Volume 7

The cyclopædia of practical medicine. Comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc. etc / Edited by John Forbes, Alexander Tweedie, John Conolly.

Date:
1833-1835
Catalogue details

Licence: Public Domain Mark

Credit: The cyclopædia of practical medicine. Comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc. etc / Edited by John Forbes, Alexander Tweedie, John Conolly. Source: Wellcome Collection.

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    General Washington died within twenty-four hours of the commencement of his illness ; and we cannot deny that in this supposed case of croup, the remedies employed, however justi- fiable in the then state of medical information, probably shortened the general’s life. If bleed- ing fails to subdue an inflammatory disease, it will be hurtful “ by depressing the power by which the muscles act ;” and on the vigorous action of the muscles which expand the chest, depends a continuance of that struggle by which the lungs are supplied with air sufficient for the arterialization of the blood. We acquire a juster view of laryngitis by contrasting that disease with croup. They are both truly inflammatory diseases, but in that point alone do they resemble each _ other. Croup is a disease occurring before puberty, generally affecting, not merely the larynx, but ‘the whole of the bronchial membrane, ending in an effusion of lymph on the free surface of the membrane, to be cured, probably, in ninety- nine cases of a hundred, by emetics and bleed- ing timely employed ; and it is a disease in which a surgical operation will only add to the danger, to which in the second stage the patient is exposed. Laryngitis, on the other hand, is a disease which rarely occurs before puberty ; is confined to the upper extremity of the wind- pipe ; ends in a serous effusion into the cellular tissue beneath the mucous membrane; will probably terminate unfavourably in a great majority of cases under any method of treat- ment, in which emetics aggravate the danger and bleeding is often a doubtful remedy, and in which, when the patient is in extremis, bronchotomy will afford the only reasonable hope of safety. Bloodletting has been successfully practised in this disease, as the reader may be convinced by several recorded cases: for example, by a case to be found in a paper on laryngitis, published by Dr. Beck of New York, in the twelfth number of Dr. Beck’s Journal. The case occurred in the person of Dr. Francis, one of the editors of the journal, who, having for three days had soreness of the fauces and thirst, was attacked with pain, difficulty of breathing and swallowing, and a sense of strangulation, for which symptoms 152 ounces of blood were ab- stracted.* For three or four days after, the patient was still in a precarious condition, and required a repetition of the bloodletting. Other cases are published, in which the lancet was successfully employed: in one of these, to be found in the sixth volume of the Medico-Chirurgical Trans- actions, viz. that of Sir J. Macnamara Hayes, as reported by Dr. Roberts of Bishop Stratford, we learn that the first bleeding “ was attended with considerable relief,” the second “ with manifest advantage,” by the third “ his safety appeared to be ensured.” In the case of a young woman who earned a pittance by gather- ing cockles on the strand at ebb-tide, and afterwards hawking them through the streets of * On the 17th Nov. 1823, V.S. ad xl.; evening, 3xx. 18th Nov. 3xvi.; evening, 3xvi. {9th Nov. 3xvi.; evening, 3xvi. 20th Nov. 3xvi. 22d Nov. 3xii,—Total Zclii. 23 Dublin, who, on the 13th of July 1813, pre- sented herself at the county of Dublin Infir- mary on the second day of laryngitis, pale, scarcely able to articulate or swallow, the effort producing a convulsion as when a crumb enters the windpipe, the voice sounding as if she were throttled, inspiration being slower than natural and sibilous, the following treat- ment proved successful. At noon, she was bled ad deliquium, which by the way had nearly proved fatal. The venesection was repeated twice in the course of the evening. On the following day respiration was rendered difficult hy tbe least exertion; hitherto unable to swal- low. She was again bled, and a purgative enema and blister prescribed. Next day she began to expectorate yellow mucus, and could swallow fluids. On the 16th July convalescent. It is observable that the lividity of com- plexion which, especially in the more advanced stages of laryngitis, arises from imperfect arte- rialization of the blood, did not exist in any of these cases. On the other hand, bloodletting has been unsuccessfully practised in laryngitis, not only in the case of General Washington, but also in many others. In the second attack of laryngitis, that to which Sir John Hayes fell a victim, he was three times bled from the arm on the second day of his illness, and the result of his case and the other cases reported by Dr. Baillie, in which also blood- letting was practised, led Dr. Baillie to affirm that ‘ venesection, even when employed stre- nuously and early, was of no real use.” But the most remarkable instance of the inefficacy of bloodletting may be found in Dr. Arm- strong’s Practical Illustrations of Typhous Fe- ver, p. 393. The loss of one hundred and sixty ounces of blood within six hours gave temporary respite to the difficulty of breathing, yet was so far from arresting the inflammation that death took place within twenty-four hours. As, then, there are cases in which bloodletting is salutary, and cases in which itis hurtful, let us try to ascertain when and to what extent that remedy ought to be practised; and let us be permitted to premise that cases will occur in which it may be difficult to come to a satis- factory conclusion with respect to bloodletting— in which the considerations for and against that remedy will be balanced, so as to make the most skilful and experienced physician pause. In such a dilemma, however, it will be well that the physician should not allow his doubts to transpire; as doubts which may be the result of an accurate weighing of indications against contra-indications, and which prove that he is a pathologist, will, perhaps, by the world and by his unreflecting brethren, be thought to proceed from inexperience and perplexity. We conclude, first, that bloodletting will be more clearly indicated in youth than in age: it may be observed that the same means by which Sir John Hayes was relieved during his first attack which took place in the meridian of life, failed fifteen years after :—and, secondly, that we may bleed with most hopes of success when the symptoms of inflammatory fever are