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BLOOD-LETTING. There are certain morbid conditions when a patient may obtain marked relief from the abstraction of a certain amount of blood, from three or four ounces up to twenty or even thirty in extreme cases. This may be effected by venesection, or the application of leeches, or more rarely by cupping (q.v.). Unfortunately, in years gone by, blood-letting was used to such excess, as a cure for almost every known disease, that public opinion is now extremely opposed to it. In certain pathological conditions, however, it brings relief and saves life when no other means would act with sufficient promptness to take its place.

Venesection, in which the blood is usually withdrawn from the median-basilic vein of the arm, has the disadvantage that it can only be performed by the medical man, and that the patient’s friends are generally very much opposed to the idea. But the public are not nearly so prejudiced against the use of leeches; and as the nurse in charge can be instructed to use these if occasion arises, this is the form of blood-letting usually practised to-day. From one to twelve leeches are applied at the time, the average leech withdrawing some two drachms of blood. Should this prove insufficient, as much again can be abstracted by the immediate application of hot fomentations to the wounds. They should always be applied over some bony prominence, that pressure may be effectively used to stop the haemorrhage afterwards. They should never be placed over superficial veins, or where there is much loose subcutaneous tissue. If, as is often the case, there is any difficulty in making them bite, the skin should be pricked at the desired spot with the point of a sterilized needle, and the leech will then attach itself without further trouble. Also they must be left to fall off of their own accord, the nurse never dragging them forcibly off. If cold and pressure fail to stop the subsequent haemorrhage, a little powdered alum or other styptic may be inserted in the wound. The following are the main indications for their use, though in some cases they are better replaced by venesection, (1) For stagnation of blood on the right side of the heart with constant dyspnoea, cyanosis, &c. In acute lung disease, the sudden obstruction to the passage of blood through the lungs throws such an increased strain on the right ventricle that it may dilate to the verge of paralysis; but by lessening the total volume of blood, the heart’s work is lightened for a time, and the danger at the moment tided over. This is a condition frequently met with in the early stages of acute pneumonia, pleurisy and bronchitis, when the obstruction is in the lungs, the heart being normal. But the same result is also met with as a result of failure of compensation with back pressure in certain forms of heart disease (q.v.). (2) To lower arterial tension. In the early stages of cerebral haemorrhage (before coma has supervened), when the heart is working vigorously and the tension of the pulse is high, a timely venesection may lead to arrest of the haemorrhage by lowering the blood pressure and so giving the blood in the ruptured vessel an opportunity to coagulate. (3) In various convulsive attacks, as in acute uraemia.