1358

ELEMENTS OF MATERIA MEDICA.

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quently proper to bleed in the recumbent posture: but I hagainst bleeding patients to syncope in this position. j oS s of

I have yet to notice another class of the general effects of tj 1 ® afe inblood, which may be denominated secondary or remote, and wine* 1 rr

no way useful in the treatment of disease. In some cases exceS' ;,i

action occurs, attended with throbbing of the vessels of the f ,r£l ^g 1 i i>’and disorder of the cerebral functions. Examples of this are - ^ 0 )i,women who have suffered severely from uterine hemorrhage. Exb a , ]nwith insufficient re-action, is another remote effect of loss of biotwo cases of infants, I have seen this effect consequent on hen 1 ® 0 tafter a leech bite, terminate fatally. Other secondary or remote et* ^blood-letting are mentioned: they consist principally in disordersensorial functions, marked by delirium, coma, or even amaurosi sM. Hall, op. supra cit.). ^jy, I

Having hitherto described the consequences of bleeding S eIlC [ or gr-in list now refer more particularly to leeching. The constitutioua ^ jjineral effects caused by the application of leeches are best 0 ^ s . el '. e) o’ 1 ,children and delicate females—more especially the former. I 1 ^ o*several occasions, seen infants completely blanched by the apph ca 0 1(1>one or two leeches. Pelletan mentions the case of a child, six V® tlr’who died from the hemorrhage occasioned by six leeches apph ett j e o*chest. Leeching, then, is here, to all intents and purposes, a 3

general blood-letting, arising in part from the powerful influence " 0 n>'

small quantity of blood produces in infants ; and secondly, beca pleech will cause the loss of more blood in them than in adults, oVV t j )e r t ”the greater vascularity of the cutaneous system. It is apparent h’fore, that in the diseases of infants, leeching may, in most c “ a Sfsubstituted for venesection. But in disorders which are rapidly itcroup, opening the jugular vein is undoubtedly to be preferred,is necessary to produce an immediate and powerful effect. A s ^advance in years they become capable of bearing larger evacua jj j;blood; and, therefore, leeching excites a less influential c ^" e f titid ,quite impossible to say at what age venesection ought to be sim-or, in infancy, what number of leeches should be applied; t pik*take away such unequal quantities of blood. These are points t ^gii 1be decided by the practitioner in each case. Here is a tabular s .of the amount of blood which Dr. James Blundell ( Lancet , &

1828, p. 773) has taken from children at different ages :—•

Ages. Quantities.

2 months. 1 oz. to H oz.

4 months. 1J oz. to 2 oz.

8 months. 2 oz. to 3 oz.

12 months. 3 oz. to 4 oz.

18 months. 4 oz. to 5 oz.

3 years. 8 oz. to 10 oz.

6 years. 10 oz. to 12 oz. ,<

s P ei %

But the quantities are exceedingly large, and in most instances t>than you wall find it prudent to abstract. Guersent sa ' S J ilI jinfants up to two years of age, we ought never to draw more t ^ eC tior four ounces of blood in twenty-four hours. (On the sensibleleeches on man, see Yitet, Traite de la Sangs. Med. 1809). . , s of ^

2. The local effects of leeching must now be noticed. The j a "