Venesection

“ Venesection has been recommended and successfully used by some physicians. If the stomach be emptied, and the patient kept roused, as may almost always be done when means are resorted to in time, venesection will be unnecessary. Sometimes, however, when the pulse is full and strong, it may be prudent to withdraw blood ”

“ Nevertheless, there may arise, in connection with the operation of venesection, a number of questions which are quite likely to puzzle an inexperienced physician and perhaps lead him into error. For example, infants and old people possess as a rule diminished vigor, and the woman who is about to be confined needs all her strength for the period following delivery, both for herself and for the nourishing of the child. ”

“ Although the mode of performing venesection be known to everybody, yet, in order that no part of surgery may be omitted, and for the sake of its technical distinctions, it must not be overlooked by us. The first object then in venesection is the evacuation of a fulness of blood. It has been shown that fulness of blood is of a twofold nature: first, with regard to the strength, although the veins do not appear full, in which case those affected soon become weak and enervated, nature not being able to support, as it were, the load ”

“ It appears, however, that this direction obtained less general surgical recognition, but referred principally to blood-letting. Even to this limited extent it implied a high-handed interference with the art of the ancient as well as of the medieval physician; for venesection occupied an entirely different position among therapeutic measures during that period than it does to-day. ”

“ However this may he, there can he no doubt, I think, that life is often lost, or health permanently impaired, by the omission of venesection in cases proper for its use; for by no other means can the morbid changes, incompatible with either, be so effectually arrested and prevented. Observation at the bedside, uninfluenced by theory or prepossession, must guide the judgment in each individual case. ”

“ Venesection carried to a great extent does harm by lessening the restorative powers of the frame. It appears to interrupt the process of adhesion between the pleural surfaces and the steps taken by nature to repair the existing mischief, while it leads the injured structures into a condition favorable for gangrene, or encourages the formation of ill-conditioned purulent effusions. When inflammation has arisen, venesection may be joined with other means to control its excessive action, and to give relief, which it certainly does, to the patient ”

“ The experienced physician well knows the value of this remedy, in the first period or invasion of the phlegmasiæ, and of some fevers called general. He is fully aware, that if he cannot produce by it a decided impression on the malady in the commencement, he is but too often afterwards a prey to doubts and anxieties, wishing to relieve, but unknowing what to attempt. Conceding, however, the power of venesection, in the forming stage of the disease, now under review, so that we by this remedy may control the series of morbid actions in the second period, and diminish the extent of the eruption ”

“ When the colour of the blood is dark, and it is thick in consistence, a larger amount is to be abstracted than when it is thin and of a light colour. He makes the important remark, that bleeding sometimes kindles up a fever. He forbids the bath immediately before the operation, and food or exercise immediately afterwards. When a piece of fat obstructs the flow of blood, he directs that it should be gently pushed aside, but not cut out. (i, 4, 20.)
No author, ancient or modern, has described the modes of performing venesection in all parts of the body more accurately than Albucasis. ”

“ Thus, to give an example from the Arabians, Averrhoes says, our famous physician, Abumeron Avenzoar, states that venesection ought not to be had recourse to until the body is purged, for the veins being emptied of blood attract the crude superfluities. (Collig. vii, 1.) This rule of practice is now too little attended to. In general Celsus holds that the second or third day of a disease is the fittest time for abstracting blood. He forbids bleeding upon the very onset of a fever, which he says is enough to kill a man outright. ”

“ When the menstrual or hemorrhodial discharge is expected, he directs us to bleed less profusely than otherwise. Persons of a hard, sanguine, and compact habit of body are said to bear bleeding best. In practising venesection, he directs the physician to pay more attention to the strength of the patient than to the period of the fever. He is particularly earnest in recommending the use of cold drink: he directs it to be given at the acme of the disease, but not at the commencement. He forbids us to administer it freely when there is obstruction or inflammation of an internal viscus ”

“ The monthly effusion of blood from the uterus or vagina is owing to a torpor of the veins of those membranes in consequence of the defect of venereal stimulus; and in this respect resembles the mucus discharged in the periodical venereal orgasm of the female quadrupeds, which are secluded from the males. The menorrhagia, or continued flow of this discharge, is owing to a continued defect of the venous absorption of the membranes of the uterus or vagina. See Class IV. 2. 4. 7.
M. M. Venesection in small quantity. A cathartic. Then opium, a grain every night. Steel. ”

“ In more advanced ages, if a large portion of intestine has fallen down, and if attended with pain and vomiting, which symptoms generally arise from retention of the fæces, it is clear, he says, that the knife is not applicable, and that the case is to be remedied by other means. He recommends venesection in the arm, the tepid bath, warm cataplasms, and spare diet; but he disapproves of purgatives. This is his treatment of strangulated hernia. When an operation with the scalpel is resolved upon, an incision having been made in the groin down to the middle tunic (tunica vaginalis?) ”

“ He states that persons in extreme heat or cold do not bear bleeding. He mentions that in bleeding from the basilic vein there is danger of wounding the artery, that a nerve lies under the median; but that the cephalic may be opened without danger.
Oribasius gives an interesting dissertation on venesection, principally condensed from the works of Herodotus, Antyllus, and Galen. (Med. Collect. vii.) Antyllus directs us when going to bleed at the elbow to apply a ligature two fingers broad round the arm, so as to produce a swelling of the veins ”

