the swelling on the right hand.  Again, suppose in the liver or in the right kidney an acute tumor, and in the joints of the right hand there is present a moderate pain.  I say that we ought first to medicate the more dangerous lesion, and, possibly, two results may be obtained by the attraction of the peccant material.  Or suppose a woman has gout in her hand, and with this a suppression of the menstrual flow.  I say she ought to be bled from the foot and not from the hand for two objects, to solicit the material from the diseased hand, and to provoke a return of the menstrual discharge.

“But to return to our original patient.  I may say that after the third venesection, with an interval of two hours, I withdrew a half-pound of blood from the saphena vein, and that night she slept, although she had not slept for many nights.  And I did nothing more, except to prescribe a light and cool diet.  The third day after the bleeding she was entirely free from any trouble in her hand.  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.”

The vigorous plan of treatment thus outlined Gilbert seems to regard as original and peculiar to himself, for the next chapter bears the title, “The treatment of gout according to the authorities (secundum magistros).”  Here he says he quotes the opinions of the modern teachers and writers, who lay down definite rules for the guidance of the physicians.

Among these he mentions, as primary and of general application, the rule that, before all things, the body must be purified, either by venesection in cases where the material is sanguineous, or by purgation in other varieties of the disease.  If the cause is rheumatic in its nature, fomentations should never be employed, for fear of increasing the flux.  That the peccant material is to be eliminated gradually by mild remedies, just as it accumulated by degrees.  In all cases of gout, and in all chronic diseases generally, much attention must be devoted to the stomach, since if this organ rejects the medicine, the latter must be at once abandoned, lest the stomach becomes weakened and even other organs, and thus the humors flow more readily (magis reumatizarent) to the joints, etc.

These general medical rules are succeeded by some twenty pages devoted largely to special formulae for the different forms of gout, with remarks as to their applicability to the different varieties of the disease.  Most of the formulae bear special titles, apparently to lend the weight of a famous name to the virtues of the prescription itself, something as in these modern days we speak of “Coxe’s Hive Syrup,” “Dover’s Powder,” “Tully’s Powder,” etc.  Thus we read of the “Pilulae