The first remedy that I shall mention for reducing great morbid action in the blood-vessels and viscera, is blood-letting. I was first taught the safety of this remedy in the gout by reading the works of Dr. Lister, above thirty years ago, and I have used it ever since with great advantage. It has the sanction of Dr. Hoffman, Dr. Cullen, and many others of the first names in medicine in its favour.
The usual objections to bleeding as a remedy, have been urged with more success in the gout, than in any other disease. It has been forbidden, because the gout is said to be a disease of debility. This is an error. Debility is not a disease. It is only its predisposing cause. Disease is preternatural strength in the state of the system now under consideration, occasioned by the abstraction of excitement from one part, and the accumulation of it in another part of the body. Every argument in favour of bleeding in a pleurisy applies in the present instance, for they both depend upon the same kind of morbid action in the blood-vessels. Bleeding acts moreover alike in both cases by abstracting the excess of excitement from the blood-vessels, and restoring its natural and healthy equality to every part of the system.
It has been further said, that bleeding disposes to more frequent returns of the gout. This objection to the lancet has been urged by Dr. Sydenham, who was misled in his opinion of it, by his theory of the disease being the offspring of morbific matter. The assertion is unfounded, for bleeding in a fit of the gout has no such effect, provided the remedies to be mentioned hereafter are used to prevent it. But a fit of the gout is not singular in its disposition to recur after being once cured. The rheumatism, the pleurisy, and the intermitting fever are all equally disposed to return when persons are exposed to their remote and exciting causes, and yet we do not upon this account consider them as incurable diseases, nor do we abstain from the usual remedies which cure them.
The inflammatory or violent state of the gout is said most commonly to affect the limbs. But this is far from being the case. It frequently makes its first attack upon the head, lungs, kidneys, stomach, and bowels. The remedies for expelling it from the stomach and bowels are generally of a stimulating nature. They are as improper in full habits, and in the recent state of the disease, as cordials are to drive the small-pox from the vitals to the skin. Hundreds have been destroyed by them. Bleeding in these cases affords the same speedy and certain relief that it does in removing pain from the stomach and bowels in the first stage of the yellow fever. Colonel Miles owes his life to the loss of 60 ounces of blood in an attack of the gout in his bowels, in the winter of 1795, and major Butler derived the same benefit from the loss of near 30 ounces, in an attack of the gout in his stomach in the spring of 1798.
I could add many more instances of the efficacy of the lancet in the gout when it affects the viscera, from my own experience, but I prefer mentioning one only from sir John Floyer, which is more striking than any I have met with in its favour. He tells us, sir Henry Coningsby was much disposed to the palsy from the gout when he was 30 years old. By frequent bleedings, and the use of the cold bath, he recovered, and lived to be 88. During his old age, he was bled every three months.
I have said, in the history of the symptoms of the gout, that it sometimes appeared in the form of a hectic fever. I have prescribed occasional bleedings in a case of this kind accompanied with a tense pulse, with the happiest effects. It confined the disease for several years wholly to the blood-vessels, and it bid fair in time to eradicate it from the system.
The state of the pulse, as described in another place[61], should govern the use of the lancet in this disease. Bleeding is required as much in its depressed, as in its full and chorded state. Colonel Miles's pulse, at the time he suffered from the gout in his bowels, was scarcely perceptible. It did not rise till after a second or third bleeding.
Some advantage may be derived from examining the blood. I have once known it to be dissolved; but for the most part I have observed it, with Dr. Lister, to be covered with the buffy coat of common inflammation.
The arguments made use of in favour of bleeding in the diseases of old people in a former volume, apply with equal force to its use in the gout. The inflammatory state of this disease frequently occurs in the decline of life, and bleeding is as much indicated in such cases as in any other inflammatory fever. The late Dr. Chovet died with an inflammation in his liver from gout, in the 86th year of his age. He was twice bled, and his blood each time was covered with a buffy coat.