CHAP. I. Of the Gout, and what it is.

Theoph. I Have underſtood with joy, Theodidactus, that you have a ſingular opinion of the Gout, its Cauſe, Seat, Paſſages and Ways; as alſo, that you know the true and genuine Remedy againſt this cruel Diſeaſe, which is alſo come to your door, no leſs than it had aſſaulted your Father and Father-in-Law, who were ſo grievouſly tormented therewith, that they became altogether helpleſs, and were ſo ſpent and conſumed thereby, that before they arrived to any conſiderable old age, they fell into their graves. Whereas I ſee you, to admiration, advanced to ſo great an age, and in ſo much vigour, as if you had never known or had any Podagrical perſon in your Family, or among your Relations, or had never been ſubject your ſelf to that mercileſs diſeaſe. Hence it is, that I moſt heartily intreat you, that you would be pleaſed to explain this matter to me, according to the good inclinations, which I have always perceived in you, of doing good to your Neighbour.

Theodid. My dear Theophilus, although in doing this I ſtep ſomewhat out of my Vocation; yet Chriſtian charity conſtrains me to comply with your deſires herein, and 10 to confine this knowledg of mine to my particular Friends and Relations; on condition only, that at this time you do ask me no more queſtions, than what ſhall be pertinent to make us come to the knowledg of the Gout and the Remedy thereof.

Theoph. I moſt kindly thank you for your goodneſs, and promiſe you to contain my ſelf within the bounds preſcribed.

Theodid. Very well; be pleaſed therefore to propoſe your queſtions in that order, and I ſhall anſwer you to the beſt of my knowledg.

Theoph. To recover gouty perſons, and to free them from their pains (without which all the bleſſings of this life are inſignificant,) what is above all things neceſſary?

Anſw. To have a thorow knowledg of the Diſeaſe and of the true Remedy thereof; both which are equally neceſſary, inſomuch that the one without the other is not valuable.

Queſt. Why is it, that for accompliſhing a happy Cure, there is firſt of all required a well-grounded knowledg of the Diſeaſe?

An. Becauſe 'tis impoſſible to cure a diſeaſe according to Art, if the nature thereof be hid from the Artiſt: And the want of this is the chief reaſon, why the care and pains taken by ſo many learned Phyſitians hath proved ſo ineffectual in the Gout.

Qu. What then are the Requiſites to attain to the true knowledg of this Diſeaſe?

An. There is required a ſolid knowledg of theſe following particulars:

1. Of the next and ever-concomitant Cauſe of the Gout.

2. Of the Seat of this Evil.

3. Of the Part affected.

4. Of the Ways and Paſſages, through which this Evil takes its courſe.

5. What are the inſeparable ſigns thereof?

6. What Symptoms commonly accompany it?

7. That the Symptoms of this Diſeaſe be rightly diſtinguiſhed.

If you err not in theſe main points, you are in the right way of arriving to a happy cure of this Malady.

Qu. Do you underſtand by the name of Gout, all pain in the Limbs?

An. No; but that pain which in ſharpneſs and fierceneſs exceeds all other, and that which I mean to deſcribe.

Qu. To let paſs the name of the Gout, pray give me a full and plain deſcription of the Diſeaſe it ſelf?

An. The Gout is a preternatural, inward, deep-lurking, and for the moſt part inviſible little ſwelling within in the perioſtium, that is, the membrane that enwraps all Bones; cauſed from a dry and cold ill-natured damp or vapor, which out of the arteries, by the expelling vertue of the heart, is driven out into the place that is between the bone and the perioſtium, for the moſt part into ſuch Limbs of the Body as are about the Joints; in which this vapor being and remaining impacted and incloſed, and diſtending that moſt ſenſible membrane, produces thoſe violent and intolerable pains, whereby the motion of thoſe Limbs is incumbred and diſpoiled, and many other grievous accidents occaſioned.

Qu. Doth this deſcription differ much from that which hath been hitherto delivered of this Diſeaſe?

An. It doth: Whence it is, that I exceedingly apprehend, I ſhall incur ſharp cenſures from many.

Qu. But let this paſs; let us weigh rather your deſcription in its principal parts. And, Firſt, I do remember, that you make the Gout to be a preternatural ſwelling; whereby you doubtleſs imply, that the Gout is a Diſeaſe wherein violence is done to nature in ſome part or other of the Body. But this is a novelty to me, that you add, viz. that it is an inward deeplurking, and for the moſt part inviſible little ſwelling, and that that ſwelling is cauſed by a damp, &c. intreating you, that you would vouchſafe to expreſs this more plain, and to render reaſons thereof. And firſt, why you call it an internal and deeplurking tumor?

An. The better to diſtinguiſh it from other windy ſwellings, in reſpect of its ſeat: For, whereas thoſe other lye between the fleſh and skin, this lies deep, underneath the membrane that covers the bone; as hereafter ſhall be more largely proved.

Qu. But why do you add, that it is a little and moſtly inviſible ſwelling?

An. Becauſe it is ſo indeed.

Qu. But pray, Sir, take care that you run not againſt ſenſe, out of a blind zeal of producing a novelty. For, is not the tumor which manifeſts it ſelf in the Gout, big and conſpicuous enough?

An. You do not diſtinguiſh between the Diſeaſe it ſelf and the Symtom, which is the ſtumbling ſtone of many even learn'd men. And the want of this very diſtinction ſeems to me to have been the main, if not the only obſtacle, why they have not lighted upon the true cauſe of the Gout, and why they have taken quid pro quo?

Qu. What then is to be done, not to miſtake herein?

An. You muſt ever make a difference between the ſwelling, which is cauſed by the morbific gouty matter, and that which is conſequent to the Gout; and this is to be laid as a fundamental Truth, never to be remov'd, viz. That the humour, which makes the external palpable and viſible ſwelling in the Gout, is not the Gout or dolorifique matter. Which are not ſo much my words, as the words of that famous Phyſitian of Dort, called John Van Beverwyck, deliver'd by him in his Book of the Gout, and which he hath borrow'd out of the deſcription of that diſeaſe, which that learned and experienced Profeſſor of Phyſick at Wittenberg, Daniel Sennertus, left behind him. Which alſo is the reaſon that I ſhall place that aqueous and ſerous tumor amongſt the ſymptoms of the Gout; where alſo it is to be handled, and not here, where we ſpeak of the Diſeaſe it ſelf.

Qu. What, is not the humor, that cauſes the outward and viſible ſwelling, the Gout or dolorific matter?

A. No, they differ very much from one another, and may be ſufficiently diſtinguiſht by thoſe that will attentively conſider.

Qu. Wherein conſiſts this difference?

