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leged, idiopathic be different from traumatic inflammation.

If the so-called pneumonia, following upon chest wounds, be of the true inflammatory type, excessive depletion would, even then, be of doubtful propriety, as an excess of fibrine is not much affected by copious bleeding, even when frequently repeated ; and the red corpuscles are certainly lessened in number, rendering exudation easier, and as Travers, at page 59, says, “ We cannot prevent inflammation by bleeding before its advent." This is an observation made by an acute observer, and without reference to a preconceived theory. Let us see how it is practically, but unintentionally, proved. The following case is reported by Dr. McLeod in the Edinburgh Monthly Journal, vol. ii, page 54: - A soldier of the Buffs was wounded on the 8th of September by a ball which entered his chest on a level with, but external to, his right nipple. The ball was lost. Profuse hæmoptysis, fainting, great dyspnea, oozing of blood from the wound, and the escape of air followed. He was largely bled, and his symptoms were thereby greatly alleviated. Ten hours afterwards, a return of the dyspnea called for further depletion and the use of antimony. Pneumonia followed, and the lower half of the lung was seriously implicated.”

The italics are by the author of this Treatise. No further commentary is necessary to show that bleeding will not prevent pneumonia. Case No. 10, reported by the same gentleman at page 197, leads to the same conclusion. Marshall Hall says, on the subject of bleeding, in a paper read before the Medico-Chirurgical Society on the 23rd of November, 1824, and published in the 13th vol. of Transactions : “ The symptoms of exhaustion with reaction have, I am persuaded, frequently been mistaken for those of inflammation. Under this impression, recourse has frequently been had to the further detraction of blood by the lancet, and the effect of this practice is such as greatly to impose upon the inexperienced: the symptoms relieved are those of reaction."


A passage in No. 1, page 177, of Copland's Dictionary, bears closely upon this subject, but it is too long to transcribe; also Carpenter, at page 134, speaks to the same opinion. There can be no doubt that this reaction is generally “asthenic,” or, in other words, the effects of the previous de. pletion.

Connected with this subject-viz. whether venesection is always necessary in cases of chest wounds - is the important question, but which can be only most cursorily dealt with here, whether there is a change in the type of disease, or, in the words of Sydenham, the “ constitutio morborum stationaria”, or whether there is an actual and progressive change in the constitution of the mass of mankind, which, in the treatment of alterations from a state of health, requires the employment of stimulative, and the avoidance of depletive, measures : or whether, as Dr. Bennett says, our improved knowledge of physical diagnosis has taught us to recognise, with greater accuracy, the advent of inflammatory action.

If our improved means of diagnosis be the sole reason for the change of treatment which has arisen within the past thirty years, taking pneumonia as “le cheval de bataille”, how comes it, that, in those inflammatory affections, for the detection of which no “improved knowledge of diagnosis” is claimed, viz. “ cerebritis”, “peritonitis”, s cystitis”, etc., etc., venesection has been found in the present cycle to be equally inimical ?

Dr. Markham has recently promulgated peculiar opinions on this subject. I am not prepared to endorse the general principle propounded by him, that venesection is useful, only so far as it relieves cardiac congestion. In the illustration that this prolonged cardiac congestion explains the benefit of venesection in wounds of the lung, he assumes, like many writers, as a fact that which is very problematical. If a lung, or lungs, are thrown out of use, and consequently a diminished quantity of blood passing through it or them, the right side of the heart cannot become congested, because there is a lessened quantity of blood being poured into it; and, therefore, according to Dr. Markham, venesection relieves an evil which is not present.

. It has been said that bleeding lessens the necessity

for decarbonation ; also the number of inspirations. I can give no opinion as to the former, but I am certain that the latter statement is incorrect.

So far as the data contained in this Treatise will warrant a conclusion, it would appear that pneumonia is very infrequent in wounds of the chest. Even if it were a common sequence, there would still be grave doubts as to the propriety of practising the large and repeated bleedings, so strongly recommended by the writers quoted. Statistics have failed to show the great benefit of depletion: indeed, they show the contrary. In the DirectorGeneral's Report, it is shewn that, out of eight fatal cases, two were bled, and these died the most rapidly of all. In the Crimea many of the wounded men were just in the condition in which only asthenic diseases, such as a low or typhoid form of pneumonia, could arise. This low inflammatory type characterized the progress of all classes of wounds in the Crimea, as shewn by Dr. Matthew ; also by Mr. George Lawson, in his very interesting paper on “Gun-shot Wounds of the Thorax”. I am gratified to observe that the observations of both those gentlemen have led them to conclusions nearly, and in some cases entirely, similar to those I have formed. This agreement of opinion, arrived at under similar circumstances, with similar data, and a total absence of all collusive views, has greatly strengthened my statements. Under such


an anæmic condition of system, it is certain that venesection will act upon the injured organs with an effect proportioned to their impaired “ vis vitæ :" and, although after venesection there may be less blood circulating, there will be, in an equal ratio, less power of resistance to morbid actions; and a greater evil, viz. “irrecoverable exhaustion”, will arise, than if there were more blood and more strength.

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