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In the early nineteenth century adults with good health from the country districts of England were bled as regularly as they went to market;3 this was considered to be preventive medicine. In earlier times specific veins were described as heart veins, breast veins, and head veins. Buchan's4 DOMESTIC MEDICINE discussed this in the 1784 edition. Buchan realized that since systemic blood made a full circuit, little significance should be placed on the site chosen for venesection. The median basilic vein was the site most frequently used.

The term antiphlogistic means to counteract inflammation. Redness, heat, and swelling were considered the abnormal responses to be treated. With infection, the formation of laudable pus was thought to be an essential part of healing. It was not appreciated that these responses represented an attempt by the body to counteract bacterial infection; this discovery came later. Our current efforts to treat cancer without understanding the underlying etiologic factors will someday no doubt appear just as illogical. Bloodletting counteracted the redness, heat, and swelling by relieving the vascular congestion. The following quotation comes from Watson and Condie's5 PRACTICE OF PHYSIC in 1858.

The main object of general blood letting is to diminish the whole quantity of blood in the system, and thus to lessen the force of the heart's action. The object of local bleeding is, in most instances, that of emptying the gorged and loaded capillaries of the inflammed part. Sometimes the blood is thus taken directly from the turgid vessels themselves; more often, I fancy, topical bloodletting produces its effect by diverting the flow of blood from the affected part, and giving it a new direction, and so indirectly relieving the inflammatory congestion.

 

Watson goes on to state, "I cannot too strongly inculcate the precept that in order to extinguish or check acute inflammation, you must above all bleed early." An indication for bleeding in acute inflammation was a hard pulse of 90 to 120 beats per minute, which was measured by the resistance that the pulse of the artery made to the pressure of the examiner's fingers. Rapid bleeding by venesection with the patient standing was advised. It was surmised that the early onset of faintness and softness of pulse was beneficial. Slow bleeding with the patient supine led to more blood loss before the soft pulse and faintness developed, which was thought to be undesirable. Blood losses averaged 16 to 30 oz. Sufficient bleeding had occurred when the fever subsided, the pulse had become soft, or suppuration had developed.

Variations of the concept of body balance persisted until the end of the nineteenth century. Most physicians of that century believed that illness was due to either an excess or deficiency of some body product. Cathartics were used to reduce an over-excited nervous system by cleansing the bowels. Diuretics were used to restore systemic balance. Tonics were used to stimulate a depressed nervous system. Bloodletting allowed the physician to reduce body fluids and decrease body temperature. The febrile patient with a full pulse, red skin, and agitated state could be rendered pale and cool. The physician concluded that this represented clinical improvement