Anſ. In this, that the one is the cauſe of the Diſeaſe, the other a ſymptom; which will be made very clear, when we ſhall come to treat of this ſymptom. But in part to ſatisfie your curioſity, pray mark the ratiocination of the lately named Beverwyck, ſaying in the quoted Book: That the humour which makes the ſwelling, is not properly the peccant matter, is from hence evident; becauſe that in the beginning, before the part ſwells, the greateſt pain is felt, and the ſame grows leſs, when the ſwelling appears. 'Tis true, that that learned man adhereth ſtill to the opinion of the ſaltiſh Serum, affirming that it is a ſerous humor, pervaded by a ſalin acrimony, that cauſes the Gout. But herein he, as well as the great Sennertus, hath miſtaken. Mean time, tis certain, that the external tumor is not the morbid matter it ſelf, for the reaſon given; and, which is more, ſome podagrical perſons endure great pain, without the appearance of any viſible ſwelling.

CHAP. II. Of the inward Tumour of the Gout, and how it is moſtly inviſible.

Qu. I Shall for the preſent reſt contented with the proof alledged, until we come to the ſymptoms: But, when this ſymptomatical or accidental ſwelling of the Gout is preſent, do you then obſerve two ſorts of ſwelling in this Diſeaſe, one inward, the other outward?

An. I do ſo; of which two, the firſt is that which I ſay in the deſcription to be a ſwelling that is little, and for the moſt part inviſible?

Qu. Why do you ſay ſo?

An. Becauſe it is indeed ſmall, and for the moſt part cannot be ſeen by the ſharpeſt eye of the body, though it be ſeen by the eye of reaſon. For, although you outwardly perceive no ſwelling, you may not thence infer, that there lurks none within, foraſmuch as the contrary is true in theſe and other ſwellings. See the proof hereof in a couple of obſervations of the skilful Phyſitian and Chirurgian Hildanus in his ſecond Part, the 37th. and 38th. concerning dangerous and deſperate tumors in the muſcles of the ſtomach, in which nothing preternatural of ſwelling, or other diſorder could be ſeen outwardly.

Qu. If this tumor cannot be perceived by the eye, whence do you then know that there is an inward one?

An. From the violent, pungent, beating, diſtending, and continual pain, to be eaſily perceived by ones finger.

Qu. But, it ſeems, by what you intimate in the deſcription of the Gout, that ſometimes this tumor may be ſeen?

An. Yes, it may; for at times it appears plainly enough, though few Artiſts take it for a gouty ſwelling, miſled by the external appearance of it, which is in the form of a ſmall hard pimple on the place of the part affected; of which you have a manifeſt proof in Pareus, the French Chirurgian, treating of a diſtemper in a young woman at Bourdeaux, that had ſuch a tumor on her thigh; though Pareus doth not record it for ſuch.

Qu. When may this tumor be perceived by the eye?

An. Then chiefly, when the gouty cauſe attacks the Patient, not about the joints of the limbs, but in or about the middle of thoſe places, with a boyling pain, wherein nature labours as much as ſhe can (though ſhe be not ſtrong enough) to expel the peccant matter. At which time, if you obſerve it carefully, ſome tumor appears, as was ſaid above. This I have found not only in my ſelf, but very notably in another, that was a young man, employed here in the Foundery of Batavia, called Martyn Smith of Breſlaw, who having the Gout in his right foot, without a conſiderable afflux of humors, the evil ſetled on the midſt of his foot, in the form of a protuberant hard pimple or button: Which I alſo, by the help of God, did preſently cure, ſo that he the ſame hour, without any pain, went out of the houſe to his Work-houſe, which can be atteſted by the Phyſitian Thomas Flory, and the chief Chirurgian Warner Leuretius, as eye-witneſſes, that ſaw it with great admiration.

CHAP. III Of the next and always concomitant Cauſe of the Gout

Qu. A After you have ſufficiently made out, that the gouty matter cauſes a ſwelling, for the moſt part inviſible; be pleaſed to explain to us what is the next and always accompanying cauſe of this tumour; which to know, I think to be of great importance.

An. You judg aright; foraſmuch as the Cure hath always a reſpect to the Cauſe of the diſeaſe; and ſince 'tis in vain to hope for a recovery, as long as there is an error or miſtake about the peccant or gouty matter.

Qu. Have Phyſitians been of one opinion herein?

An. No: For ſome have aſſigned the cauſe to be a ſlimy and cold humor; ſome, a mixture of gall and ſlime; ſome, a crude, indigeſted and impure blood; others, a ſerous humidity, mix'd with an acrimonious ſaltneſs; others, winds, with a mixture of the four known humours; others, ill-conditioned winds alone.

Qu. Whence, I pray, ariſeth this great diverſity of opinions?

An. From thence only, that (as hath been already intimated) they have not diſtinguiſh'd the Gout from its ſymptoms; which hath ſo abuſed them with the notion of the humors, that they have put thoſe out of the liſt of gouty perſons, who in their Gout perceived no afflux of humors, abſolutely requiring the ſame in this diſeaſe; notwithſtanding that ſuch as find no ſerous ſwelling in their gouty diſtemper, do feel full as much pain as others that are wont to find that afflux, whoſe grievous pains alſo are conſiderably abated upon the ſwelling.

Qu. Which then is, in your judgment, the next and immediat Cauſe?

An. We have expreſſed it in our above-recited deſcription of the Gout, to wit, that it is a Vapor or Damp, dry and cold, and mixed with malignity.

Qu. But many will look upon this as an airy and windy fancy, and no ſolid truth.

An. If men ſhall deveſt themſelves of prejudice, and maturely conſider all what hath been ſaid, and is yet to follow; I ſhall then expect a more favourable judgment, and an unanimous conſent to my doctrine.

Qu. According to your theory, the Gout is to be reckoned among Windy ſwellings?

An. So it muſt be, becauſe grounded upon experience, the Miſtreſs of Fools.

Qu. But is not this a quite new opinion; or hath there ever been any learned man that hath delivered the ſame?

An. When I lately enumerated unto you the various opinions concerning the cauſe of the Gout, you may remember, that the laſt of them was that which placeth it in meer winds, Now, among thoſe Doctors, Sennertus reckons Guainerius and Matthaeus de Gradibus, two eminent Phyſitians; and, as far as I can find, the Chineſe Doctors are all of that mind. Beſides, that ancient Phyſitian, Guido de Culiaca (though in the Gout he follows the Humoriſts) relates, that he had read in ſome preſcriptions of health given to the Popes of Rome, that this diſeaſe did ariſe from winds; and the Royal Chirurgian Pareus, p. 534. aſſigns, for the certain cauſe of the running Gout, a very thin fuliginous matter, which is nothing elſe but a ſubtile ſmoaky damp, or ſpirituous ſubſtance.

