A TREATISE ON THE GOUT.

THE Gout is a tenſive and lacerating Pain about the Joints, chiefly returning in^* Spring and Autumn, ariſ⯑ing from an Obſtruction in the nervous Veſſels and A⯑crimony of the Fluids; whence Redneſs, Swelling, and chalky Con⯑cretions^†. In general it is called Arthritis, from the Greek Word [...], ſignifying a Joint, becauſe this Complaint chiefly ſeizes thoſe Parts. It likewiſe takes its Name from the ſeveral Parts of the Body it attacks, to wit, in the Hands, Chiragra from [...] [8]a Hand, and [...], a Prey or Seizure, there⯑by denoting its cruel Ravages and Injury whereſoever it comes.

The Sciatica or Hip-Gout, from [...] the Hip. In the Knees Gonogra, from [...] the Knee, and [...].

Podagra in like manner is from [...], the Foot, and [...], whence the Gout in the Feet is ſo termed.

There are various other Denominations which all take their origin from the parts affected, the Cauſe being ſtill the ſame, ſome⯑times ſeizing one Place ſometimes another.

Many are apt to believe the Rheuma⯑tiſm to be either Gout or Scurvy, but impro⯑perly; it has its Name from [...], to flow, hence [...], a Rheum, thereby denoting a Flowing of Humours to a Part, yet the Rheu⯑matiſm partakes ſomewhat of theſe Diſeaſes.

The renowned Sydenham hath well treated this Diſeaſe, yet muſt own in my Opinion, he makes uſe of bleeding too frequently. It chiefly ſhews itſelf in the ſame Places, where the Gout appears, whence in ſome meaſure the Miſtake ariſes.

The Lumbago was obſerved by the An⯑tients; in which the Pain in the Loins is ſo great, that the Patient is obliged to ſit or ſtand upright: If he moves to either Side, or endeavours to bend forward or backward, then he ſuffers excruciating Pains, and ſome⯑times even Convulſions. The ſame Diffi⯑culties [9]are found in moving the Neck, if that Part is afflicted, as it often happens to be. When it ſeizes the Region of the Os ſacrum it is often termed the lower rheu⯑matic Lumbago; by ſome alſo it is called the rheumatic Gonogra, if in the Knees: Yet this Diſeaſe may for the moſt part be diſtinguiſhed from the Gout and Scurvy; if the Perſon has not had either of theſe be⯑fore, then I ſhould eſteem it the Rheuma⯑tiſm, and not the Gout.

It is not neceſſary for me here to explain the Cauſe of the regular Fit of the Gout, which invades a little before the vernal E⯑quinox, and after the autumnal; for Win⯑tringham has learnedly treated of this^*.

The noble Willis and Heinſius alſo [who has wrote in Dutch a Tract of this Malady] deſerves to be read again and again; which makes good the old Proverb,

The Gout under its various Denomina⯑tions is either hereditary or acquired. Its Cauſe is two fold,

Firſt, From a Straitneſs and Rigidity or Stiffneſs of the nervous Veſſels.

Secondly, From an Acrimony and Tena⯑city of the Fluids^*.

Hence every Fault committed in the Non-naturals ^† (as they are termed by Phy⯑ſicians) haſten and bring on the Fit. It principally afflicts in Parts remote from the Brain. The Defect lies in the laſt Office of Digeſtion. 1ſt. From our Food is Chyle produced, 2dly. The Serum or Whey, 3dly. The Blood, and laſtly, The nervous Spirit.

The Viſcera, or Organs of the firſt Con⯑coctions are good, but that ultimate or laſt Effect is not properly performed. Our Ma⯑ſter of the Faculty, the great Boerhaave is of the ſame Opinion; for he ſaw a Patient who had about the Joint a Swelling that broke without Pain; he forced a Needle quite through to the Bone without any Un⯑eaſineſs, and took out this chalky Matter which was made up with the ſmalleſt Veſ⯑ſels, thus deſtroyed and changed. It is alſo plain, that the Blood, Serum, &c. are not in fault, for they equally exerciſe their ſeveral Functions; the gouty Subject can rea⯑ſon properly, and feels the Power of Love as before: Hence I have often admired Hip⯑pocrates, where he ſays, the Gout cleanſes [11]the moſt minute Receſſes of the Blood in old Men; for after a Fit, they, for the moſt part remain free and well for Months; and in this Courſe, they may obtain the good old Age of Fourſcore or upwards; where⯑fore this Diſeaſe muſt not be in the Blood, but in the Ultimate [...], or Spirit of the Blood.

