they do not accord with the sound practical experience of American physicians, and do not meet the conditions of disease with which we are familiar. I am hopeful that ere long a truly national American system of medical thought and teaching will be developed, which shall be animated by a more practical spirit, and shall embody the results of the broadest and most thorough clinical work.

BLOOD-LETTING AS A THERAPEUTIC MEASURE

IN PNEUMONIA.

By WM. C. WILE, M.D.,

CONNECTICUT.

It is with not a little timidity that I approach the discussion of the subject-substance of this paper, and did I not feel it a positive duty urged on by an actual experience sufficient to warrant the conclusion I have arrived at, I should not have dared to lay myself liable to the certain opposition and criticism it is bound to give rise to before this eminent body. I cannot, in the short time allowed me, enter minutely into the etiology or pathology of pneumonia, nor would it be necessary, for they are familiar to you all; and it would be only needless repetition of facts of which there can be no discussion, therefore I shall confine myself to a therapeutic measure that seems to me to have been too long neglected, but of the greatest curative value; in fact, of more value than all others combined. Briefly, however, I desire to quote from Juergensen, in Ziemssen's Cyclopædia, in reference to the pathological changes that occur in pneumonia during its three stages.

"The first stage is one of congestion, or, in other words, of inflammatory engorgement. The lungs are of a dark red color, heavy, firm, and retain the depression caused by the pressure of fingers, showing little or no air but fluid. On section, the substance is found to be dense, the result of swelling of the tissues and infiltration of a bloody, serous fluid."

"The second stage, hepatization, is marked by a very adhesive, viscons, redddish-brown, secreted fluid. The lung is now internally and externally of a dark brownish-red color, solid, but easily torn, no longer crepitate on being cut, and usually exudes only on pressure, a brownish-red, opaque, bloody serous fluid."

"The third stage is that of purulent infiltration. The cut surface is now of a straw-yellow color, and from it exudes, in large quantity,

a very viscid, purulent fluid, of a faint odor." In short, we have congestion or inflammatory engorgement, hepatization, and purulent infiltration as the three grand pathological changes that occur in pneumonia. The physician is generally called in during the first or congestive stage, or in the earlier part of the second stage, while the rusty colored sputa is being expectorated, and while the lung is engorged with stagnant blood; and it is in this stage of the disease that I firmly believe we have in the lancet, freely and thoroughly applied, no uncertain measure of modifying the whole course of the disease, if not abating it entirely. My mission in this world, through my profession, is to save life, to relieve suffering, to cure disease. I have neither the time nor inclination to run after theories or fancies. I have no particular tenets of my own, to which I must bend all my cases. My ambition is to succeed in curing disease. My modest desire is that I may be a useful member of this noble profession, trying in my humble sphere to perform a sacred duty. Therefore, if I find, from actual experience, a remedy that is valuable for the relief of diseased conditions, were all the world against me, I should still use it. I know that, while I am advocating the use of the lancet, I am treading on dangerous ground; that I am advocating a therapeutic measure which has been relegated to the past; and while I am willing to admit that it, like morphia, chloral, and mercury, has been abused, has done harm, and is spoken of by eminent Gross as the "Lost Art," yet in acute inflammatory disease of the lung, in its early stages, I firmly believe it is a measure of the greatest power for good. The venerable Dr. Hiram Corson, in his s irited articles on Pneumonia in the Phil adelphia Medical and Surgical Reporter, January 15, February 12, March 5, of the current year, made the ringing tones reverberate throughout the whole length and breadth of this great land, attracting the attention of the profession to the importance of this question, viz., the treatment of pneumonia. The number of valuable lives that have been lost in the past, and are every day being sacrificed on the altar of this dread disease is simply appalling, and it is the duty of the profession to halt, and listen, let the tones come from whence they may, be the sources ever so humble which will lead to a more thorough understanding of how and when to successfully treat this malady. The earnest, truthful words in the above articles attracted my serious attention; and knowing the large experience of Dr. Cor