Qu. But Pareus doth not ſpeak ſo of the other kind of Gout.

Anſ. 'Tis true, that he affirms it of the running Gout; but then I muſt ſay, that that kind doth not at all in its eſſence, or next cauſe, differ from the other Gout, but only in ſome qualities, relating to the thinneſs and thickneſs of damps; thoſe, from whence proceeds the running Gout, thinner and ſubtler; and thoſe which cauſe the other Gout, courſer and thicker. And 'tis notorious, that almoſt all intelligent Phyſitians aſſign damps for the next cauſe of Toothaches, Head-aches, Pleuriſies (at leaſt baſtard Pleuriſies), Colicks, and Epilepſies: Diſeaſes which in name indeed, place, and ſome ſymptoms, differ from the Gout, but not in their true eſſence; they being ſo near a-kin to one another, that they acknowledg but one and ſame cauſe.

Qu. 'Tis true, that ſome learned men have affirmed, winds or damps to be the next cauſe of the Gout; but others have rejected that opinion, and for their ground of doing ſo, I ſhall produce but one argument for all, which M. Beverwyck alledgeth out of Sennertus in his Treatiſe of the Gout, ſaying, All ſickneſſes which ariſe from winds, do not laſt ſo long as the Gout; and making uſe of this reaſon for his denying the flatus or winds to be the true Cauſe of the Gout. And further in his Medicina, p. 62. treating of Tumors in general, he declares, That the windy ſwellings do vaniſh eaſieſt of all. What you can ſay to this objection, I long to hear.

Anſ. Thoſe great men ſpeak here only in general of windy tumors; and what they ſay is only true of ſuch windy ſwellings as lurk under the skin, or in fleſhy parts; not in thoſe that lie in deep parts, and under firm and thick membranes, as in the Gout, and other hidden or manifeſt ſwellings, raiſed from latent winds: See the proof hereof in Hildanus, p. 6. obſ. 40. in a Tympanites that was refractory to all remedies.

Qu. What then is the true cauſe why the Gout is ſo long a curing? Is the gouty cauſe (the damp) ſo difficult to be with ſpeed removed and evaporated?

Anſ. The gouty damp is eaſy enough to be evacuated, and 'tis even forward to be exhaled; but there is a notable obſtacle which hinders the ſpeedy performance of it. And that is this; The impacted and incloſed damp, which cauſeth the windy tumor in the Gout, ſeeks a paſſage to iſſue out at, but finds none; partly becauſe of the groſneſs of the damp; partly and chiefly by reaſon of the cloſe and firm membrane of the bone, under which it lurks; eſpecially ſince the place, in which this cold damp lodgeth, enjoys but little warmth, for the attenuating of this groſs damp, and expelling it through the ſmall pores of that membrane.

Qu. But, I pray, Sir, let me know what is the chief motive that hath induced you to make Damps the only next cauſe of the Gout?

Anſ. Firſt, This remedy which I here offer, as that which ſuddenly cures this diſeaſe: For, if it be true, that the Medicine declares the Diſeaſe, as Phyſitians afirm with their Maſter Hippocrates; I muſt then conclude, that no humors, but only a Spirituous thing, is the cauſe of this Diſeaſe. Secondly, obſerving the ſudden motion of the gouty matter, ſometimes diſlodging in a very ſhort time from one limb to another, from the hand to the foot, from one foot to the other, &c. flying as 'twere with ſwift wings from above to beneath, and back again; I find my ſelf obliged to judg, that theſe are not Humors, but ſome Spirituous matter able to do ſuch things.

CHAP. IV. Of the Qualities of the damps that cauſe the Gout.

Qu. OF what quality, I pray, are theſe gouty Damps?

Anſ. The above-recited deſcription ſaith, that they are dry, cold, and illconditioned.

Qu. Why do you ſay they are dry?

Anſ. The better to diſtinguiſh theſe Damps from windy Humors.

Qu. Why cold? Is there not a hot as well as a cold Gout?

Anſ. As there is but one next cauſe, which for quality is always cold; ſo is the diſtinction of a hot and cold Gout, vain: My opinion agreeing with that of Fernelius, that all Gout ariſes from a cold cauſe.

Qu. But with what reaſons can you maintain this opinion?

Anſ. Irrefragably by the remedy it ſelf; as alſo by the pruriency and ſhivering which gouty perſons, upon the motion of this cold damp, do commonly feel, eſpecially in thoſe parts through which it takes its courſe; as alſo happens in Epilepſies, Pleuriſies, Colick, and the like, that come from cold damps.

Qu. But ſoft and fair: Your laſt proof taken from ſhivering doth not hold, as Beverwyck objects; for then ſhould the matter of hot Fevers be alſo cold, which paſſing through parts endowed with the ſenſe of feeling, not only cauſe ſhivering, but alſo claſhing of teeth.

Anſ. This is not ſaid from wellgrounded knowledg; ſince it hath never yet (that I know) been ſatisfactorily proved, that Hot Fevers (as they are called) muſt needs procced from an hot cauſe; and upon a thorough diſquiſition, it might perhaps be found, that they have been produced from ſome cold matter or other; which I think at leaſt to be half proved, becauſe ſometimes an hot Fever ends in the Gout; as I have found; not to go far, in my ſelf, when I was in the 50 th. year of my age. It ſometimes alſo comes to paſs, that the Gout determines in an hot Fever; as appears from what Beverwyck ſaith in his Book of the Gout, p. 110. ſpeaking of the ways through which the gouty matter takes its courſe. The damp, ſaith he, turns back into the veins, and aſcends up again to the noble part (meaning the heart,) where it raiſes hot Fevers, Anguiſh, and the like evils; or ſhoots ſuddenly into ſome other limb, whereby the pain that is in the hand, is ſoon after felt in the foot.

Qu. But is not that notable inflammation, which is often ſeen and felt in the Gout, ſufficient proof that there is a ſort of Gout which comes from heat?

Anſ. This is a Symptom or accident in the Gout, which is not cauſed by the next and always accompanying cauſe of it, but by the violent pain; as I ſhall more clearly make out, when I come to ſpeak of this Symptom; But 'tis a Symptom, (not to paſs that by in this place) which hath ſtrangely miſled thoſe who have miſtaken it for a mark of the Gout, as Sennertus and others do ackuowledg.

Qu. Is this damp alſo ill-conditioned and malignant?

