A large number of cups and leeches may produce the systemic effects of a general bleeding. But, as a rule, these applications are intended to withdraw blood from the affected part, and thus act in the manner entitled revulsive. The local irritation caused by cups and leeches must, through the agency of the nervous system, affect distant parts in the same manner as other counter-irritants.

Leeches are preferable to cups when the parts are very sensitive or inaccessible. The quantity of blood drawn can be more accurately measured when cups are used. The counter-irritant effects are much more pronounced from cups than from leeches.

The amount of blood drawn by a leech will depend on its size, and the subsequent loss of blood, when the bleeding is encouraged, is determined by the vascularity of the part. As a general rule it may be stated that a leech will draw about four times its own weight—about one to two drachms. To obtain from any given patient four ounces of blood, one ounce of leeches must be applied.

In acute gastric, enteric, and peritoneal inflammations, if the patient be plethoric, and there is decided sthenic reaction, leeches to the abdomen are very serviceable. The number to be applied will always depend on the effect to be produced, employing the rules given above as the basis of the estimate. In typhlitis and perityphlitis, the author has seen such good results produced by leeches, that he holds they should never be omitted when the tenderness and fever begin. In acute hepatitis and congestion of the liver, and in acute dysentery, the best results are obtained by the application of leeches to the margin of the anus. Haemorrhoids that are swollen, painful, and irreducible without great suffering, are much relieved by the application of leeches directly to them. Pruritus of the anus, when due to engorgement of the portal circulation, and accompanied by heat of the anal region, may sometimes be cured by leeching the parts affected.

Acute desquamative nephritis, pyelitis, and congestion of the kidneys, are ameliorated by the application of cups to the lumbar region.

The following acute affections of the respiratory organs, when they occur in robust persons, and are accompanied by sthenic reaction, are favorably influenced in their course and duration by the application of cups or leeches—usually the former: pleuritis, pericarditis, acute tonsillitis, acute laryngitis, and inflammatory croup.

In acute inflammations of the uterus and its appendages, decisively good results are obtained by the application of leeches to the hypogastric region, to the iliac fossae, or to the uterus.

Cupping the nape of the neck, or leeches to the mastoid process, are probably of service in acute congestion or inflammation of the intracranial structures; but the indiscriminate employment of bloodletting in any case of cerebral disease is to be condemned. The correct rule may be formulated as follows: When bloodletting is indicated in intracranial maladies, venesection or arteriotomy (temporal artery) is to be preferred to the use of cups or leeches.

Although good results are obtained by the local abstraction of blood in the diseases above mentioned, the author must express his conviction that the chief utility of cupping and leeching consists not in the blood withdrawn, but in the derivant and counter-irritant effect which they produce. Dry cups, a mustard-plaster, a turpentine-stupe, or other counter-irritant application, may render the painful process of cupping or leeching unnecessary.