for instance, is neither the age nor the pregnant state of the patient, but rather the degree of physical strength. In the case of a youth who is feeble, or of a delicate woman (aside from the question of pregnancy), it would be wrong to draw blood, for it would be robbing them of what little strength they possessed. But, in the case of a vigorous child, a robust old man, or a pregnant woman who is in good health, one need not hesitate to resort to this procedure. Nevertheless, there may arise, in connection with the operation of venesection, a number of questions which are quite likely to puzzle an inexperienced physician and perhaps lead him into error. For example, infants and old people possess as a rule diminished vigor, and the woman who is about to be confined needs all her strength for the period following delivery, both for herself and for the nourishing of the child. But the mere fact that one must give some thought to questions of this nature and must exercise prudence does not justify the immediate rejection of a method of treatment like that of venesection. For is it not the very essence of our art, not merely to consider the factors of age and the pregnant state, but also to form an estimate of that other and more important factor, viz., the patient's strength,—be that patient an infant, an aged person, or a woman advanced in pregnancy,—and then to decide whether it is, or is not, great enough to bear the loss of blood? In deciding a question of this kind it will be necessary to distinguish between real vigor and obesity, between thinness and feebleness, etc.
Venesection is an easy operation for a physician who has already familiarized himself with the manner of performing it, but for one who is ignorant of these details it may prove very difficult. It is necessary, for example, to bear in mind that the artery and vein are united and that they are accompanied by nerves; and, further, that the injuring of the latter will induce spasms and violent pains. On the other hand, it must also not be forgotten that an artery once opened has no disposition to close, nor does it heal, and that sometimes the blood escapes in an impetuous manner. If, perchance, the vein is cut transversely, the edges of the opening contract and no more blood escapes. Again, if the scalpel is plunged into the parts timidly, the skin alone will be divided and the vein will not be opened. In some cases this vessel is so hidden from sight that the physician may experience difficulty in bringing it into view. Thus it will be seen that there are several circumstances which may render this operation difficult for an ignorant or inex-