Anſ. So 'tis judged by conſiderable and experienced men, as well as by my ſelf, and that from the intolerable pain and other accidents. So doth that old Maſter Guido de Culiaco; and Pareus in his 7th. Book, ch. 2. proves it by two Examples; and our new Medicine confirms the ſame. Beſides, the foetid damps of the Gout do plainly ſpeak this malignity, which is perceived both at the time of the act of burning, and after it; that being ſuch, that ſometimes both the Patient, and the Perſon that adminiſters the Cauſtick, and dreſſes the part, are ready to fall away. And this is moſt of all found at the dreſſing of the little wounds, when they begin to omit good ſtore of moiſture. For as ſoon as you ſhall in a morning open the little Plaiſters, you will be ſo ſtruck with a ſtrange ſtinking ſmell, that it will almoſt caſt you into a ſwound. 'Tis very probable, that this ſtuff is already malign before it be caſt out from the heart into the limbs; yet remaining for a while wedged in the limbs, from the evaporation obſtructed, its malignity is heightned. Hence it is not adviſable, to ſerve this burning or dreſſing upon any one that is faſting; but 'tis beſt, that both the Patient and the Agent ſhould firſt breakfaſt, and take a cordial.

Qu. But, is it poſſible for Winds to occaſion ſo much miſchief?

Anſ. Very poſſible; and then eſpecially, when they are more peccant by their quality than quantity: So Hippocrates in his golden Tract of Flatus's doth not without cauſe judg of winds, that moſt of all the grievous and dangerous Diſeaſes owe their original to them.

Qu. But can Winds breed ſuch viclent pain?

Anſ. They can; chiefly when the membranes (the main inſtrument of the ſenſe of Feeling) are by them attacked and diſtended.

CHAP. V. Of the Part affected, and Seat of the Gouty matter.

Qu. WHich then, in this painful Diſeaſe, is the part that is attacked and offended by theſe Winds?

Anſ. Principally, if not only, that ſenſible membrane called the perioſtium, that is, that membrane which immediatly covers the bones.

Qu. Do you not think, that the membranous ligaments do alſo ſuffer here, or rather the membranes of the ligaments?

Anſ. No; but I agree herein with Galen, that they have no feeling; the which is alſo confirm'd by the learned Barbette in his Praxis, chap. 5. p. 30.

Qu. What do you underſtand by the Peri-oſtium?

Anſ. That ſingle membrane or film, whereby the Author of Nature hath outwardly inveſted and covered all the bones of our body, and which is a cloſe and firm ſubſtance, extendible, and very ſenſible.

Qu. Doth the gouty matter fall from without upon this ſenſible perioſtium, fretting and biting it by its acrimony?

Anſ. Not ſo; for then it could not cauſe ſo intolerable a pain, or the right Gout.

Qu. Where then are we to look for the true ſeat of the gouty matter?

Anſ. No-where elſe but between the membrane and the bone.

Qu. Wherein then conſiſts the genuine eſſence of this Diſeaſe?

Anſ. In the violent diſtenſion or ſtretching of this ſenſible membrane by the Winds, whereby this membrane being forced out of its due and natural form and ſituation, excites ſo violent a pain.

Qu. Whence do you infer that the gouty matter lies ſo deep, and particularly between the membrane and the bone it ſelf?

Anſ. Not only from the diſtending pain, (which is to me proof ſufficient) but alſo from the contumaciouſneſs of the Gout, which made Hippocrates ſay in his 6th. Book, aph. 49. That the Gouty fit doth not ceaſe before the fortieth day. And truly, whereas all other windy tumors, that are not lodged ſo deep, are in a ſhort time made to evaporte; this windy ſwelling of the Gout lying ſo deep, and lurking under ſo firm and cloſe a membrane, (and beſides, in a place of little warmth, and it ſelf coming from a cold cauſe) cannot be eaſily brought to a quick evaporation, but by ſuch a kind of remedy as ours is.

Qu. Have not the old and new Maſters miſtaken the Part affected, and the true Seat of the Gout?

Anſ. Certainly they have: For, (to ſpeak of the part affected, and the ſeat together,) I muſt firſt alledge the opinion of Galen, (as 'tis cited by Beverwyck;) he affirming, that the gouty moiſture doth flow into the hollow of the joynts, and there forces aſunder the bones; whereby the ligaments and membranes, that faſten them together, are ſo violently expanded, that they cauſe that exceſſive pain.

Qu. Hath this ſentiment of the great Galen been generally judged and received to be conform to truth?

Anſ. It hath been rejected by many, as by Beverwyck and others; and by others maintained.

Qu. Where do thoſe that contradict Galen, find the Part affected, and the Seat?

Anſ. In the ligaments and membranes that tye the bones together, being penetrated and ouzed thorough by a ſharp humor.

Qu. What hath moved thoſe that are of the later opinion, to reject Galen's Doctrine?

Anſ. See and read Beverwyck and others.

Qu. But how doth Galen refute their opinion, who ſay, that the gouty matter ouzeth thorough the ligaments and membranes?

Anſ. Thus, that never a gouty perſon hath been perceived to have convulſions or drawings of the limbs: Which yet muſt needs happen, if the warm humor did paſs through the ligaments and membranes.

Qu. But theſe alledge, to ſtrengthen their opinion; Firſt, that the pain, as ſoon as the limb is but touched, preſently increaſeth. Secondly, the debility and troubleſome motion of the part. Laſtly, the laxity of the ligaments, which being ouzed thorough by the humor, do ſtretch, and ſometimes cauſe diſlocation, Are not theſe ſolid reaſons to perſwade you and all others that they have hit right?

Anſ. Not at all; for their proof is lame in all its parts. And, not to repeat the irrefragable proof of Galen againſt their opinion, the pain doth not increaſe when the limb is but touch'd and moved, becauſe, forſooth! the gouty matter hath ouzed through the ligaments and membranes: No; for, not theſe, but the perioſtium is the part affected in this evil, which being by the gouty damp already diſtended, is upon the touching, or leaſt motion of the limb, irritated a new, and ſo cauſeth new pain. Where I eſtabliſh this for a certain truth, that never the gouty matter, but only the accidental affluxed humor ouzeth through the ligaments, ſo as to occaſion ſtretching and diſlocation: Which we intend more fully to make out, when we come to ſpeak of this accident of diſlocation.

Qu. But againſt Galen's proof, the defenders of this opinion alledge, that 'tis no ſtrange thing, that the acrimonious humor of the Gout ouzing through the ligaments of the joynts, cauſeth no drawing in the limbs, becauſe ſay they, the nerves themſelves are not offended, but only the membranes and membranous ligaments, which do not cauſe the motion; and that therefore, although they are ſeized with great pain, they cauſe no convulſion; juſt as 'tis alſo found in the Tooth-ach, Pleuriſie, and Colick.

Anſ. This is an exception that concludes nothing, foraſmuch as the Gouty matter provokes not the organs of Motion, but thoſe of Senſe.