Hence it is neceſſary (as alſo Paracelſus and Helmont obſerves) that the whole Body be recruited in the Solids, and the Fluids mended, and corrected before the Cure can be accompliſhed; but this is to be done by reſtorative Medicaments, and not thoſe of a purgative Quality.

Otto Tachenius (in his Tract de Morborum Principe) ſays, that a ſubtile corroding Acid is the Cauſe of the Gout, and hence an Alcali, it being quite an Oppoſite, deſtroying and driving out the Malady, he eſteems as a Specific: which acrid Cauſe, ariſing from too great Rigidity or Straitneſs in the Veſſels, Venery, &c. deſtroys the beſt and fineſt Part of the Nerves. He got great Profit by this Invention, yet the Medicine did not anſwer. It is inſcribed on the Statue erected to the Memory of Paracelſus, that he could cure the Gout, by which, I ſuppoſe, is to be underſtood, he cured the Fit by order⯑ing a good Diet, giving proper Anodynes, &c. But this does not root out the Seeds of the Diſeaſe; Nature left to herſelf would have performed thus much.

A Man in Holland made Trial of all the Remedies he could pick up, among the reſt the Caryocoſtinum, but was much the worſe for it, notwithſtanding the great Praiſes given it by its Inventor Eugenius.

In England, as well as in Holland, there is a noted Powder highly recommended in this Diſeaſe; it is made with Germander, Ground-pine, the leſſer Centaury, the Roots of Birthworth and Gentian; and diſtinguiſh⯑ed by the Title of the Great and Noble Duke of Portland. It is true, this Powder will mitigate the Pains; but in my Practice, I have found it to produce Obſtructions in the ſmaller Veſſels, and cauſe the morbid Matter to attack freſh Places; hence if it ſhould retire to ſome of the more noble Viſcera, Death in a ſhort Time, muſt be the Event. I readily own, that if the gouty Perſon, having this Malady, only in a recent and ſlight manner, obſerves a good Diet, during the Uſe of this Powder, he may, for a Time, have his Pains leſſened and abated; but it is not in the Power of this Remedy to era⯑dicate the peccant Matter.

The Gout is not only dangerous in it⯑ſelf, but likewiſe of all Diſeaſes the moſt ſevere, and obſtinate in its Continuance, tormenting poor Mortals, for the moſt part, as long as Liſe laſts; from whence the Saying,

We may further add the Words of Dr. Wintringham in the End of his Treatiſe, where he obſerves, ‘"That notwithſtand⯑ing the vain Boaſtings of Empirics, it is quite evident, that no Specific has been given, by the Help of which, this Di⯑ſeaſe has been rooted out."’

Hippocrates takes notice, ‘"That Eu⯑nuchs have not the Gout, neither are bald or bare-headed. Alſo, that Women^† are free from it unleſs their natural Courſes are deficient:"’ And further, ‘"That Youth have it not before they Uſe Venery^*."’

Our Father Hippocrates has here declared Things worth notice, but yet he does not ſay this Diſeaſe is incurable.

The excellent Boerhaave obſerves, ‘"That this Diſeaſe cannot be cured, unleſs by Medicines, which have Power to cor⯑rect and change the bad State of the Body, whence this Diſorder ariſes ‖."’

The hereditary Gout, and that attended with ſtony Concretions are of all the moſt dif⯑ficult to cure ‡. For the hereditary is the Effect of the whole Compages of the human Machine, and ſhews itſelf in its own pro⯑per [14]time, in like manner, as the Secretion of the male Seed appears after Puberty, having its Origin from the Nerves ſo ingen⯑dered.

The Tophi, or Chalk-ſtones do not hap⯑pen till after all the Juices of the Body have been infected; hence we may plainly learn, why they are the worſt and moſt difficult to be cured^*.

Now to the Method of treating this Diſeaſe.^*

During the Paroxyſm or Fit, I carefully avoid every Thing which may hinder or diſturb the Evacuation of the peccant Matter. Therefore I ſhun bleeding, for the Blood being leſſened in Quantity, the Preſſure to⯑wards the excretory Veſſels is likewiſe dimi⯑niſhed; and thus the Matter which ſhould be evacuated, is retained, whereby grievous and heavy Symptoms enſue ‡.

Dr. Wintringham directs Emetics and Purgatives to be repeated occaſionally, in order to clear the Primae Viae of their Cru⯑dities; [15]but I abſtain from ſuch Remedies, for they occaſion a Tumult in the nervous Juices, draw off the more fluid Parts, and deſtroy their expulſive Power^*, whereby the natural Secretions are much hindred.

