I read with interest Dr. Ober's informative and entertaining paper [1]. Although the medical practices of the 19th century, particularly as viewed through the acerbic wit of Mark Twain, appear crude and often dangerous, it seems inappropriate to state that "Nineteenth century medicine was as stagnant as it was toxic; therapeutic bloodletting had been championed in James' Medicinal Dictionary of 1743, and it was still being strongly advocated in 1892 by William Osler." In a broad sense, the therapeutics of the 19th century saw the discovery of emetine, chloral, pilocarpine, antipyrine, ephedrine, suprarenal extract, general anesthesia, antisepsis, and radiation therapy-hardly a stagnant period! Phlebotomy is currently used to treat polycythemia, hemochromatosis, and porphyria.

William Osler's advocacy of venesection is somewhat overstated. Osler recognized the abuses of this technique when he wrote on pneumonia [2]:

"In many cases the question comes up at the onset as to the propriety of venesection. The reproach of Van Helmont, that ‘a bloody Moloch presides in the chairs of medicine,’ cannot be brought against the present generation of physicians. During the first five decades of this century, the profession bled too much, but during the last decades we have certainly bled too little."

In 1898, in his textbook, he quoted P.C.A. Louis's seminal attack on bloodletting in pneumonia but continued to advocate the practice [3].

Interestingly, Osler, when offered James's Medicinal Dictionary by a bookseller in 1910, wrote that "... the James Dictionary I do not care for, the only important thing about it now is that Johnson wrote the Preface" [4]. Although Samuel Johnson had a hand in the book, modern scholars do not agree that he wrote the preface.

As Mark Twain said, "It were not best that we should all think alike; it is difference of opinion that makes horse races" [5].