AN ESSAY ON THE NATURE AND METHOD Of TREATING the GOUT.
LONDON: Printed for the AUTHOR, M.DCC.XLVI.
IT is certain, that many Treatiſes have been publiſhed on this im⯑portant Subject, and conſidera⯑ble Diſcoveries and Improve⯑ments made to the Science of Phyſick; yet, it is manifeſt, the Aſſiduity of the Learned, and the moſt Inquiſitive, [4]have hitherto failed, to find out a Specific in this Diſtemper, which is too conſpicuous in the Practice: Therefore, I hope this ſhort Tract will be acceptable, and not deemed a ſuperficial Performance.
THE Baſis of the Deſign is, Reaſon and Experience, adapted to every Conſtitution and Age; and, I do not apprehend, but will anſwer the grand Intention, not only alleviating the Symptoms, but effectually the Cauſe.
BEFORE the Virtues of the Cortex where known, many Diſtempers were removed with great Difficulty; and if the Public will but give me Leave, I ſhall endeavour to render this Method apparently as efficacious in the Cure of the GOUT, as the Cortex is in Fevers.
THIS Diſeaſe is called in Greek Ἀρθρἰτις, in Latin Arthritis, the GOUT; and by affecting various Parts, has received as ma⯑ny Terms, viz. Ὀνάγρα, the GOUT in the Shoulder; Χειράγρα, the GOUT in the Hand; Ἰσχιὰς, in or about that Bone that is connected to the Os Ilium; Γονάγρα, in the Knee; and Ποδάγρα, in the Foot.
I SHALL confine myſelf to treat of theſe two, that implies all the other, viz. Here⯑ditary, [5]and Adventitious. The firſt deſ⯑cending from the Parents, the Adventitious from Cauſes ariſing through Intemperance in the Non-Naturals, but both, from an Efferveſcence of the nervous Juice with the ſaline Particles of the Blood, received with our Food, or too great Freedom of ſpiritu⯑ous Fluids: Whence the Nerves, Tendons, Ligaments, the Membranes about the Bones are tormented; and from whence proceed Swellings, Redneſs, hard ſandy Concretions on the Joints.
WHAT Time of the Year this Diſtem⯑per invades, is no material Circumſtance; but it is certain, that in hereditary GOUTS, be the Regimen ever ſo ſtrict, the Patient ſhall have one or more Fits.
THE Acquired, or Adventitious, comes unexpectedly, and no certain Time of Con⯑tinuance.
THE Signs are, a vehement Pain in the Joints, viz. the Heel, the Ancle, Leg, or the Knee, but not to all alike. Preſently after a Chillneſs with a ſhaking Fit, and a ſlight Fever ſucceeds, which increaſes with Pain, ſo exquiſite, as is hardly to be endured; the Preſſure of the Bed-Cloaths, or the leaſt Motion in the Room, giving Uneaſineſs, and continues ſome [6]little Time before it remits; then a gen⯑tle Sweat coming on, the Pain abates, and the Sick falls into Sleep, and the Part affected is immediately found to ſwell. The following, and perhaps for many Days af⯑ter, it may return with equal Violence in the Evening, and gradually go off in the Morning. In like Manner other Parts at that Time may be affected, and with the Severity of Pain, until the principal Pa⯑roxyſm is compleat, which is longer or ſhorter, according to the Quantity of Salts, as well, as the Age of the Sick.
IN ſuch who are young and ſtrong, and have ſeldom the GOUT, the Fit may con⯑tinue fourteen or ſixteen Days; but in el⯑derly People, and ſuch as are frequently af⯑flicted, it generally holds for two Months: Such as are broken, or much weakned, either by their Years, or a long Continu⯑ance of the Diſeaſe, it is moſt commonly ſix Months, more or leſs, or till the Heat of the Summer.
IN the Increaſe of the Fit, the Urine is commonly of a high Colour, with a red Sediment, abounding with Sand, and the Belly uſually coſtive; a depraved Appetite, a Coldneſs ſeizes the whole Body about Evening, which continues the whole Fit.