CHAP. VI. That the Gout is a general Diſeaſe of the limbs, receiving its denomination from that limb which it ſeizes on; together with the place in which the Gouty matter is bred.

Qu. IS the Gout a general Diſeaſe, (as Galen affirms) attacking all the joynts of the limbs of the body?

Anſ. It is ſo general, that not one external part of any limb of the whole body is by its own nature exempt from it. The reaſon is, becauſe that all parts and limbs are wrapped about with this ſenſible membrane, called Perioſtium, the head, neck, jaw-bones, breſt, back, and the teeth themſelves, foraſmuch as they are incloſed in their groves or pits.

Qu. Doth this Diſeaſe take different names, according to the limb which it infeſts?

Anſ. It doth ſo: Hence 'tis called Podagra, when it falls upon the feet; Gonagra, when upon the knees; Chiragra, when upon the hands; Iſchiatica, when upon the hips: And ſo, the Tooth-ach, when upon the teeth; the Pleuriſie, when upon the skin that clothes the ribs, &c. All which I eſteem to proceed from one and the ſame cauſe; though many will think this ſtrange.

Qu. What is the antecedent cauſe of the Gout?

Anſ. Whatſoever breeds theſe damps.

Qu. In what place grows this damp, being the next cauſe of the Gout?

Anſ. The learned do as little agree in this, as they do in the next cauſe it ſelf; and Fernelius complains, that no man had thoroughly ſearched into this point, and that through the want of the knowledg thereof, the Gout had been left for incurable.

Qu. Is this peccant matter bred only in the head, excepting the skull, as Fernelius would have it; or without the brain, as others think; or moſt of all in the Viſcera, as the ſtomach, ſpleen, liver, gall, and the reſt?

Anſ. I give my voice for thoſe that affirm the laſt, viz. that theſe Gouty damps are moſtly generated in the inner parts, yet not excepting the head.

Qu. But can you tell, Sir, in what manner they are there produced?

Anſ. Doubtleſs they are, through want of heat, gathered and laid up in ſome or other of the aforementioned parts from corrupted humors, and particularly from corrupted blood.

CHAP. VII. How, and through which ways, the Gouty matter comes to the Limbs.

Qu. SInce theſe morbid damps do cauſe ſuch grievous pains in the external limbs, but are bred in the inner parts; by what means and paſſages do they come to thoſe limbs?

An. By means of the Circulation of the blood through the manifeſt ways of veins and arteries.

Qu. Do not theſe damps aſcend or deſcend directly into the limbs, without paſſing the heart?

An. They muſt needs firſt paſs into the heart.

Qu. By what ways?

An. Through the veins, which, gathering out of the inner parts the generated damps, carry them, together with the not yet ſufficiently concocted blood, into the heart.

Qu. But do not theſe malign damps offend that noble part, ſeeing they cauſe ſuch grievous pains in the limbs?

Anſ. Certainly they do; and are the cauſe of Fevers, beating of the heart, and other diſtempers; and frequently cauſe death, when the heart wants ſtrength and vigor to expel them.

CHAP. VIII. Of the Expelling Part.

Qu. IS the heart then the only ſtrong expelling part, which drives thoſe damps into the limbs?

An. It is, as is evinced by the ſtrong motion and beating of the arteries in the Gout; whereby the heart labours to deliver it ſelf from ſuch a pernicious damp, and to diſcharge and purifie the nouriſhing blood of the ſame.

Qu. Through what ways doth the heart drive out theſe damps into the limbs?

An. Through the arteries.

Qu. Whence is it, that the Gout for the moſt part manifeſts it ſelf in the extremities of the limbs of the body, as (for example) in the great Toe of the left Foot?

An. Becauſe that the heart, undertaking the expulſion, drives this offenſive matter as far as it can.

Qu. May one from the Gout judg of the vigor and debility of the heart?

An. You may probably do ſo from the ſuffering part: For, if that be far from the heart, then the heart is ſtrong; if near it, then 'tis leſs vigorous, and unable to ſend that noxious matter far away.

Qu. But when the heart through the arteries doth expel into the limbs, together with the nouriſhing blood, theſe damps; muſt thoſe limbs receive them?

An. They muſt receive them as well as the nutritive blood which accompanies it; the heart expelling them chiefly by the force of the arteries, not reſting till they be thruſt out.

Qu. But why doth not the part aggrieved expel thoſe damps, and ſend them further away?

An. Sometimes it doth ſo; namely, when the expelling force of ſuch a limb is ſtrong and vigorous; for then it ſuffers not this bad gueſt to harbour there, but forces it by the veins to retreat back to the heart; whence it not ſeldom comes to paſs, that by another expulſion from the heart it falls upon a weaker limb; as we ſee, that the pain which at firſt was felt in the hand, ſoon after is found in the foot, &c.

Qu. When and how comes it to paſs, that the limb is not able to drive or ſend away this peccant matter, but is conſtrained to lodge that unwelcome gueſt?

An. When the expelling vertue and the natural heat of that limb is defective, and too weak.

Qu. But, Sir, can you ſully make it our, that theſe malign damps take their courſe to the limbs, only through the arteries?

An. I can, my reaſons being theſe: Firſt, I prove it by the beating pain, which, amongſt others, is in the Gout one of the ſure marks; for, that beating pain ſufficiently ſhews, that the Gouty matter comes out of the arteries. Secondly, 'tis plain from the ſwelling, diſtenſion, and quick pulſation of the arteries, as thoſe through which this matter takes its courſe. Laſtly, 'tis moſt evident from that remedy, which hath been uſed by the ancient famous Phyſitians, as likewiſe from our diſcharging medicine.

Qu. What remedy of the Ancients do you mean?

Anſ. That of Arteriotomy, or the opening of Arteries; by means whereof, they declare to have found incomparable more help and eaſe for the gouty Patient, than from the opening of veins; for a proof, that the gouty matter is protruded from the heart through the arteries.

Qu. But how doth it appear from your own Remedy?

An. Foraſmuch as the ſame being applied to the Arteries, (when they by their ſtrong pulſation give ſufficient aſſurance that the peccant matter is not yet quite expelled, but in part ſtill harbours there,) fetches out that offenſive ſtuff, and frees them therefrom; as we ſhall more plainly ſhew in our manner of curing the Tooth-ach: where it will manifeſtly appear, that this Burning of ours is not only a diſcharging, but alſo an excellent exhauſting aid, forcing theſe damps in the arteries and veins to evaporate.

Qu. Doth this painful matter cauſe no pain as long as it is included within the coats of the arteries?

An. It cauſes no pain until it does violence to the perioſtium, becauſe the tunicles of the veins and arteries are void of feeling.

Qu. When the Arteries (in thoſe that already feel great pain) do not ceaſe to beat ſtrongly, what conclude you thence?

