It may appear singular, that among the means of lessening heat, or removing topical congestion, we have omitted bleeding in all its forms. The consideration was postponed to introduce it in this place, where the whole subject may be more advantageously considered in one view.

Bleeding has been a general remedy for fevers of every kind; and when the increased action is so violent as to threaten the rupture of a vessel, this evacuation is essentially necessary: it is equally so, when with, or soon after the attack of a fever, with inflammatory symptoms, local inflammation appears. Here then we would stop, did not the conduct of some practitioners in every fever, and of some respectable ones, in fevers highly asthenic, suggest to us that our limits are too narrowly restricted. Sydenham recommended bleeding in the early stages of every fever; and we are told by almost every practical author first to take off some blood; occasionally limited to patients in the prime of life, to robust constitutions, or to fevers from cold. Yet we find Dr. Dover bleeding in a highly putrid fever, not only in the commencement, but in the progress: the older surgeons have employed this remedy with little apprehension in a highly asthenic fever, the puerperal; Dr. Rush bleeds repeatedly in the yellow fever; Dr. Moseley and Dr. Jackson in similar fevers, in the West Indies, employed the same remedy. Must we condemn the practice of physicians so respectable, or must we resign all the pathological views we have attempted to inculcate ? We will do neither; but may, by the way, inculcate an useful lesson: that empiricism- for such we will venture to style it - with a happy boldness will sometimes succeed, by means which the timid dogmatist will scarcely dare to follow.

Modern practitioners have taken blood to moderate the increased action, and to prevent accidents from its violence when the vessels are weak. In this way, by ineffectually employing an active remedy, they have injured by debilitating, while they have only imperfectly moderated the stimulus which they attempted to oppose. The physicians mentioned, if they had any views, employed it with different ones. If the practice of each author be examined, it will be found that they bled when the system was over loaded with the accumulated fluids from the surface; and they bled boldly, because it was necessary to relieve each part: and the quantity drawn from the arm can affect each according only to the proportion of the whole mass which it receives. We have stated, in many parts of this work, with a view to this subject, and particularly in the article of Blisters, q. v. the effects of only a slight evacuation in relieving distended vessels; effects not only derived from the diminished quantity, but from the spring this relief imparts to the muscular fibres. Whoever reads Dr. Dover's animated, but somewhat quaint, description of the case, in which he succeded so completely, will at once see that bleeding could have relieved only in the way we have explained; and Dr. Rush's descriptions strongly elucidate the same ideas. Mr. Coleman, in his work on suspended animation, has recorded a fact which illustrates our explanation; as he found, that taking blood from the jugulars restored the action of the right side of the heart, which was suspended from distention.

If general bleeding then be useful, itmust be in cases where the internal congestion is considerable, and where, from distention, the irritability of the muscular fibres of the internal vessels is for a time suspended. It will not be difficult for the experienced practitioners to distinguish this situation; and we would recommend extreme caution in this respect to the less experienced, who are, in general, too fond of the lancet.

Whatever may be the opinion of general bleeding, topical evacuations of blood have been employed to remove internal congestions. Blisters and purgatives best relieve those which occur in the abdominal viscera; but to the head, besides blisters, leeches are applied: and cupping glasses, with previous scarifications, to the neck. These are remedies which many are fond of: but, except in sudden attacks of phrenitic delirium, which sometimes come on in the progress of fever, we have found little room for evacuations of blood.

To sum up the whole of this intricate subject, the general practice of bleeding at the commencement of every fever appears highly improper. If not certainly from cold, if the patient is not in the prime of life, and if no topical inflammation apparently impends, it should certainly be avoided. In some of the worst fevers, pains in the limbs, we have said, occasionally appear on the attack, and sometimes in the progress. These should be carefully distinguished from true inflammatory ones. The reigning epidemic, the symptoms of general "debility, the period of life, and the apparent cause, will assist the distinction. The features afford an excellent criterion. If these are sunk, and the character of the countenance lost in a greater degree than can be expected from the duration of the disease, general bleeding should be avoided. Even topical bleeding we would not particularly recommend, unless the congestion appear inflammatory. Blisters will supply its place more safely.

3. To support the strength.-this indication, apparently the most obvious and necessary, is not easily followed. Bark is a tonic; and bark has been given in profusion, with little discrimination, and with most decided injury. If, by the prudent and judicious use of the medicines already described, we can lessen the congestions in the liver and the head; if we can preserve the strength by the due regulation of temperature, and support it, after the first days, by more nourishing broths and jellies; we shall find little opportunity for administering tonics. Let us repeat, that the largest doses of bark and wine will not so effectually give strength and spirits as two or three loose motions; and no cordial will be so refreshing as free cool air. If at the conclusion bark must be given, it should be in the inefficient forms of the decoction and tincture.