[7]IN the decline, the Part or Parts are ſubject to a violent itching, from whence falls a Leprous kind of Scurff.
WHEN the GOUT is enraged by Medi⯑cines unſkilfully applied, and the Length and Obſtinacy of the Diſeaſe perverted, other Parts are then infected, as Head, Shoulders, Stomach, Hands, Wriſts, Elbows, and ſome⯑times one or more of the Fingers are diſ⯑torted, or made crooked, and at length ge⯑nerating Tophs, and chalky Concretions like Crabs-Eyes, which in Time break the Skin, and fall out, and freſh Chalk comes in their Place.
IT frequently afflicts the Thigh and Hip, that the Patient complains of an heavy Weight, but without exquiſite Pain; and the Sick have their Joints almoſt every Way contracted and weakned, eſpecially the Knees, whereby the Uſe for a long while is taken away; and by frequent Tits to thoſe Pares moſt oppreſſed, partly by Age and Weakneſs, a total Loſs enſues.
THE Urine, in the Decline of a Fit, is generally loaded with Sand; and too fre⯑quently, if the Diſeaſe happens to be of a long Duration, ſo as to confine the Patient [8]from Motion, is the Beginning of a Fit of the Stone.
IT is to be obſerved, that as the Fever is, that uſhers in the GOUT, ſo will be the Fit; if the Fever be ſhort and ſharp, the Fit will be ſo.
PARACELSUS terms it Morbus Tar⯑tareus, as proceeding from, and cauſed of Tartar; a Mixture of an acid Liquor or Salt, with the Synovia, which is a tranſparent Mucilage, like the White of Eggs; and this being hardened, is the chalky Matter ſo common to gouty Per⯑ſons.
Helmont ſays, its Original is in the Sto⯑mach, which breeds an Acid, which inſi⯑nuating [9]itſelf into the Synovia, coagulates it, and by a preternatural Heat, it is hard⯑ened into Chalk; and that the Intenſeneſs, or Remiſsneſs of the Pain, is to be attri⯑buted, according to the Difference of the Salts. But the intemperate Uſe of Wines, eſpecially thoſe of the French, I believe to be a very good Reaſon, we have ſo fre⯑quent Complaints of the Obſtinacy of this Diſtemper; for the ſmaller the Body of the Wine is, ſo much the more is it loaded with tartarous Salt: Likewiſe an immode⯑rate Freedom of Port-Wines has a vrey bad Effect, but more ſo, if ever ſo little prickt, as Experience has demonſtrated.
SOME hereditary gouty Subjects, that have ſeverely ſuffer'd, and had a narrow Eſcape for their Lives, I have known en⯑tirely forſake their darling Liquor, and take to Madeira Wine, or Brandy mixt with a little Water, and with the Aſſiſtance of a few proper Medicines, continued free for a long Time, that before the Regimen have been ſubject to tedious and long Fits.
THE adventitious GOUT, is known to proceed immediately from the immoderate Uſe of Wine, or fermented Liquors; where⯑by, the acid Faeculencies remaining in the Stomach, become an acid and vitious Tar⯑tar, corrupting the Lympha and Juices, [10]create the antecedent Cauſe, which Nature, in her Defence, to preſerve the principal Parts, forces to the Extreams, as the Joints of the Hands, Arms, Legs, and Feet, which irritates and hurts the Fibres of the Nerves and Tendons, and thereby cauſes Pain, Tu⯑mour, Redneſs, and Inflamation. This Matter remaining long in the Parts affected, for want of proper Remedies to carry it off, by Degrees coagulates, and becomes Chalk or Stone.
A LATE learned Gentleman, who wrote a Treatiſe on this Diſtemper, ſays, that an hereditary GOUT is ingraned and tranſub⯑ſtantiated into the Solids, and impoſſible to be rooted out by Art and Induſtry; but ſpeaks more favourable of an acquired, as being more confined to the Fluids, a pro⯑per Diet, due Exerciſe, and a few well choſen Remedies may go a great Way, if not to a perfect Cure, yet to make Life to⯑lerably eaſy; but I hope my Endeavours will convince the World of this Error, by ſhewing, that there are Medicines, that will in moſt Caſes totally remove this Com⯑plaint, and at the ſame Time, ſtrengthen the Tone of the Stomach.