An. That the Gouty matter in part ſtill reſts in the arteries.

Qu. May this matter be totally expelled out of the arteries?

An. Not only it may; but the heart, as the ſource of the arteries, never reſts till it hath effected it.

Qu. Can this damp of it ſelf, or by too ſtrongly repercutient means, be turned back again through the arteries to the heart?

An. Some indeed are of opinion that it can; but I ſay that 'tis not poſſible: Nature, or rather the wiſe Author of it, having provided certain valves, which towards the heart are ſhut, and ſo hinder the return of blood and vapors thither through thoſe veſſels.

Qu. Through what veſſels then returns this damp to the heart, as it often doth?

An. Through the veins, the Antagoniſts (as one calls them) of the Arteries; for this way is open and unobſtructed, all the valves of them towards the heart being open.

Qu. How comes it to paſs that this damp returns to the heart?

An. Either when the expelling virtue, and the natural heat of the part that receives the damp is great; or when ſtrong repelling means are unwarily applied; by which latter way the Patient is exceedingly prejudiced, becauſe thereby the pernicious damp is made to return to the heart, which with ſo much labour had diſcharged it ſelf from it; and there it cauſes Fevers, Anguiſh, and the like diſtempers, and often Death it ſelf.

CHAP IX. Of the Diagnoſticks, or Signs of the Gout.

Qu. IS it neceſſary to know the proper Signs of the Gout?

An. Certainly it is; foraſmuch as thoſe only are fit to cure the Gout, who know well the proper Signs thereof.

Qu. Hath there been no miſtake herein hitherto?

An. There hath; for men have made thoſe to be ſigns of the Gout that are none, as Inflammation, Heat, Fever, &c.

Qu. Which then, in your opinion, are the proper ſigns whereby the Gout can be beſt diſtinguiſhed from other diſtempers?

An. Vitiated motion and Pain: which ſigns are preſent from the beginning of the Gout, and as 'twere born with it, and do grow up with the ſame to its height, and abate alſo and vaniſh with it.

Qu. Are theſe the only and always concomitant ſigns, by which we may know this inward, and, for the moſt part, unſeen windy tumor?

An. They are ſo; though ſwollen veins, and ſtrong beating arteries, may alſo be put for ſigns of the ſame.

Qu. Thoſe two firſt, are they Signs only, or alſo Symptoms?

An. They are ſure ſigns, but they are alſo ſymptoms.

Qu. Inflammation, Heat, Fever, outward ſwelling from afflux of humors, &c. why may not they be eſteemed to be proper ſigns here?

An. Becauſe they do not immediately follow the Diſeaſe, nor any proper effects of the Gouty matter, nor do they always appear in the Gout; and therefore are deceitful ſigns, not to be truſted to, and ſuch as have miſled ſome of the moſt ſagacious men.

Qu. Are they to be reckoned amongſt the Symptoms?

An. Not among the proper ſymptoms of the Gout, but only ſuch as proceed from ſome proper ſymptom of the ſame.

Qu. How is that pain conditioned, which you make to be a proper diagnoſtick or ſign of the Gout, whereby the Gout, or the inward tumor in tho perioſtium, is made manifeſt?

An. 'Tis a pungent, diſtending and beating pain, which begins and ends with the Gout, and grows up, and declines with the ſame.

Qu. What denotes the pungent pain?

An. That the perioſtium ſuffers.

Qu. What the diſtending pain?

An. That the ſenſible membrane is raiſed and ſtretched by the Gouty matter.

Qu. What the beating pain?

An. That the gouty matter is already impacted and wedged in.

Qu. What ſignifies the intolerable pain?

An. Both the plenty and malignity of the damps, whereby the ſenſible perioſtium is forcibly ſevered from the bone, and ſtands by the force of the intruded winds bent, like a ſtring upon a bent Bow.

Qu. What doth the Pain indicate, which not only pervades all the parts of the body, upwards and downwards, but alſo paſſes to the moſt extreme part, in ſuch a degree, that the poor Patient can reſt neither day nor night?

An. This plainly and palpably ſhews (beſides what was juſt now ſaid in the next foregoing anſwer,) that the membranes of the parts have a ſtrict communication with one another, and a mutual ſympathy.

Qu. What doth the Vitiated motion indicate, which increaſes and decreaſes as the Diſeaſe doth?

An. Not that the organs of motion are attacked, hurt or tormented, but only that the perioſtium is put out of its natural poſture; which is manifeſt from hence, that as ſoon as this membrane is reſtored to its natural ſtate, you cannot perceive the leaſt defect in thoſe organs.

Qu. Why then doth the pain increaſe, and grow more violent upon touching or moving the part affected?

An. This comes not to paſs becauſe that the organs of motion, or their membranes do ſuffer; but becauſe that the membrane being already diſtended, by the touch or motion thereof it comes to ſuffer, and to ſtretch a new; whereupon new pain muſt follow.

CHAP. X. Of the Symptoms of the Gout.

Qu. FOraſmuch as there are found many and different Symptoms in the Gout, will it not be proper to make a diſtinction between them, thereby to come to the true knowledg of them?

An. You will do very well to diſtinguiſh firſt the Symptoms in general from the Diſeaſe it ſelf; and then to make a diſtinction between the Symptoms themſelves.

Qu. What diſtinction is there to be made between the Symptoms of the Gout?

An. This; that the ſymptoms that ariſe and vaniſh with the Diſeaſe, are to be diſtinguiſh'd from thoſe that are bred not from the Gout, but from the ſymptoms of the Gout.

Qu. Which are the Symptoms that do immediatly accompany the Gout, and are born and dye with it?

An. Of theſe there are but two, already ſpoken of, viz. the Vitiated motion, and the Violent pain: Theſe come and go away with the Diſeaſe, following the Gout as a ſhadow doth a body.

Qu. Which of theſe two Symptoms is the chiefeſt and moſt grievous?

An. The Pain; which is not the Diſeaſe it ſelf, or the cauſe of the Gout, as hath been already ſaid; nor yet is it a ſimple Symptom, in regard it is a cauſe of other ſymptoms, eſpecially when it is violent.

Qu. What Symptoms are occaſioned, or rather cauſed thereby?

An. Inflammations, Fevers, Faintings, Sleepineſs, Loſs of ſtrength, Afflux of humors.

Qu. Is it certain, that all theſe ſix Accidents are cauſed by the raging Pain of the Gout?

An. Dr. Paul Barbette reckons them all amongſt the effects of the Gouty pain, when he treats of the Symptoms of Wounds in his Chirurgery, p. 165. of his Dutch Edition. Beſides that 'tis manifeſt, that moſt of theſe do then firſt appear when the pain grows violent, and diſappear with the diminution and ceaſing of the pain.

