Accepting the mathematical dictum as correct that the power expended in each contraction of the heart is equivalent to supporting a column of water 9 ft. in height, it must be apparent that when this force is applied over seventy times in a minute a very little congestion of the portal system will call from the living engine increased work and much expenditure of fuel. The necessity of watching and treating for blood-tension is therefore obvious, and exigencies dictate remedies either mechanical or medicinal. The old school were sadly wanting in exact physiological or chemical knowledge, but they recognised the symptoms of extreme blood-pressure, and the practical as well as immediate relief given by mechanically removing a small quantity of effete or waste blood, and, though they did not understand the how or the why, they thereby did an incalculable amount of good by saving the spleen from being made an enlarged reservoir for the portal blood and so interfering with its other important functions.

I was once pupil to a father and son, the former a moderate believer in venesection, while the son, with the rising school, discarded it. I may have been wrong, but as a looker-on I certainly had a suspicion that the father would sometimes cure with one visit and a venesection what might have required a week or two’s attendance from his painstaking son.

Fifty years previously the system of blood-letting had passed from an occasional to a popular remedy until it came into the ordinary routine of every barber. They had a semicircle cut out of the rim of their basins to fit the arm, and the practice of it was carried out so recklessly that the public, inspired by clever and sensational novelists, rose in their wrath and would have none of it. The profession bowed to the storm, and the members exerted themselves to do indirectly what frequently ought to have been performed without loss of time and in one act – viz., in removing some waste product, relieving the blood-tension. The prejudice became so extreme that I have been told by a hospital surgeon that he thought bleeding might have given a good chance of saving a certain patient, but he was not familiar with it, and in the face of popular opinion he dared not do it.

I have never allowed moral funk or false sentiment to militate against my first duty to a patient, and so I am able to relate three instances in which the saving of a life was most certainly due to bleeding in the first two, and probably in the last.