Medicines that encourage Sweat, and alſo thoſe that paſs by Urine, make the Cir⯑culation of the Blood more rapid, and of Courſe the offending Matter is determined in a larger Quantity to be ſeparated and car⯑ried off, hence the preſent Fit will be in⯑creaſed. It is beſt that the Concoction and Evacuation of the gouty Matter be left to the ſole Work of Nature.

I would refer the Reader to the 1273d Aphoriſm of the immortal Boerhaave, it deſerving a particular Regard, nay even all of them on this Subject are well worth our peruſal.

During the Fit, we can only endeavour to render the Pain as mild as poſſible, by blunting the Acrimony or Sharpneſs of the morbid Matter, and gently helping forward its Expulſion out of the Body. To effect this, I endeavour to dilute and thin the Blood, that the Matter unfit for Circulation, and lodged at the Joints, may flow with more Facility and Eaſe. I order a temperat⯑ing Powder, three or four Times in a Day, with a medicated Liquor to be plentifully drank. When the Pain is ſevere and ſcarce [16]ſufferable, I give fifty, ſixty or ſeventy Dops of an anodyne Elixir in a large Draught of the above Drink. I never uſe any outward Application during the Fit, unleſs the ſick Perſon ſhould be very impatient and deſirous of it; in which Caſe, I apply an anodyne Cata⯑plaſm or Fomentation. If the gouty Mat⯑ter ſhould recoil to the internal Parts; and there attack ſome of the noble Viſcera or Bowels, we muſt immediately try all in our Power to drive it out again to the Joints, with large Draughts of an aromatic Decoction, Fomentations and Bliſters too if requiſite.^* By theſe Means many may be preſerved from ſudden Death.

Out of the Fit, I take Care to prevent the Encreaſe of the gouty Matter, alſo to ſhake off that which has, in ſome meaſure, begun to fix itſelf. And for that Purpoſe.

Firſt the Patient muſt carefully obſerve a good Diet, eſpecially a milky one, for Milk has been ſeparated from every groſs Part, having already paſſed through the ſeveral Di⯑geſtions in the Animal; hence it does not beget thoſe Crudities any other Diet is liable to.

The gouty Patient, while he is under his Courſe of Medicines, ought to have the following Verſe inſcribed over his Chamber⯑door.

The celebrated Dolaeus writ well on this Head^*, learn a Leſſon (ſays he) from the rank herd of Debauchees, who, in our Tippling-houſes gorge themſelves with ſtrong Beer: What foul Savours exhale from their impure Bodies, how are they agitated by an unquiet and reſtleſs Life, how great a Dull⯑neſs to their Wit, how benumbed their Senſes, how feeble their Limbs, how over⯑whelmed is that noble Part, their Brain. As when the Earth is wet by heavy Rains, Linnen and Paper grow limp and moiſt, ſtanding Waters and Sewers ſtink and are offenſive; even ſo, when too much Liquor has diffuſed itſelf through the whole Body, the Breaſt, &c. are beſet with Catarrhs, the Ears have a Tinkling Noiſe, the Eyes grow dim, a Cough invades the Lungs, the Head is ſeized with Giddineſs, the Nerves and Muſcles are tortured with Pains not unlike thoſe of the Gout; and all this is the Effect of too hard drinking.

The great Boerhaave directs, ‘"The Uſe of aromatic, bitter and antiſcorbutic Plants; lixivial fixed Salts in a ſmall Doſe, often repeated, and continued a a long Time; nouriſhing Meats and Drink, that are light and eaſy of Digeſ⯑tion; conſtant riding on Horſe-back in a pure and clear Air, with frequent Friction and Motion of the Parts; laſtly, going to bed early, and ſleeping late in the Morning^*."’

The Reader may farther compare this with the Words of Doctor Wintringham in his before-mentioned Treatiſe: He may alſo ſee my Diſſertatio Medica de ſanitate ejuſque Conſervatione, where I have expreſsly wrote on Diet, and the Preſervation of Health.

Conſtant Exerciſe is directed by the noble Boerhaave, and very juſtly too; for Sloth is Sepulchre of the Living; to ſtand ſtill and be unactive is pernicious; if the Air ſtag⯑nates it becomes peſtilential; if Water is without Motion, it ſoon is putrid and cor⯑rupt; if the Land is not cultivated it be⯑comes Deſert and waſte; in like manner the Warrior laying aſide his Arms, Ruſt and Canker prey upon them; the Muſician too neglecting his Inſtrument, the Chords of Harmony decay and are uſeleſs; the Moth alſo makes his Inroads on our horded Gar⯑ments: Thus ſings the Poet Ovid.

