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all the symptoms of inflammation return; and the general reaction is ascribed entirely, but erroneously, to the return of the inflammation, instead of the latter being imputed to the former, which has re-kindled or exasperated it, when beginning to subside. The consequence is, that another depletion is again prescribed for its removal; and the pa. tient, recollecting the relief it temporarily afforded him, readily consents. Blood is taken to full syncope —again relief is felt — again reaction returns, -and again the local symptoms are re-produced: and thus, large depletion, full syncope, reaction, and the supervention on the original inalady of some or all of the phenomena described above as the consequence of excessive loss of blood, are brought before the practitioner, and he is astonished at the obstinacy, courso, and termination of the disease; which, under such circumstances, generally ends in dropsical effusion u the cavity in which the affected organ is lodged, or in convulsions, or in delirium running into coma, ei'. !n death either from exhaustion or from one of the forecoung states; or more frequently, in partial subsidence of the original malady, and protracted convalescence. Such ar, the consequences which but too often result which I have seen on numerous cases to result, when blood le:ting has been looked to as the only or chief means of cure --- the "sheet anchor" of treatment, as it too frequently has been called and considered during the last twenty years.
The next remarks devoted to bleeding, we shall do our. selves the pleasure, our author the justice, and our readers the profit of quoting some of Prof. Dr. Dunglison's observations, of a practical nature. They are sensible and judicious:
The extent to which blood letting should be carried, in cases of violent internal inflammation, is often a matter of great difficulty with the discriminating, but of no difficulty whatever with the reckless and uninformed. In this state of blissful ignorance, the latter continues to bleed, and consoles himself, when the fatal result has been has. tened— perhaps mainly induced by his agency, that the sufferer has fallen a victim to an incurable malady. Many have laid down a rule, before referred to, that when we have pushed the blood letting to such an extent, and so often, that we are in doubt whether the operation should be repeated, the decision should be in tho affirmative. But with the disposition which prevails so generally - and which prevailed a few years ago to a much greater extent than it does even at present, to bloed without due, con sideration, such a doubt will rarely be felt, without good ground at the same time existing for staying the hand. The argument communly urged for the further abstraction of blood is, that the inflammation manifestly persists, and that it must inevitably destroy, if not arrested; that blood letting is more likely to subdue it than any other therapeutical agent; and that if it should not, the physician will have the consolation of knowing, that he has done
every thing in his power to avert the melancholy termina. tion. Were the abstraction of blood, in all cases, and to any extent, devoid of danger, this method of viewing cha subject might be logical; but mischiefs result from bleeding in these and similar cases, which are fairly referable to the operation, and aro equally serious in their results with the disease for which it may have been employed.
The satisfaction often felt at tho exhibition of energy on the part of the practitioner, is well exemplified by a anocdote which an illustrious native of this country - 110
who had filled the highest office in the gift of: free people, was in the habit of recounting,
Travelling from Virginia toward the north, he rester for the night at a tavern on the road; soon after his arrival at which, the hostess came in from a noighboring house with the females of her family, -all exhibiting, marks of deep distress. He was informed that they haci been witnessing the parting scene of a young friend, who had died of some acute affoction. “ But thank God!" obsorved the contented matron, “every thing was done for him that was possible, for he was bled seven and twenty times."
A most unfortunato circumstance of a similar character took place in Germany, a few years ago, which produced great excitement in the medical world.
Professor Grossi, of middle ago, well known in the literary world in Germany, happened to become diseased with a severe inflammation of the lungs. He was bled nine
times, without any mitigation of pain, or any alleviation in the difficulty of breathing. He died, and to the as. tonishment of all, the post mortem examination did not show, in the least, traces of irritation: all the organs were found perfectly sound and healthy.
The inveterate theoretical bleeder, says Dr. Ticknor, will bleed in the most opposite states of the system; he will bleed to check the circulation when it is too rapid, and to subdue febrile excitement-when the circulation is depressed, he will bleed to restore it, and to increase the heat of the body, when it is below a healthy standard - he draws blood to subdue reaction, and to excite it- he calls bleeding a sedative, and again he says it is a stimulant -- with such a man, bleeding is a sine qua non - it is almost food and drink, and is about equivalent to vomiting and purging it is refrigerant in summer, and calefacient in winter a hobby which he rides, either rough or smooth shod.
The following case, related by Prof. Magendie, specifies particularly the consequences of frequent blood letting, and merits to be noticed :
One of our principal men, well known in the literary world, was subject to frequent attacks of inflammation of the lungs. On an examination, I discovered that sovere inflammatory engorgement of the lungs still existed, though large quantities of blood had been taken.
It could not possibly be supposed, that the frequent return of the malady proceeded from exposing himself too much, to cold. None used, in this respect, more caution than himself.
The cause, it appears to me, must be ascribed to bleeding only, which brought the system into that sickly habit, through debilitating the arterial system, and diminishing the vitality of the blood. *
Leeches. Leeches are not so extensively used in the United States as on the continent of Europe, - especially in France, which may partly be attributed either to the difference of medical doctrines, or to the peculiarities of a national character
There, most maladies are conquered with leeches and diet. Here, according to the prevailing principles, the treatment, in most cases, commences and ends with calomel and jalappa, aloes, rhubarb, scammoneum, tartar emetic, ipec., etc. Those who are favorable to the theory of irri. tation of Broussais, (erroneously called medicine physiologique,) consider leeches indispensible in medical practice : it may be so, to a certain extent, to the practitioner of
*L'un de nos savants les plus celebres fut attaque, il y a quelque tems, de plusieurs pneumonies successives, qui furent combattues par de large saignees; je fus appele pres de lui et je constatai que le poumon etait encore le siege d'un engorgement inflammatoire des plus intenses, malgre les abondants emissions sanguines auquelles on avait eu recours. Et qu'on ne dise pas que le froid dans cette circonstance pouvait avoir quelqu' influence sur ces nombreuses recidives; le malade savait trop combien il lui importait d' eloigner le moindre courant d'air, le plus leger abaissement ou accroissement de temperature. N'est -il pas plulot naturel de supposer que cette tenacite des phenomenes mor. bides, se liait a une alteration de sang produite par les saignees multipliees ?