= Solution
\b[An 1867 answer would distinguish general depletion to relieve a supposed dangerous circulatory overload from local depletion intended to relieve a circumscribed inflammatory condition.] General <bloodletting> meant opening a <vein> by <venesection>. Local <bloodletting> meant <medicinal leeches> or <wet cupping>; ordinary dry cupping did not remove <blood>. In <wet cupping>, superficial incisions and a partially evacuated cup withdrew <blood> from the <skin>. The apparatus and the quantity removed mattered: a supposedly local procedure could still produce substantial systemic <blood loss>.
In the period's vocabulary, a robust person with an early “sthenic” attack, a strong full <pulse>, severe oppression of breathing and an apparently engorged <lung> might be considered for general <bloodletting>. The intention was to lessen vascular distension and the work imposed on the <heart>, or to arrest an advancing <inflammation>. Local <bloodletting> over a painful region was intended to moderate local <inflammation> without the full depletion of <venesection>. These were therapeutic theories, not proof that <blood> beneath the <skin> drained an inflamed organ selectively. A contemporary account of <pneumonia> explicitly preferred early <bloodletting> in severe “sthenic” cases and distinguished them from debilitated “asthenic” cases.<On the Treatment of Pneumonia by Alexander Smith>[1866, pp. 23–29, distinctions between sthenic and asthenic cases and indications for early bloodletting]{ref}
Even within that framework, the decision needed the stage of illness, previous <blood loss>, age, general strength and response to any previous depletion. A weak rapid <pulse>, pallor, faintness or exhausted convalescence argued against further <bloodletting>. “There is <fever>” or “the <blood> looks inflammatory” was not an adequate indication. A hot flushed face alone could not establish excess circulating volume. The period evidence also needs scrutiny: selecting the most severe cases for <bloodletting>, then comparing their recovery with mild unbled cases, confounds treatment with initial severity. The reported recoveries establish what was done; they do not isolate its causal effect.<On the Treatment of Pneumonia by Alexander Smith>[1866, pp. 4–9, allocation by clinical severity and comparison of treatment periods]{ref}
\b[Modern correction: remove <blood> only for a defined indication, not to treat ordinary <fever>, <pneumonia> or a presumed surplus of “inflammatory” <blood>.] In <haemochromatosis>, controlled <venesection> removes <iron> contained in <red blood cells>; repeated replacement of those <red blood cells> draws down the body's <iron> stores. The amount and frequency depend on <haemoglobin> and <ferritin> monitoring.<Treatment of Hemochromatosis by NIDDK>[Phlebotomy; adjustment of frequency using iron and ferritin levels]{ref} In <polycythaemia vera>, <venesection> reduces excessive <red blood cell> mass and the associated risk of <thrombosis>.<Polycythemia vera by MedlinePlus>[Treatment; reduction of blood thickness and clotting risk]{ref} These measurable targets are different from the historical idea of “plethora”. In an exhausted person, indiscriminate <bloodletting> can worsen <anaemia> and circulatory failure; modern care identifies and treats the cause of the <respiratory distress> or <inflammation> instead.
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