THIS is the eſſential Reaſon of the wri⯑ting this Treatiſe, viz. to remove this in⯑graned and tranſubſtantiated Conception, and [11]to make it appear, that it may be done, with as much Safety and Certainty, as any other Diſtemper; and that either hereditary or adventitious GOUTS, in Proportion to the offending Salts, may be effectually re⯑moved: And if the Patient be but freed from chalky Concretions, and of a Conſti⯑tution not too much broken with frequent Paroxyſms, to prevent a Relapſe; but if ſo worn out with Age, and frequent returns of the Fit, I can aſſure him of a better State of Health, tho' not abſolutely of a Cure.
DILUTION frequently by proper Li⯑quors, ſuch as old ſmall Beer, with a little Madeira Wine; Water boiled with a few Spices, mixt with a little Brandy, that may lie warm on the Stomach: Thin Wa⯑ter-Gruel with Madeira Wine, during all the Time of the Fever, is not to be omitted, Liquors may be more freely indulged than ſolid Food, and are always to be regulated by their Lightneſs on, and Agreeableneſs to [13]the Stomach, and by their not rendring the Patient more hot and reſtleſs than the GOUT itſelf would do; for whatever cauſes Sickneſs, muſt of Courſe draw in the gouty Matter; but if it produce an agreeable Sen⯑ſation, and not inflame, will procure Cool⯑neſs and Reſt.
THE Diet ought to be eaſy of Digeſtion, ſuch as Sagoe, or Panado, with a little Ma⯑deira Wine, or Brandy, or Jellies, little or no fleſh Meat during the Fever, is beſt, and that the Patient ſhould eat ſparingly; for overmuch feeding nouriſhes the Diſeaſe: All Salt and pickled Meats, and Food of large Nouriſhment is to be avoided. The Body is to be kept ſoluble, which is com⯑monly the reverſe, but may eaſily be ſo, by a ſimple Glyſter of Broth, now and then, with a few carminative Seeds boiled in it.
THE Urine is to paſs freely and plenti⯑fully, becauſe ſometimes a good Part of the morbific Matter may be carried off that Way. Immoderate Sleeping and Watch⯑ing is to be avoided, likewiſe Venery.
IF the Patient can ſuffer Motion, it is better to uſe it, by which the Calculus is prevented.
[14]LASTLY, The Mind is to be kept ſe⯑rene and pleaſant, a chearful Friend, and a Glaſs of good Madeira Wine will keep up the Spirits, and in ſome Meaſure leſſen the Fatigue of a tedious Confinement.
BY this Method, I am certain, this ſtub⯑born Diſtemper is to be removed, and have known ſome to have been freed from it for ſeveral Years, who by Intemperance and Irregularities of Life, have taken as great Pains for a Relapſe; but this is to be attri⯑buted chiefly to the Goodneſs of their Con⯑ſtitution.
To ſpeak ſomething of the Medicines that have this ſalutiferous Effect. The Pro⯑feſſors in Phyſick do generally concur, that if a Medicine could be diſcovered, that would ſweat the Part affected, it would be the only and infallible Means of Succeſs, and the propereſt Way to remove the Load of tartarous Salts and viſcous Matter, which is the principal Motive of this chronical Diſeaſe.
Now, the Nature of theſe Medicines are of ſuch Effect, ſuppoſing the Complaint in the Foot (which is a conſiderable Diſ⯑tance from the Stomach) that ſoon after the firſt Doſe is received, they have this Con⯑ſequence, [15] viz. give the Patient very ſenſible Reaſon of its reaching that Part, by an ad⯑ditional Warmth and Moiſture; Indications ſufficient to a gouty Perſon. And if one Doſe have ſo great Effect, what muſt re⯑ſult from repeated Doſes every Day, but removeing the Obſtruction, enlarging the Pores braced tight with Pain and Anguiſh, and by a full and free Perſpiration ſetting at Liberty the Cauſe of the Diſtemper.