What ſays the old Divine Hippocrates? Indolence moiſtens and renders the Body weak and flaccid; Labour and Induſtry throws off the ſuperfluous Juices, and makes it firm and robuſt.

The Diſeaſe of Drowſineſs and unſtable Judgment is the Offspring of Negligence and want of Care^†.

Always to ſit is bad, for the pancreatic Juice and Bile, which is a Balſam neceſſary to be mixed with the Chyle, is by this Inactivity precipitated in the ſmaller Inteſ⯑tines, hence ariſes a Cacochylia or bad State of Chyle; wherefore inſtead of a ſweet nu⯑tritious Chyle, an acid aquoſe Fluid enters the Lacteals.

Alſo the Ferment in the Stomach becomes acid, which afterwards changes whatever it receives into the ſame Acidity, after the manner of the Fermentation in making Bread (for a little Yeaſt being mingled with the Flour, &c. ſoon communicates the ſame Ferment to the whole Maſs.) Hence vari⯑rious Diſeaſes ariſe.

Blautus Palinurus ^* directs a Cappadocian (whoſe Blood had not a free Circulation) to walk, it being the beſt Remedy for the Spleen.

Agreeable to Boerhaave, every gouty Perſon ought to ride in a clear, but not a cold Air: As Chillineſs or Cold is the Fore⯑runner of Mortality, thus a due Warmth ſhews the vital inteſtine Motion, that is ſo ne⯑ceſſary to Life; for as long as we live, we muſt enjoy a more or leſs Degree of Heat: Cold is injurious to the Nerves as Euripides bears Teſtimony, where he ſays, [...], that is, Cold is very hurtful to a thin or lean habit of Body.

Hippocrates alſo takes notice, that thoſe who travel through Snow, or in extreme cold Weather, ſo as to have their Feet, Hands, &c. benumbed thereby, are much afflicted by their Approach to any ſudden Heat, and have intolerable Itchings, and that in ſome even Bliſters ariſe, like thoſe from a Burn, but this happens not till after they begin to grow warm.

Cold Bathing is prejudicial, for it pro⯑duces a ſudden Hurry and Tumult to Na⯑ture, becauſe of the immediate Change from the warm Air into cold Water; thus the Perſpiration is in a Moment checked, and all the moiſt impure and ſaline Effluvia re⯑maining [21]within the Pores, they putrify and inflame the whole Maſs of Blood, and ſo produce Fevers, Inflammations, Gout, &c. ^*

The Reaſon is that the Body undergoes a greater Alteration by Air from [...], (Tranſpiration) or Breathing of Vapours through the Pores, than from [...] (Inſpi⯑ration) or taking Air into the Lungs; hence an [...], or Obſtruction of the na⯑tural Perſpiration is the Mother of many Diſeaſes.

It is obſerved that many who labour under Fevers, &c. in the Spring, if they do not guard themſelves well againſt the Air, though they may eſcape Death, yet are ſub⯑ject to Relapſes.

Moreover, the ſick Man ſhould be early in Bed in the Evening, and late in the Morn⯑ing, as Boerhaave obſerves; for Sleep is the beſt Specific in all Diſeaſes, it is a Secret in Medicine more valuable than Gems or pre⯑cious Stones; and that Phyſician ought to be much eſteemed who can aſſiſt the Wants of Nature in this Reſpect, with Security and Advantage to the Sick^†. Sleep is Health to the Body, and a Refreſhment to [22]Nature, as neceſſary as our Meat and Drink: It is beautifully deſcribed in the following Lines of the Poet, viz.

Doctor Young, in his Night Thoughts, ſpeaking of Sleep, calls it^*

Secondly, He muſt every Morning rub well the gouty Parts, eſpecially about the Joints, with a Flannel full of the Smoak from a Suffimugation, which is made by a Powder ſprinkled on live Coals for that Uſe; and take one Drachm of an Arcanum anti⯑podagricum reformatum, three Times a Day (when the Stomach is moſt empty) drink⯑ing after it a Draught or two of medicated Drink.

The gouty Subject muſt regularly con⯑tinue this Courſe of Medicine for a ſhort Time, carefully keeping to a good Regimen of Diet, and duly obſerving the enſuing Verſe.

If he will indulge me thus far; then I dare promiſe a compleat and certain Cure.