Medical Inquiries and Observations. To which is added an Appendix, containing Observations on the Duties of a Physician, and the Methods of improving Medicine. By Benjamin Ruch, M. D. Professor of Chemistry in the University of Pennsylvania. The Second Edition. Philadelphia, printed. London, reprinted for C. Dilly, in the Poultry, MDCCLXXXIX.
An Account of the Effects of Blisters and Bleeding, In the Cure of Obstinate Intermitting Fevers.
The efficacy of these remedies will probably be disputed by every regular-bred physician, who has been a witness of their utility in the above disorder; but it becomes such physicians, before they decide upon this subject, to remember, that many things are true in medicine, as well as other branches of philosophy, which are very improbable.
In all those cases of autumnal intermittents, whether quotidian, tertian, or quartan, in which the bark did not succeed after three or four days trial, I have seldom found it fail after the application of blisters to the wrists.
But in those cases where blisters had been neglected, or applied without effect, and where the disease had been protracted into the wintermonths, I have generally cured it by means of one or two moderate bleedings.
The pulse in those cases is generally full, and sometimes a little hard, and the blood when drawn for the most part appears sizy.
The bark is seldom necessary to prevent the return of the disorder. It is always ineffectual, where bloodletting is indicated. I have known several instances where pounds of this medicine have been taken without effect, in which the loss of ten or twelve ounces of blood has immediately cured the disorder.
How shall we reconcile the practice of bleeding in intermittents, with our modern theories of fever?
May not the long continuance of an intermittent, by debilitating the system, produce such an irritability in the arteries, as to dispose them to the species of inflammatory diathesis which is founded on indirect debility? Or,
May not such congestions be formed in the viscera, as to produce the same species of inflammatory diathesis which occurs in several other inflammatory diseases?
Doctor Cullen has taught us, in his account of chronic hepatitis, that there may be topical affection and inflammatory diathesis, without much pain or fever; and had I not witnessed several cases of this kind, I should have been forced to have believed it possible, not only in this disorder, but in many others, from the facts which were communicated to me by Doctor Michaelis in his visit to Philadelphia in the year 1783.
I once intended to have added to this account of the efficacy of blisters and bleeding in curing obstinate intermittents, testimonies from a number of medical gentlemen, of the success with which they have used them; but these vouchers have become so numerous, that they would swell this essay far beyond the limits I wish to prescribe to it.