ABRAHAM JACOBI ON BLOODLETTING IN CHILDREN (1870)

Abstract

In a masterly discourse on the "Antiphlogistic Treatment in Diseases of Children," Jacobi deals with the possible value of bloodletting in children and asks the question, "Are we justified in resorting to depletion at all?" he wrote¹:

It is an established fact, or at least a very general conviction, that when we perform venesection—for the relief of pneumonia or meningitis, for example we do not relieve the pneumonia or the meningitis itself, but we do relieve the collateral edema which has taken place in the tissues as yet uninvaded, or but partially invaded, by the inflammation. And by this relief of the collateral congestion and edema, of the meninges or of the brain, we may save a patient from approaching dissolution. Such cases are rare; but when they occur...we have to deal with acute edema. We then must of course resort to depletion in many a case. I recall a case of convulsions in which I myself opened the jugular vein. I did not know the cause of the convulsion, but the venous congestion was so evident and so extreme, that I was led to relieve it as soon as possible. I think Trousseau relates a similar case. We know that the immediate danger in such cases depends not on the primary cause of the affection, but on the prolonged congestion, which may give rise to effusion or extravasation. To avert these I do not object to venesection—indeed it may become imperative....But to depletion as a general antiphlogistic I must object, and this whether it may made by venesection or by local bloodletting.