The Expletive Method Blood-letting

Categories: TREATMENT OF SCARLET-FEVER.
Sources: 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

Charybdis.