son, and his marked ability as practitioner, I was greatly impressed with what he said. The light began to dawn upon me that if he was right, I was wrong; that many lives had been lost that might have been saved. I determined to give the treatment a fair trial, and with most gratifying results to both myself and my patients. Only a few days after reading the first number of the above paper, I was called to see the following typical case of pneumonia, and I shall proceed to give, in minute details, the history and treatment of this case, as illustrative of the plan I followed in the other cases, which are simply enumerated further on, with the name, age, etc., with results; only noting such exceptions and peculiarities as happened in each individual case. In the enumeration of these cases (thirteen in all), I desire to have it understood that they were not selected. They are just as they came to me in my ordinary daily work, and are all the cases I have had between March 9 and April 12, 1881.

CASE I. John L, aged 24, Irish, mechanic; strong, robust young man, of good habits. On Thursday, March 10, while at work, during the forenoon of the day in question, felt a great lassitude overpowering him. At noon he was so overcome that he was compelled to leave his work and go home. Just before arriving there, he was taken with a severe chill, which lasted nearly one hour. Soon after he was taken with the chill, he experienced a great pain in the left lung, point of intensity being immediately beneath the left nipple. The chill was at once followed by a high fever. I was sent for as soon as he reached home, but being otherwise professionally engaged, I did not see him until 11 o'clock in the evening of the same day, when I found him in the following condition. On inspection, there was apparently great exhaustion; the surface hot and dry; temperature 1021; respiration, short and humid, 32 to the minute. Pulse 132, full and bounding; tongue covered with a thick white. coating; bowels constipated; violent headache, and moaning constantly with the pain in lung and head. Face was flushed and cyanotic; slight cough; no expectoration. On percussion, I found extreme dulness over the whole area of the left lung. On auscultation, I found almost entire absence of the respiratory murmur, and the whole burden of respiration seemed to be thrown upon the other lung. As I was about to finish my examination, he had an attack of coughing, with the result of raising

a small piece of thick, gelatinous mucus, tinged with blood. I made the diagnosis at once of acute pneumonia in the first stage, and advised the abstraction of blood; but, as the family so violently objected, I gave way, much against my will, and giving him a hypodermic injection of bromide of morphia to relieve the pain, and an aconite mixture every two hours, I left him for the night, directing that large poultices should be made to envelop the whole left chest, back and front. Saw him at 8 A. M., March 11; had passed a tolerably comfortable night, under the influence of morphia, and the pain was not so intense. The other symptoms were aggravated. Temperature 1043°; pulse 140; respiration 40 to the minute. He had expectorated, with considerable difficulty, a thick, gelatinous looking substance, streaked with blood throughout; it was so tenacious that you could turn the receptacle into which it was coughed upside down, without its falling out. I notified the family that if I was not allowed to deplete the patient by blood-letting, that I must retire from the case. I was compelled to take this decisive step, because, had I not a severe case of pneumonia on hand? Was this not a fair prototype of the bad cases I had had before? Were not these cases very fatal in this section of Connecticut? Had I not tried aconite, digitalis, veratrum viride, stimulants, etc., in vain, and with the result of a very large percentage of deaths; and, if Dr. Corson and Dr. Gross were right, then the most important thing that I could do to save the man's life was to bleed him, and bleed him freely. This conviction had become so firmly seated, that it amounted to an actual duty which I could not, and dared not, disregard. The result was too momentous to be trifled with; the symptoms all pointed to a grave lesion, and my path was plain. The family finally consented, as I was about to leave the house, and I at once opened the median basilic vein, and bled until my patient complained of fainting, when I desisted, and bandaged the arm. On measuring, I found that I had abstracted twenty-six ounces of blood. At once he experienced great relief. I directed a large blister to be applied to the left side; gave him four pil. cathart. comp. to be taken at once; a teaspoonful of a weak aconite mixture was ordered to be taken every two hours. Saw him at 6 P.M.; was feeling much better and easier; bowels had moved freely; blister was dressed, and pain in side most gone. On placing my ear over the left chest, I could hear the air entering over a considerable area of