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The Expletive Method Blood-letting
Category: TREATMENT OF SCARLET-FEVER.
Source: Hydriatic Treatment Of Scarlet Fever In Its Different Forms
has been advocated by some of the best authorities, and there cannot be
a doubt but that it must have rendered good service in cases of violent
reaction, or else men like de Haen, Wendt, Willan, Morton, Alcock,
Dewees, Dawson, Dewar, Hammond, &c., would not have pronounced
themselves in favor of it. However it requires nice discrimination and a
great deal of experience, as in any case where it does no good it is apt
to do a great deal of harm, by weakening the patient and thus depriving
him of that power which he so much needs in struggling against the enemy
invading his system. Besides, the expletive method has found many
antagonists of weight: Simon, Williams, Tweedie, Allison and others have
shown the danger of a general and indiscriminate use of it. Williams,
in his comparison of the epidemics of scarlatina from 1763 to 1834, has
come to the conclusion that the possibility of a cure in cases of
blood-letting, compared with the cases where the patients have not been
bled, is like 1:4; i. e. four patients have died after blood-letting,
when only one died without bleeding. "Experience has equally shown, says
Dr. Allison, that the expectation entertained by Dr. Armstrong and
others, that by early depletion the congestive or malignant form of the
disease may be made to assume the more healthy form of inflammation and
fever, is hardly ever realized; and in many cases, although the pulse
has been full and the eruption florid in the beginning, _blood-letting
(even local blood-letting) has been followed by a rapid change of the
fever to a typhoid type, and manifestly aggravated the danger_."--My own
experience would prompt me to declare myself against blood-letting in
general, even if I had not a sufficient quantity of water at hand to
manage the violent or irregular reaction of a case. Blood-letting, in
any case of eruptive fever, and with few exceptions in almost every
other case, appears to me like pulling down the house to extinguish the
fire. A little experience in hydriatics, a few buckets of water, with a
couple of linen sheets and blankets, will answer all the indications and
remove the danger without sending the patient from Scylla into
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