Qu. Whence comes it, that theſe Symptoms that are cauſed by the Gout, not only in divers Patients, but alſo in the ſame, ſhew themſelves at one time more than another, and differ ſo much from one another?

An. It comes from the greater or leſſer intenſneſs of the efficient cauſe, the Pain; which receives its degrees from the quality and quantity of the gouty matter. For the more malign and abounding the damps are, the more grievous alſo are not only the proper Symptoms, but alſo theſe Accidents of the Gout.

Qu. Doth the raging pain excite in all Gouty perſons theſe Symptoms all together, and at once?

An. Not ſo; for in bodies that have but little ſeroſity in the blood, the firſt five Symptoms do appear; but not at all, or very ſeldom, the ſixth and laſt, which is the afflux of humors: In others, who abound in that ſeroſity, the afflux of moiſture will be perceived firſt of all, and often without inflammation. Again, when the gouty matter lurks deep, as in the Sciatica, and in the Gout of the ſhoulders, you are not then to reckon upon the change of colour, and the afflux.

Qu. That raging pains do cauſe inflammations, is eaſily underſtood; but how do they produce Fevers, Faintings, Sleepineſs, and loſs of ſtrength?

An. The intolerable pain drawing to the heart, cauſeth there a Fever and Fainting; and paſſing to the brain, produces there Waking: whence muſt neceſſarily follow Loſs of ſtrength.

CHAP. XI. Of the external Serous Tumor, which often manifests it ſelf in the Gout.

Qu. IS it worth while, to treat ſomewhat more largely of this Tumor, than of the other Symptoms cauſed by the Pain?

An. 'Tis very neceſſary, becauſe by this Symptom many Learned men have been ſo miſled, as to take it for the Gout-breeding matter it ſelf, or at leaſt not to diſtinguiſh it from the Sickneſs it ſelf: Whence, as from a fruitful ſoil, have ſprung ſo many errors about the Gout, and eſpecially about the proxime Cauſe thereof. Yea this is the only cauſe, that ſo many Phyſitians and Chirurgians are ſo much wedded to the Notion of Humors, that they dare almoſt take it for granted, that the Gout cannot be without this Swelling and Afflux of Humors; inſomuch, that if they meet with any Gouty perſon, in whom they cannot find this Swelling or change of Colour (although they find great pain,) they will rather diſcard them out of the number of the Gouty, than acknowledg, that ſometimes there are no humors at all accompanying the Gout.

Qu. But ſince the Affluxed humor, which breeds the external ſwelling, is neither in whole nor in part the Cauſe of the Gout, what ſhall we make of that tumor and its matter?

An. It is a Symptom, which is no inſeparable companion of the Gout; yea never begins, and ſeldom ends with that diſeaſe: Which I think I can ſo plainly make out, as that the moſt ordinary capacity ſhall underſtand it to be ſo.

Qu. Does then this ſerous Swelling not always accompany the Gout as an inſeparable Symptom?

An. No; for, beſides that ſome Gouty perſons ſeldom or never perceive this Tumor (cauſed by affluxed humors,) as I have experienced, and many Writers muſt witneſs; commonly there is no affluxed Humor found in the Sciatica.

Qu. But does this Swelling never begin with the Gout?

An. 'Tis never perceived in the beginning of the Gout; for, though in many Patients this Tumor very ſoon follows upon the Gout; yet, if it be well obſerved, it is never of the ſame age with the Gouty tumor, which in order of time always precedes it: Yea, if care be had, its birth may ſometimes be altogether prevented, by being timely ready to evaporate this dolorifick damp by a ſpeedy application of my matchleſs diſcharging Remedy; as I have often experimented on my ſelf, and ſhall further teach in the ſecond part, treating of the Cure of the Gout.

Qu. But as this Symptom never begins with the diſeaſe, does it neither end always with it, as other Symptoms do?

An. No: This Symptom alone ſurvives the Gout; yea the cauſe whence it riſes ends not with it. For, as for the moſt part it firſt appears when the ſickneſs is at its height, and the pain rageth; ſo it is often ſeen a good while after the Gouty pain, and then by good means and ſome patience diſpelled.

Qu. It ſeems then, that the pain, which is the cauſe of this Symptom, ceaſing, the outward tumor doth not vaniſh at the ſame time?

An. No; for very often the limbs remain ſwelled as before, and it requires ſome days, and ſome trouble, before this Swelling can be removed; yea, if you do not take care, it not only lames the Patient, but alſo deforms him by Nodes and Schirres, whereby the Motion of the limbs is for ever deſtroyed.

Qu. What then is to be done, to judg aright of this Symptom?

An. You muſt hold it for a certain truth, that the Humors which in the Gout breed the Swelling, are not the peccant or Gout-breeding matter.

Qu. To make me the better comprehend this, pray give me a clear deſcription of this Swelling, which hath been the occaſion of ſo many Errors, and hath deceived ſo many Learned men?

An. It is a Preternatural ſwelling in the Fleſhy parts, conſiſting of a ſerous humor pervaded with ſaltiſhneſs, by the ſharp pain penetrated into the Limbs, and 'tis ſoft, pale, and cold.

Qu. But how may we beſt diſtinguiſh this Swelling from the Gout?

An. If it be view'd at the time when its Efficient cauſe is gone; for then it may be ſeen in its true eſſence and qualities, and looks no otherwiſe than a Serous humor is wont to do.

Qu. I ſee, you make two ſorts of Swellings in the Gout?

An. I do ſo; the one is Windy, which is the Gout it ſelf; the other Serous, which is a Symptom: And they differ exceedingly from one another.

Qu. Wherein conſiſts that difference?

An. Chiefly in theſe particulars: 1. In reſpect of the Name, which they receive from their ſeveral Cauſes; for the Gouty tumor coming from Winds, takes the name of Windy tumor; the other, coming from a ſerous humor, is called the Serous tumor. 2. In reſpect of the Part or Place affected; for, whereas the Windy tumor diſtends the Membranes of the bones, the Serous fill the Carncous parts, as water a ſpunge, and render the Fleſh very ſpungy. 3. In regard of the Signs; for, whereas the Inward ſwelling excites grievous and intolerable pain, the Serous none or little. 4. The Internal ſwelling is a proper diſeaſe; the other is raiſed by the pain, and is a Symptom bred by Conſent of parts.

Qu. But ſince that the Serous tumor in the Gout is not produced by any External cauſe, but by an Internal, what is this Cauſe?

An. The violent pain, as hath been often ſaid, which is here the cauſe of the Afflux of humors, it being known by Artiſts, that Pain draws humors after it; which therefore is by them aſſigned to be one of the principal cauſes of the Afflux of humors.

