AN ESSAY ON THE NATURE AND METHOD Of TREATING the GOUT.

LONDON: Printed for the AUTHOR, M.DCC.XLVI.

AN ESSAY ON THE NATURE and METHOD Of TREATING the GOUT.

IT is certain, that many Treatises have been published on this im­portant Subject, and considera­ble Discoveries and Improve­ments made to the Science of Physick; yet, it is manifest, the Assiduity of the Learned, and the most Inquisitive, [Page 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 ma­ny 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. Here­ditary, [Page 5]and Adventitious. The first des­cending 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 spiritu­ous 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 Distem­per 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 Con­tinuance.

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 [Page 6]little Time before it remits; then a gen­tle 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 af­ter, 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 Pa­roxysm 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 con­tinue fourteen or sixteen Days; but in el­derly People, and such as are frequently af­flicted, it generally holds for two Months: Such as are broken, or much weakned, either by their Years, or a long Continu­ance 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.

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 Medi­cines unskilfully applied, and the Length and Obstinacy of the Disease perverted, other Parts are then infected, as Head, Shoulders, Stomach, Hands, Wrists, Elbows, and some­times one or more of the Fingers are dis­torted, or made crooked, and at length ge­nerating 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 fre­quently, if the Disease happens to be of a long Duration, so as to confine the Patient [Page 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.

It is the general Opinion, that a tar­tarous urinous Salt, is the princi­pal Cause of this Distemper.

PARACELSUS terms it Morbus Tar­tareus, 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 Per­sons.

Helmont says, its Original is in the Sto­mach, which breeds an Acid, which insi­nuating [Page 9]itself into the Synovia, coagulates it, and by a preternatural Heat, it is hard­ened into Chalk; and that the Intenseness, or Remissness of the Pain, is to be attri­buted, 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 fre­quent 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 immode­rate 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 en­tirely 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; where­by, the acid Faeculencies remaining in the Stomach, become an acid and vitious Tar­tar, corrupting the Lympha and Juices, [Page 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, Tu­mour, 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 transub­stantiated 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 pro­per Diet, due Exercise, and a few well chosen Remedies may go a great Way, if not to a perfect Cure, yet to make Life to­lerably 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 Com­plaint, and at the same Time, strengthen the Tone of the Stomach.

THIS is the essential Reason of the wri­ting this Treatise, viz. to remove this in­graned and transubstantiated Conception, and [Page 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 re­moved: And if the Patient be but freed from chalky Concretions, and of a Consti­tution 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.

The general and direct Method in Curing the GOUT in the Fits, is a gentle Perspiration and breath­ing Sweat by Medicines, repeated twice a Day, as long as the Fit continues; that causes no Sickness at the Stomach, and that are ea­sily digested, giving a gradual Heat and Warmth through the Body.

DILUTION frequently by proper Li­quors, 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 Wa­ter-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 [Page 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 Sen­sation, and not inflame, will procure Cool­ness and Rest.

THE Diet ought to be easy of Digestion, such as Sagoe, or Panado, with a little Ma­deira 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 com­monly 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 plenti­fully, because sometimes a good Part of the morbific Matter may be carried off that Way. Immoderate Sleeping and Watch­ing is to be avoided, likewise Venery.

IF the Patient can suffer Motion, it is better to use it, by which the Calculus is prevented.

LASTLY, The Mind is to be kept se­rene 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 stub­born 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 attri­buted chiefly to the Goodness of their Con­stitution.

To speak something of the Medicines that have this salutiferous Effect. The Pro­fessors 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 Dis­tance from the Stomach) that soon after the first Dose is received, they have this Con­sequence, [Page 15] viz. give the Patient very sensible Reason of its reaching that Part, by an ad­ditional Warmth and Moisture; Indications sufficient to a gouty Person. And if one Dose have so great Effect, what must re­sult 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 unex­pected Relief the Patient so suddenly re­ceives, to some Assistance from the opiate Tribe.

THE publishing this Secret would imme­diately 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 Argu­ment, and when proper make it publick; but to satisfy the timerous, shall so far de­clare, that there is not one Grain of an O­piate, or those Minerals in the Compo­sition.

IT is certain, Minerals, such as Mer­cury and Antimony, have been us'd, but [Page 16]prudently condemned as dangerous Medi­cines, breaking and tearing the smallest and finest Vessels and Fibres, by their Particles, so that the Body, when the Blood is reple­nished again with gouty Salts, becomes in a worse State in respect of the future Fits, which will become more painful and obsti­nate, 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 sto­mach 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 breath­ing Sweat, and so repeated for a few Days, the Symptoms of a regular Fit are com­pleatly carried off.

THE irregular GOUTS, where the Con­stitution is broken and impaired, and the gouty Humour fixes on the Head, the In­tention 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 bleed­ing in the Foot, blistering on the Ancles [Page 17]to give the gouty Matter a vent down­wards. 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, with­out an absolute Necessity, is not to be ad­mitted of, but when other mild Methods has been ineffectually used. Gentle sto­mach 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 com­mon and less dangerous Case, for it rarely comes on or goes off without touching there, and is as easily removed; but to­wards the Decline of Life, especially in those that have been long afflicted, the Pa­roxysm generally of great Length, is more obstinate, especially when it settles in a constant Pain, and in nauseating and keck­ing in the Stomach.

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 pre­scribed, as a Dose of the Indian root and re­peated as they found Occasion; but, I ne­ver had a Patient that pursued my Method of Evacuation by Sweat, to have any Call for such an Operation, therefore cannot ea­sily admit of the Remedy. Stomach Pur­ges, such as Hiera Picra, with Tincture of Diambra, or Snake-root, blisters on the Ancles, highest Cordials, and most gene­rous 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 Sto­mach Purges frequently repeated, a regular Diet and Exercise, perpetual Blisters be­tween the Thighs, powerful Evacuation by the Pores, cupping between the Shoul­ders, or Bleeding in the Foot, are the only Means effectually to remove it.

THE GOUT in the Intestines, must be treated altogether as in the Stomach, and no Opiates to be used, but in the last Ex­tremity.

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 Inflama­tion on the Lungs.

THESE are Cases that are generally at­tended 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 A­qua Mirabilis, would rest on his Stomach.

AFTER some Weeks, and various Me­thods had ineffectually been made use of, I was admitted, and gave him the Medi­cines, and along with them, warm spice [Page 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 res­tored, 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 Constitu­tions 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 to­wards the grand Climacteric, then the Time [Page 21]cannot so easily be limited: However, I may affirm, that it will be barely half the Time of the customary Length of the Pa­roxysm.

IN young Subjects, I have known the Cure performed in ten or twelve Days, to an entire Extirpation; and this great Bene­fit obtain'd by no other Method, than Me­dicines that promote Evacuation by Sweat, that cause no Sickness, Thirst, or any In­conveniency whatever, but sit easy on the Stomach.

IN the Practice of ten Years in this Dis­temper, I do not remember an Instance of the GOUT either hereditary or adventitious, that withstood the Efficacy of these Me­dicines 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 Under­taking of this Nature, that has not the Sanction of the Superiors in Physick; but I hope in Time, every one will be convin­ced, that the sole End and Design is im­mediately calculated for a publick Benefit; [Page 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 de­sire 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.

FINIS.

ERRATA.

PAGE 7, Pares read Parts. Page 9, vrey read very, Page 11, freed read free.

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