IN anſwer to ſome invidious People, who attribute the Operation of the Medicines to a Preparation of Mercury; others again to Antimony; and from the quick and unex⯑pected Relief the Patient ſo ſuddenly re⯑ceives, to ſome Aſſiſtance from the opiate Tribe.
THE publiſhing this Secret would imme⯑diately convince them of their groſs Errors, beſides, a ponderous Medicine as Mercury or Antimony muſt of Courſe detect itſelf; but I ſhall at this Time wave the Argu⯑ment, and when proper make it publick; but to ſatisfy the timerous, ſhall ſo far de⯑clare, that there is not one Grain of an O⯑piate, or thoſe Minerals in the Compo⯑ſition.
IT is certain, Minerals, ſuch as Mer⯑cury and Antimony, have been us'd, but [16]prudently condemned as dangerous Medi⯑cines, breaking and tearing the ſmalleſt and fineſt Veſſels and Fibres, by their Particles, ſo that the Body, when the Blood is reple⯑niſhed again with gouty Salts, becomes in a worſe State in reſpect of the future Fits, which will become more painful and obſti⯑nate, than they would have been in ſeveral Years Time under the common Symptoms.
AND as to Opiates, they are never to be given but in Extremities, when the Patient has been many Days without Reſt, and not then, but by joining ſpicy nervous and ſto⯑mach Medicines to them: So that it is plain, nothing of that kind can be in the Compoſition, which is to be adminiſter'd Morning and Evening, and has no other Effect, but a gentle Perſpiration and breath⯑ing Sweat, and ſo repeated for a few Days, the Symptoms of a regular Fit are com⯑pleatly carried off.
THE irregular GOUTS, where the Con⯑ſtitution is broken and impaired, and the gouty Humour fixes on the Head, the In⯑tention to be had in View is to expel the ſaid Humour outwardly upon the Muſcles and Joints, and to fix it there; and is to be treated as any other violent Head-Ach, or as an Inflamation on the Brain, by bleed⯑ing in the Foot, bliſtering on the Ancles [17]to give the gouty Matter a vent down⯑wards. Some Authors are bold enough to preſcribe mercurial and antimonial Vomits, but they are ſeldom to be ventured on in any Conſtitution, for the active Part of the GOUT is too dangerous to be attempted by ſuch an Operation; even Bleeding, with⯑out an abſolute Neceſſity, is not to be ad⯑mitted of, but when other mild Methods has been ineffectually uſed. Gentle ſto⯑mach Purges may be frequently and ſafely repeated (but Care muſt be taken that the Medicines be not too hot, eſpecially in young ſanguine Conſtitutions) and at the ſame Time Endeavours muſt be made towards a powerful Evacuation by the Pores, which will not fail ſpending the gouty Humour.
THE GOUT in the Stomach is a com⯑mon and leſs dangerous Caſe, for it rarely comes on or goes off without touching there, and is as eaſily removed; but to⯑wards the Decline of Life, eſpecially in thoſe that have been long afflicted, the Pa⯑roxyſm generally of great Length, is more obſtinate, eſpecially when it ſettles in a conſtant Pain, and in nauſeating and keck⯑ing in the Stomach.
[18]THO' Vomits are reckon'd dangerous in the GOUT, leſt they ſhould derive the Humour on the Stomach; yet I have known ſome, contrary to Advice, bold enough to make Experiment, and that have done it without any viſible Alteration on either Side. Upon the firſt Seizure of the Stomach, a gentle Vomit is by ſome pre⯑ſcribed, as a Doſe of the Indian root and re⯑peated as they found Occaſion; but, I ne⯑ver had a Patient that purſued my Method of Evacuation by Sweat, to have any Call for ſuch an Operation, therefore cannot ea⯑ſily admit of the Remedy. Stomach Pur⯑ges, ſuch as Hiera Picra, with Tincture of Diambra, or Snake-root, bliſters on the Ancles, higheſt Cordials, and moſt gene⯑rous Wines, may be now freely indulged, and without any Fear of Inflamation; but if the GOUT ſhould continue ſtill in the Stomach, and become habitual, then the Bath Waters with Steel, the aforeſaid Sto⯑mach Purges frequently repeated, a regular Diet and Exerciſe, perpetual Bliſters be⯑tween the Thighs, powerful Evacuation by the Pores, cupping between the Shoul⯑ders, or Bleeding in the Foot, are the only Means effectually to remove it.
