Change of type in disease : the address in medicine, delivered at the thirty-third annual meeting of the British Medical Association, held in Leamington, August 1865 / by William Stokes.

  • Stokes, William
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Change of type in disease : the address in medicine, delivered at the thirty-third annual meeting of the British Medical Association, held in Leamington, August 1865 / by William Stokes. Source: Wellcome Collection.

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    flammatory reaction in many cases; and it is a curious fact that this was sometimes seen at its high¬ est pitch in the relapses, when it was often far more violent and dangerous than in the first attack. Local bleeding was largely employed. In many cases, vene¬ section or arteriotomy had excellent results; so that, although there were abundance of cases with prostra¬ tion, and others marked by the typhoid condition, the old sthenic character had not disappeared. The amount of wine used at that time in hospital was quite insignificant as compared with its consumption for the last twenty or twenty-five years. In Dublin, at least, this epidemic passed into one of intermitting fever ; and it was then that I ventured on testing the nature of the practice recommended by Dr. Mack¬ intosh of bleeding in the cold stage. The result of the experiment was against the use of the lancet; but I mention it, as indicating the time when it may be said that venesection was abandoned in our wards. Thus, between 1822 and 1828, the sthenic charac¬ ter of essential and of local disease existed, and the lancet was freely used, often, as I believe, and as I have elsewhere stated, with too great free¬ dom ; but I well remember observing the frequent occurrence of the phenomena mentioned by Dr. Christison—the vehement action of the heart, the incompressibility of the pulse, the vivid redness of the venous blood, and the force with which it spouted, almost per saltum, from the orifice in the vein. I have myself taken as much as sixty ounces in a case of active congestion of the brain, with hemi¬ plegia, before any impression was made on the arte¬ rial excitement: in this case, complete success fol¬ lowed. In rheumatic fever, too, we found the use of the lancet in the early stage of the disease to be pro¬ ductive of great relief. Venesection was seldom used more than once; but its effect was to shorten the duration of the disease, to lower the fever, to lessen the liability to the so-called metastases, and to render the whole case much more amenable to treatment. But I have not bled in rheumatic fever for the last
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