuations. Those which are violent in their operation are called drastics; those which produce copious watery stools, hydragogues; and those which act mildly, aperients or laxatives.

The objects for which they are employed. 1. To remove crude matters or accumulated faeces from the intestines. 2. To act as derivatives, by draining off much of the serous portion of the blood. 3. To excite increased biliary secretion. 4. To stimulate the action of the absorbents in all parts of the body. 5. To promote the discharge of other secretions; thus, the previous use of purgatives often apparently promotes the action of diuretics. (Alison.*) 6. To affect remote organs, on the principle of revulsion or counter-irritation; e. g. Croton Oil, in cerebral affections. 7. To act indirectly as emmenagogues, by stimulating the various pelvic vessels and nerves.