is a subtile phlegm. If the color shades away into black, it
does not signify necessarily that the materies is simply black bile,
for such a color occurs at the close of acute abscesses, or from
strangulation of the blood. But if, together with the black color, we
find the tissues cold and no increase of heat in the affected part,
this indicates that the _materies_ is black bile.

By touching the diseased part we determine its heat or coldness,
hardness or softness, roughness or smoothness, fullness, distention or
evacuation, all of which signs possess special significance.

The antecedent causes of gout, Gilbert tells us, are a heat too
solvent, cold too constringent (f. 311 c), sometimes a strong bath
or a severe journey in a plethoric person (_in plectorico_), again
excessive coitus after a full meal (_satietatem_), or even habitual
excess, by which the joints are weakened and deprived of their natural
heat and subtile moisture. Hence boys and eunuchs are not commonly
affected by gout--at least boys under the age of puberty. Women, too,
do not usually suffer from this disease, because in coitus they are
passive, unless their menstrual discharge is suspended. Again gout
sometimes arises from infection of the primary semen; for a chronic
disease may be inherited by the offspring and affect the material
causes, i.e., the humors. Flatulence (_ventositas_) is likewise a
cause of gout, as we have already hinted.

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 The quantity of blood withdrawn should be in