18           YANDELL on Spasmodic Cholera.

  In giving the treatment in the different stages of cholera,
I have not yet spoken of blood-letting. The reason is, that
I had but little experience of its utility. I saw some cases,
generally in the hands of others, in which I now feel con-
vinced it would have been useful, and it gives me pleasure to
add, that a number of the practitionersof the city report most
favorably of it. Dr. Pawling, who practised extensively
in the disease in Harrodsburg, as well as in this place, in-
forms me that he resorted to it with manifest advantage. The
pulse was generally so far from indicating an inflammatory
condition, that many practitioners felt a very natural repug-
nance to its use, perhaps overlooking, that there are other
morbid states in which it is equally demanded. It cannot
be doubted from the general testimony of the profession,
that it is one of the remedies upon which, judiciously em-
ployed, reliance should be placed in the treatment of chole-
ra. At the same time, it is admitted by those who have had
extensive experience of it, that the patient occasionally
grows weaker under its operation, and that, therefore, if re-
sorted to indiscriminately, it may do mischief. If the pulse
struggles, the effect of it is to give it freedom; if it is feeble
and indistinct, it sometimes increases its fulness and force.
This is the end always desired, and if not accomplished, the
abstraction of a portion of blood from the already dimin-
ished quantity in circulation, only adds to the exhaustion of
the patient. And hence the impression of the bleeding must
be carefully observed, and if the pulse is found to become
more feeble, and the anxiety and restlessness of the patient
to increase, the vein must be closed. Where the effect is sal-
utary, the load about the heart is removed, the general an-
guish mitigated, and the operationof medicine rendered more
prompt and beneficial.
  in conjunction with blood-letting, leeches and cupping over
the epigastrium are conceded to be remedies indicated in
cases where there is much nausea, or irritability of stomach.
And some practitioners apply blisters to the same region in
the earliest stage of the disease, with the effect, as is thought,