Transcriber’s Note:
The cover image was created by the transcriber and is placed in the public domain.
Certainly it is excellent discipline for an author to feel that he must say all he has to say in thefewest possible words, or his reader is sure to skip them; and in the plainest possible words, or hisreader will certainly misunderstand them. Generally, also, a downright fact may be told in a plainway; and we want downright facts at present more than any thing else.—Ruskin.
When I began looking into medical books preparatory to practice,fifty years ago, the standard authors given us to read were not backwardin recommending blood-letting in the acute diseases; and a littlelater, when an attendant at lectures at the College of Physicians andSurgeons at New York, the professors were not lacking with the likeadvice. But there has come a change, and so much of a change that,in this section of country at least, the lancet has mostly gone out of use.That the frequent use to which it was put seventy-five or a hundredyears ago was not at all times wise is likely; but the extent to which ithas been given up is also not wise. Rather more to notice some of thereasons why it has so largely been abandoned than to argue for a reintroductionof that ready and efficient instrument is the purpose ofthis paper.
A prominent point in the consideration of this comparative abandonmentof the lancet is presented in the question: Has there beensuch a change in the type of the acute inflammatory diseases fromthree or four generations ago as to render the abstraction of blood lessnecessary and less useful? There are plenty of sound, hard-headed olddoctors who will give a negative reply to this query; and occasionallywe may notice some of them putting themselves in print to that effect.A Baltimore practitioner not so very long ago said: “The necessity forthe use of the lancet is as great at the present time as it ever was in the86past; the type of the disease has undergone no such changes as torender the abstraction of blood unnecessary or improper in the successfulmanagement of all cases attended with a full, tense, and quickpulse.” Others speak the like; but the majority of opinion is not pronouncedin that direction, but rather adverse. Conversations duringa forty-four years’ practice with men who began their professional callingsixty years ago, when the lancet was in often call, is to the importthat there has been such a change in diseases as renders the frequentresort to blood-letting less important than formerly; that there is lessof the sthenic type in even inflammatory fevers, a more general dispositionto take on what we call typhoid forms, and thus depletion, eitherby the evacuation of blood or the exhibition of reducing drugs, is notso beneficial in even the acute inflammatory diseases as formerly. This isthe view that has been entertained by a large part of those w