In gout of the sanguineous type the favorite remedy of Gilbert was
venesection, pushed to extremes which suggest the bloody theories of
his later confrere Bouillaud. This bloodletting, however, was always
to be practiced on the side opposite to that affected by the disease,
as he tells us, for two reasons: First to solicit the peccant material
to the opposite side; and, second, to retard its course toward the
seat of the swelling. If, therefore, the disease is in the right foot,
he bleeds from the basilic vein, or some of its branches, in the right
hand. No other vein should be taken, but if neither the basilic vein
nor one of its branches can be found, the bleeding may be performed
upon the median vein, for certain branches of the basilic and cephalic
veins unite to form the median. If the disease is in the hand, the
material may be diverted in two ways, either to the other hand or to
the opposite foot. Indeed, blood may be taken from both these parts
in succession. The quantity of blood withdrawn should be in accordance
with the strength of the patient, the character of the swelling, the
pulsation, distention, heat and redness of the affected part. But it
should be repeated frequently, and this bloodletting then frequently
suffices, in itself, to cure the disease.
Gilbert continues: "I will tell you also what I myself saw in a woman
suffering and screaming with pain in her right wrist (_assuere_?),
which was greatly swollen, hot, red and much distended. She was fat,
full-blooded, and before the attack had lived freely on milk and
flesh. Accordingly she was robust, and I bled her from the basilic
vein of the left hand and the saphena of the right foot, both within
an hour. Each hour I withdrew a half-pound of blood, then I fed her
and for three hours I drew half a pound of blood from the saphena. In
the last hour the pain and throbbing (_percussio_) ceased entirely,
and the woman begged me to bleed her again from the hand, for she had
experienced great relief. I wished, however, to divert the material
to the lower extremities for two reasons, one of which I ought not to
mention in this place, while the other is useful, and indeed necessary
in such cases. You should know that this woman was suffering pain in
her left hand also, though this pain was of a less severe character
than in the right. For this reason I desired to divert the peccant
matter downward, a point which the physician should consider and
observe. Once, while treating a man suffering from sanguineous gout,
the pain of which involved the joints between the assuerus and the
racheta (?) of the right hand, I asked him whether any pain was felt
in the other hand or in the feet. He replied that similar pain was
felt in the left hand or its joints, and that hitherto it had been
more severe, but that no pain had ever been experienced in the feet.
Hence I was unwilling to bleed him at all from the left hand, but I
bled him from the right foot. A physician who had treated him before,
Public-domain text, read in full here on John Shaqi.
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