Qu. But are theſe humors, of which this kind of Swelling conſiſts, drawn into the ſuffering parts by the Pain alone?

An. Artiſts are wont to add, that ſympathizing Nature, as a kind Mother, ſuccours the ſuffering part by ſending moiſture to it; and accordingly this Swelling ſhould be generated by Sympathy of Conſent of the parts.

Qu. What benefit or eaſe doth the part affected receive from ſympathiſing nature by her ſending thoſe humors thither?

An. That the raging pain is thereby mitigated, and rendred more tolerable.

Qu. In what manner is that done, or how doth the conveyed humor aſſwage the enraged pain?

An. Though this be difficult to explain; yet I cannot agree to the common opinion, importing, that the Pain-breeding matter by means of the conveyed humors is driven outward, and diſperſed thorough the neighbouring fleſh, and ſo the ſuffering member for a great part freed of the pain-cauſing matter: For, the conveyed humors can by no means approach or come to the dolorifick matter, much leſs fotch it out of its deep ſeat, and diſlodge it, becauſe 'tis ſo faſt impacted and included under ſo firm and cloſe a Bone-membrane.

Qu. What is then, in your opinion, the reaſon why the ſharp pain is often diminiſhed upon the afflux of moiſture, not only in the Gout, but alſo in the Tooth-ach? &c.

An. Methinks 'tis probable, that 'tis done after this manner: The muſculous fleſhy parts being by the conveyed humors rendred ſofter, plumper, and more ſpongious, and conſequently gentler, do not, in the firſt place, preſs againſt, or rather reſiſt ſo much the ſenſible and diſtended periostium, as before, when the carneous parts had but their own native and proper moiſture. Secondly, the periostium being by the conveyed moiſture from without made gentler, may with leſs pain be ſtretch'd; and it may alſo come to paſs, that by that little warmth, which this ſerous matter hath in it at firſt, it being now come near the periostium doth ſomewhat attenuate the included groſs damp, and ſo the better diſpoſe it to evaporate.

Qu. But doth the affluxed humor occaſion no miſchief?

An. Very much, and ſometimes more than the Gout it ſelf; for without care it cauſeth Diſlocation of the ſuffering members, and the Nodes.

CHAP. XII. Of the Diſlocation.

Qu. HOw is it poſſible, that the Gout-breeding matter ſhould cauſe a Diſlocation?

An. By the plentious ſtock of humors conveyed and drawn in.

Qu. But how; doth this abundant moiſture, falling into the cavity of the joynts, forcibly thruſt the bones out of their cavity?

An. Not ſo; but 'tis done in manner following: Pain and Nature cooperating, the one by drawing in, the other by conveying, bring ſuch a quantity of humors to the ſuffering part (for example, the Hipp,) that thereby, in time, the ſtrong ligaments, which tye the bones together, are ſo ouzed thorow, that being debilitated they ſtretch and grow ſo lax, that the bone falls out of its cavity, and ſo cauſeth diſlocation: Of which we have many ſad Examples.

Qu. Doth not this miſchief fall often out in other Caſes?

An. It may happen in all the members of the body; and then eſpecially, when an unskilful or imprudent Maſter by the uſe of wrong means occaſioneth yet a greater afflux of humors than hath been already drawn in by the pain, and furniſh'd by nature: Of which, Pareus records a memorable Example in the Diſlocation of the knees, cauſed by a Pariſian Maſter, called Greaulm, fol. 256.

Qu. May this Diſlocation be prevented by Art?

An. Very well; as ſhall be ſhewn in that part of our Book, which is to treat of the Cure of the Gout, and its Symptoms.

CHAP. XIII. Of the Nodes.

Qu. IS there yet more danger to be apprehended from this Symptom, or its matter?

An. There is; for if you take not great care, it will change into an incurable Scirrbus or hard tumor, which in the Gout are called Nodes, according to that of Ovid;

—Tollere nodoſam neſcit medicina pedagram.

Qu. When comes this ſwelling to change to ſuch an hardneſs?

An. To borrow the words of Beverovicius; when the thin humor is inſenſibly exhaled, and the ſediment reſts behind, then will that turn into hard knobs, which burſting of themſelves, or being opened, render a chalky or ſuch like matter, whereby our limbs are not only deprived of motion, but alſo diſpoſed to crookedneſs.

Qu. How many ways are theſe ſtony ſwellings generated?

An. Two; either of themſelves, or by the unskilfulneſs of the pretended Artiſt.

Qu. When of themſelves?

An. The Evaporation of the ſubtiler or thinner parts of theſe humors may be cauſed by the natural and innate warmth of the ſuffering part, aſſiſted by the adjacent parts, as alſo by the preternatural heat of the inflammation of the ſame, without any other external cauſe: Whereupon the groſs, thick, ſaltiſh, and carthy parts, as the ſediment and relicks remaining in the limb, are coagulated and concreted.

Qu. I. underſtand you very well; but, I pray, tell me alſo, how may this come to paſs by the Unskilfulneſs of Practitioners?

An. When they apply too ſtrongly repelling, or drying, or too much cooling remedies, which drive the thinner parts inward, or diſpel them, and ſo harden and render incurable the thicker ſtuff; whereas they ſhould uſe moderately warm mollifying remedies, thereby to expel and conſume the whole matter.

Qu. Do theſe Nodes, when they are cauſed without the application of perverſe remedies, grow on leiſurely?

An. They do ſo, when they are bred of themſelves: For, the foundation of this chalky matter being once laid, 'tis raiſed and encreaſed more and more upon every new afflux, and from time to time ſcaled over, until it comes to that bigneſs, that it only hinders the motion of the limb, and renders it crooked, but can alſo ſtay or have room no longer under the skin, but making it firſt protuberant, burſts it at length in pieces.

Qu. Surely an ignorant Practitioner can bring this to paſs much ſooner?

An. So he can, and to ſuch a degree, that the poor Patient in the very firſt fit of the Gout is for ever deprived of the motion of the ſuffering limb; of which we have in Banda an Example of a Lieutenant of ours, now lying here in Garriſon, called Jan van Haerlem.

Qu. But may not this growing of Tophes or Nodes be prevented and hindred?

An. Very well; as ſhall be taught in the Cure of the Symptoms of the Gout.

Qu. Will you proceed now to the ſecond principal you intended, viz, the Cure of the Gout?

An. I will, after you have heard what I had to ſay of the Nature and Cauſe of the Gout, its Seat and Part affected, its Diagnoſticks, Symptoms, and the neceſſity of diſtinguiſhing theſe latter not only from the diſeaſe it ſelf, but alſo from one another: All which have made way to judg the better of a fit Remedy to cure the ſame; ſeeing we cannot hope for Cure, before the Malady be throughly underſtood.