[19]THE GOUT in the Inteſtines, muſt be treated altogether as in the Stomach, and no Opiates to be uſed, but in the laſt Ex⯑tremity.
BUT if there ſhould be a Tranſlation of the offending Matter from the Stomach, or elſewhere, to the Lobes of the Lungs, you muſt behave in the ſame Manner, as if it was an abſolute Peripneumonia, or Inflama⯑tion on the Lungs.
THESE are Caſes that are generally at⯑tended with great Fatigue and Danger, yet I ſhall exhibit an Inſtance of a Gentleman in a hereditary Fit of the GOUT, and near Seventy Years of Age, who had been a Cripple by the chalky Concretions in his Knees full twenty Years, and had entirely loſt the Uſe of his Legs; and, during the Paroxyſm, the Stomach was affected with a continual Pain and Heat; no Liquids but the moſt ſpirituous, ſuch as Brandy, or A⯑qua Mirabilis, would reſt on his Stomach.
AFTER ſome Weeks, and various Me⯑thods had ineffectually been made uſe of, I was admitted, and gave him the Medi⯑cines, and along with them, warm ſpice [20]ſtomach Medicines, which continu'd for twelve or fourteen Days, remov'd it from his Stomach into his Hand and Elbow, whereby the Tone of the Stomach was reſ⯑tored, and the Fit gradually carried off.
I MIGHT inſtance many Caſes that would have proved dangerous, if it had not been for theſe Remedies, but for Brevity ſake muſt omit them.
SINCE hereditary and adventitious GOUTS proceed from one and the ſame Principal, a tartarous Salt, having ſeen no remarkable Difference worthy Obſervation, but that an Adventitious in ſome Conſtitu⯑tions has been equally as violent as the other, I ſhall treat them alike.
THEREFORE, a GOUT in a Perſon of a firm ſtiff ſtate of Nerves, of a middle Age, and free from chalky Concretions, I may venture to aſſure him of a Cure, in the Time of fourteen or twenty-one Days, by taking the Medicines.
A nervous GOUT in a looſe, flabby, and relaxed State, and of the ſame Age, a few Days longer; but when aſcending to⯑wards the grand Climacteric, then the Time [21]cannot ſo eaſily be limited: However, I may affirm, that it will be barely half the Time of the cuſtomary Length of the Pa⯑roxyſm.
IN young Subjects, I have known the Cure performed in ten or twelve Days, to an entire Extirpation; and this great Bene⯑fit obtain'd by no other Method, than Me⯑dicines that promote Evacuation by Sweat, that cauſe no Sickneſs, Thirſt, or any In⯑conveniency whatever, but ſit eaſy on the Stomach.
IN the Practice of ten Years in this Diſ⯑temper, I do not remember an Inſtance of the GOUT either hereditary or adventitious, that withſtood the Efficacy of theſe Me⯑dicines ſo long a Time as a Month, tho' the Patient has had both Legs and Arms at the ſame Time affected, neither an Inſtance of a Relapſe. And, I am certain, if this Practice was but generally known, it would meet with a proper Encouragement, in ſpite of the Obſtacles that attend an Under⯑taking of this Nature, that has not the Sanction of the Superiors in Phyſick; but I hope in Time, every one will be convin⯑ced, that the ſole End and Deſign is im⯑mediately calculated for a publick Benefit; [22]and that it may appear more ſo, and take off all Thoughts of an Impoſition, I am willing to wait upon any one that ſhall de⯑ſire it, and ſatisfy them, by Word of Mouth, of the Efficacy of the Method. And, as no Reward is expected till the CURE is effectually performed, ſo I hope no QUACKERY can be aſcribed to this Manner of PURLICATION.
PAGE 7, Pares read Parts. Page 9, vrey read very, Page 11, freed read free.