Journal of the New Zealand Medical Association, 16-December-2005, Vol 118 No 1227
This extract comes from a speech read before the Wellington Division, B.M.A., by W. Kington Fyffe, M.D., M. R. C. P, and published in the New Zealand Medical Journal 1905, Volume 4 (18), p308–9.
Now, the list remedy that they so invariably employed is one that it behoves us to see if we employ enough—I mean venesection, or bleeding. Their object in bleeding, of course, was the outcome of the old humoral pathology, that by letting blood they would get rid of the vicioushumours from the body, and hence effect a cure.
More modern pathology has consigned that idea to the limbo of the rubbish-heap; but, though the theory is wrong, is the practice wrong in given cases? As in the old days, many lives were lost by too generous a system of venesection, I venture to think, nowadays, not a few lives have been lost by the modern practitioner being afraid to use that form of treatment.
Any one who has been a resident house surgeon in a hospital must have noticed how very much better scalp-wounds do where there has been free bleeding than where the haemorrhage has been scanty.. In the latter, cellulitis is common; in the former, uncommon. Why this should be so I am unable to say; but as a fact of experience I think you will bear the statement out.
In pneumonia in a plethoric big man, bleeding, even in the early stages, will do good. In the late stages, when the right ventricle is engorged, there is no doubt that bleeding has saved life; and in such cases the physiological action is perfectly plain.. I admit it requires pluck on the part of the medical practitioner where a patient’s respirations are 64, perhaps, and he is delirious, with a very high temperature, to bleed him; but if he be much cyanosed, and the right ventricle is failing, with the first sound of thee heart almost gone, in most oases venesection should, if the administration of oxygen fail, be tried. Again, in certain heart cases where cyanosis and dilatation of the right ventricle are the main symptoms, bleeding should be carried out.
I was called about a week ago to see a girl of sixteen, who appeared to be at the point of death; she was extremely cyanosed, the heart was working with the utmost difficulty—the action slow and extremely irregular; the right ventricle much dilated; dulness extending 2 in. to the right of the sternum; and a loud, systolic murmur at the apex. With great difficulty I got permission to try venesection, and, had she died, no doubt I should have been held liable for her death; but, happily, the effect of removal of 16 oz. of blood was magical, and she is now convalescent. I may add that when I bleed I make a practice of giving a dose of digitalin first. There is yet one other class of case where venesection is of the utmost value, and that is where convulsions persist, and the patient is practically in the status epilepticus.
I remember seeing, when I first came here, a young man of twenty-five with mild scarlet fever. On the tenth day he developed nephritis, with blood, casts, and scanty urine. He rapidly passed into a uraemic condition, with violent convulsions. I purged and sweated him thoroughly, and in order to allay the convulsions I put him under chloroform. As long he was deeply under, the convulsions ceased; but the moment the drug was relaxed they came on again. I then bled him freely from the right arm, taking away 25 oz. of blood. The result was that he never had another convulsion, and he made a rapid recovery.
NZMJ Note: See http://www.pbs.org/wnet/redgold/basics/bloodlettinghistory.html for the history of bloodletting.
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