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When venesection is not indicated in certain conditions of low blood pressure and heart failure, ergot has saved life. It causes contraction of the blood vessels and seems to tone the heart. Incidentally it quiets the central nervous system. If the blood pressure is much increased by it, the ergot should not be repeated, as too much work should not be thrown on the heart muscle.
On a figure given in the curious old work of John de Ketam, no less than thirty-eight separate places are marked as the proper ones to bleed from, in different diseases. Even Louis, who had not wholly given up venesection, used now and then to order that a patient suffering from headache should be bled in the foot, in preference to any other part.
After repeated venesection, and other common applications, she was directed to immerse her whole head into a pail of water, which was made colder by the addition of several handfuls of salt, and the hæmorrhage immediately ceased, and returned no more; but her pulse continued hard, and she was necessitated to lose blood from the arm on the succeeding day.
He at first gazed wildly upon the still suspended body, so painfully recalled to life by the rough venesection of the hangman and the subsequent friction of anointing his body to prevent the adhesion of the plaster. “You need not fear now,” said Dr. Carnell; “I assure you he is dead.” “But he was alive, surely!”
The other two, who were both young men, had still pain and strength sufficient for further venesection, and they neither of them had any appearance of hernia, both recovered by repeated bleeding, and a scruple of calomel given to one, and half a dram to the other, in very small pills: the usual means of clysters, and purges joined with opiates, had been in vain attempted.
Hence I say that we ought in such cases to begin our treatment by venesection." After this sanguinary introduction, Gilbert soothes the diseased part with cooling and astringent ointments, unless these occasion pain, in which event he omits them entirely and trusts the case to nature, "quoniam natura per se curabit."
If the emergency is excessively urgent, the lungs filling up with blood, moist rales beginning to occur, and frothy and blood-tinged sputum being coughed up, venesection may be indicated; combined with proper hypodermic medication it may save life, and does at times. In fact, a patient who shows every sign of fatal cardiac collapse may be saved.
Of course, it owes much to earlier writers on medicine, and especially to Paul of Ægina. An example of its practical value is to be found in his description of the treatment of a wound of the brachial artery, when, as happened often in venesection from the median basilic vein, it was injured through carelessness or inadvertence.
In the third book other remedial measures, dietetic, manipulative, and even operative, are suggested. In these are included venesection, the opening of an artery, cupping, leeches, and the like. The fourth and fifth books take up hygiene, special dietetics, and general pathology. In the sixth book what the Germans call special pathology and therapy begins with the diseases of the head.
In other words, as the arteries grow older the force of the heart slightly lessens, the blood pressure lowers, and the individual is safer. This frequently occurs in otherwise perfectly normal individuals, without treatment. When the blood pressure is suddenly excessively high from any cause, venesection may be life saving, and should perhaps be more frequently done than it is.
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