The disuse to which the abstraction of blood has fallen of late years becomes more and more noticeable each year, and in this country it probably never was so seldom had recourse to as it is at the  present time.  From inquiries made at several of the large dispensing houses in Liverpool, I find that the demand for leeches has dwindled down to a mere tithe of what it was ten years ago. At most of the hospitals and dispensaries they are so rarely required, that they are not kept in stock at all, but sent for when ordered. As for cupping and bleeding from the arm, they are never heard of now.

It may therefore be doing good service if it can be shown that there are certain cases in which the abstraction of blood is not only a successful mode of treatment, but that there is not any other which can be substituted for it with equal benefit. The following cases show the mistake which will be made if  blood-letting is altogether lost sight of or omitted from our therapeutics.

Case 1 - Cook with headache and pain in an eye

A cook, aged 28, residing at Southport, exposed to great heat. For three weeks  she had suffered from constant headache, with pain in the ball of the right eye, the sight of the eye being much affected. She took purgatives and applied cold bread poultices to the eye.

Feeling no better, she came to me, December 30th, 1869. I found she could with difficulty decipher No. 19 Jäger’s types with the right eye, and only No. 10 with the left. The latter eye presented no external abnormal appearances, but the right had a slight patch of ecchymosis under the conjunctiva, upon the outer side,  and the pupil was more dilated than that of the left.

Ophthalmoscopic appearances: extreme vascularity of the optic disc of right eye, amounting to a redness, which appeared uniform with the adjoining choroid, and the vessels of the retina largely dilated.

The treatment: four leeches to the right temple, a shade over the eyes, and an evaporating lotion to the forehead. She was also ordered to avoid the heat and glare of the fire. On the 6th of January the leeches were repeated. An improvement took place immediately after the first leeches were applied. She said that it seemed as if the bleeding lifted off a cloud from her eyes. At the end of a fortnight the pain in the head was gone, and the vision completely restored.

Case 2 -Married woman with rapidly failing sight

M.G., aged 38, married, residing at Chester, consulted me on February 3. Had good sight up to a fortnight previously, since then vision had rapidly failed, so that at consultation it was found she could not decipher No. 20 Jäger with the left eye, and No. 18 but indistinctly with the right. She had constant pain and weight in the head and temples, and sick feeling at the stomach. Her face and forehead were flushed, and tongue coated. Externally there was nothing observable about the eyes, beyond the pupils being somewhat dilated and immovable. No suffusion, photophobia, or lachrymation.  The ophthalmoscopic appearances were the same in both eyes. The optic disc swollen, small extravasations of the blood on the vessels of the retina, and hyperaemic condition of the latter.

The treatment: four leeches to each temple, purgative medicine, and cooling lotion to the forehead.

Upon her return at the end of a week there was marked improvement, and she stated that the relief given by the leeches had been immediate. She was told to continue the lotion, the low diet, and the medicine. During the following week, not finding the improvement in vision to be progressive, she applied six more leeches. At the end of a fortnight I saw her again; she was now able to read No. 2 of the types with either eye, the pupils acting much more freely, and the pain of the head was gone. I saw her for the last time on March 14th, finding that she was quite well and sight completely restored.

The ophthalmic vein would have obtained a diminished supply of blood in the cases related, had not there existed an overplus upon which it could draw, and so remove, whilst the current was in abeyance.

How can this temporary diminution of the supply, be productive of any permanent change in the part? My answer, relies on the rapidity of absorption, such that the vis mediatrix naturae quickly works up the surplusage of raw material, and so readjusts the balance, if we aid and abet her by lessening, even for a short time, the supply, provided that it is merely a condition of excessive vascularity, and no great structural changes have occurred.