“ When it proceeds from hot and bilious humours, he gives for food fish, the testacea, the most indigestible parts of quadrupeds; and recommends the common bath, and purging with drastic cathartics, such as hellebore and scammony. When inflammation is the cause, he forbids purgatives, because they only increase the evil, but recommends general bleeding repeated at intervals; and, if the urine is suppressed, bleeding at the ankles; also emollient clysters, external applications of a soothing nature, and baths after venesection, but not before. ”

“ It is a very common disease, and the public know little of the evil consequences which may follow what they have persisted in regarding as a simple complaint. From its prevalence and its complications it is one of the most serious diseases that affect mankind.
As regards treatment of venereal disease of all kinds, it should be clearly understood that the causative germs are well known and can readily be destroyed immediately after exposure to infection by thorough cleansing with antiseptic lotion or ointment. ”

“ Unwelcome as the fact is there is an abundance of evidence to show that a large percentage [Pg 183] of men in particular have at some period of their life been infected with venereal disease. Of our fourteen million males in the United States under the age of thirty we find estimates by some specialists in venereal diseases to the effect that five million of them, that is, one out of three, suffer from some one of the social diseases or their consequences. ”

“ The very fact that they present themselves so coolly at the places for the special treatment of venereal diseases, suffices to show that they fully understand the cause of their illness." In Jullien's opinion, venereal disease is especially serious in children, because many of them conceal their condition as long as possible in the hope of avoiding punishment. ”

“ Of a violent inflammation of the penis, which had originated in unclean intercourse with a beast, with a coruncle, or knot, constricting the urethra, cured in a manner to the last degree empirical and cruel. The penis being laid on a rough stone, the Physician suddenly when the patient was not expecting it, struck it as heavily as ever he could with his doubled fist, so that the stoppage and ulcer might burst. This case has a smack of the Venereal disease about it; and might serve as an argument for those who hold that this disease was known to the Ancients as well. ”

“ It follows that at least every other person in the Kingdom has suffered from venereal disease. Probably not a family has escaped infection. In proportion to its prevalence syphilis is not very deadly, yet it has been reckoned as the fourth killing disease. The victims of gonorrhœa are incalculable. Venereal diseases fill our hospitals, asylums, and workhouses. They are the principal causes of heart disease, apoplexy, paralysis, insanity, blindness in children, and of that life of sterility and pain to which so many women are condemned. ”

“ A large proportion of those who are most severely struck by venereal disease are new-born children and trustful wives, while a simple kiss or the use of towels and cups in common has constantly served to spread venereal disease in a family. ”

“ The influence of the act of venery is much more injurious, when the causes which we have mentioned, and generally all those which may impair the constitution, have affected it to a greater or less degree. Diseases of long duration, if badly treated, excesses and the causes mentioned above may bring the system to such a state, that enjoyments even if seldom indulged in, may produce great suffering and disease. Venereal excesses may also create predispositions and change them as well as those which have a different origin into other morbid affections. ”

“ A conservative estimate of the spread of venereal diseases, in the writer’s opinion, would be that from every hundred men, at least ninety have had at one time or another a venereal infection; that from every hundred cases of venereal diseases, not half of them receive a thorough and scientific treatment, not half of the patients are aware of the seriousness of their condition and possibilities of different complications, and only a minority of them bring the treatment to a complete and permanent recovery. ”

“ The Royal Commission on Venereal Disease reported that there was a vast amount of ignorance as to the dangers arising from the sexual intercourse of married persons one of whom had previously to the marriage contracted syphilis or gonorrhœa. The effect upon the birth-rate, and the misery caused during married life, and in many cases to the offspring who survive, as they pointed out, are most serious, and the fact that the actual cause of the trouble often remains unknown and unrecognized prevents the calamity from serving the purpose of example or warning. ”

“ All it can establish and claim is that no acute or active symptoms or lesions have been found on examination, and that there is no urgent necessity to move this woman to the hospital as an evident and prolific source of venereal infection. In other words, medical inspection can single out and isolate a few of the most flagrant and most evident cases of venereal diseases, but the women 74not excluded by medical examination from plying their trade are just as able to carry over venereal infection to a man as their sisters removed to the hospital. ”

“ In addition, we have to reckon with dangers to physical health; among these we have the direct consequences of premature misuse of the genital organs, and, above all, the danger of venereal infection. In a great many cases, sexual offences against children are brought to light only when, on examining the child, gonorrhoeal or syphilitic infection is disclosed. Many authorities hold that the superstitious hope of curing venereal disease by sexual intercourse with an innocent child, is a comparatively frequent source of such infection in children. ”

“ It would, in this disease, be ridiculous to inspect hospital registers, for the purpose of either ascertaining the ages wherein venereal ravages prevail, or the proportion of cured and incurable. Its ravages cannot be in infancy, nor in adolescence, nor in the decline of life. The merest smatterer in medicine knows the infallible remedy and cure I except that in the application to particular cases, some more judgment and dexterity is necessary. The multitudes who now perish in these battles of Venus, are so many sacrifices either to negligence or to indigence ”

“ From what occurs in many morbid cases, we have every day evident proof of the insufficiency of any discharge for producing a cure of the venereal disease. Lues venerea often exists at the same time with diseases in which an increase of natural evacuations 49takes place. None of these diseases, whether the evacuation happens by the salivary glands, as in small-pox, by stool, as in dysentery, or by the skin, as in intermittents, have ever been found to break its force, much less to produce a perfect cure. ”