Of the Gout/Part 2
PART II.
A Treatise of the
CAUSE and CURE
OF THE
GOUT.
MDCCXXXIV.
29th June, 1733.
OF THE
GOUT.
HEN I published the letter last year, about the cure of the gout by oyls externally apply'd; I did not lay my self under any engagement to defend the practise at all adventures. I recited only what I then knew of it, having heard of and seen its success in my own neighborhood, to a surprizing degree. I had carefully weighed the thing in my mind, found it well answer'd the theory of the distemper; such as I had form'd to my self; from experience, practise, and from the best reasoning I was master of. It promis'd no more than it perform'd, which was to cure a fitt of the gout; There were no instances of ill consequences in the use. It had been try'd 3 or 4 years, and in a sufficient number of cases, Lastly, I had used it upon my self, and that in more than one species of the same distemper. After all this, I suppose I had good reason to notify it to the world, and for the world's advantage; What I wrote was as an invitation to try a remedy apparently good, in a most cruel and common distemper; and an expectation that all fair tryals of it should be made known, for the confirmation or condemnation of the practise.
I thought too there was enough to justify me in not delaying the publication: and that an excuse would be allowed from the great consequence of the thing, and from the uncertainty of human life; if I had happened to be too precipitate. If the remedy proposed should have prov'd not altogether so successful and effectual as I at first imagin'd: yet such a publication might be extremely useful, in giving a hint to the world. Very often great inventions are not brought to the last perfection in the birth. They may require addition, method, correction, maturation. My sole view was to benefit the publick. It was impossible I should have any further interest in the thing, than that I my self was part of the publick, and should continue to reap the advantage of the practise in common with other people: or be timely disabus'd, if by experience it was found prejudicial.
Therefore I shall make no apology for this present treatise, supposing 'tis become a just debt from me. The importance of the subject claims it. That from a whole years farther consideration and experience, I may give my maturer sentiments about this practise. And I profess sincerely should I happen to be mistaken in whole or in part, I should be as early to acknowledg it. Whoever have felt the weight of the distemper, would be glad for any safe lenient in the case, any approach toward a cure. Nor should I think much at the hazard I might run of an unjust attack upon my character (if any I had or deserved) for so desireable an end. All lovers of mankind will be pleas'd to have their fellow sufferers exempted from so excessive a misery; even those that are not obnoxious to it. For my own part, I cannot but look upon it as a most auspicious piece of fortune in my life, that I thus became acquainted with a method which may render my future days comfortable. But how small a pleasure is that, in comparison of being an instrument of benefiting mankind! Nevertheless the use of these oyls has been generally decry'd at home, and it took its share even in party-contests, as usual in the country. 'Tis not to be conceiv'd with what diligence and malice it was pursu'd here, as if the author of it had been a publick enemy to mankind when he recommended nothing but what he us'd first himself. Tho' instances appear'd daily before their eyes, of its good effects; yet those were detorted and misrepresented as much as possible. And they would rather believe the most irrational thing whatever, than attribute any good effect to the medicin. And those that had been wonderfully reliev'd by it, were suborn'd to deny it. And after all, when the most: extraordinary success attended the use of it every where, those very persons who had been the opposers of the oyls pretended to imitate them, but vain.
What the antients call'd our Fate, the sors vitæ, we Christians are taught rightly to call the direction of Providence. As in great societys of men, states, kingdoms, empires; so in the conduct of every private man's life, this over-rules all accidental or acquired inclinations,and turns them as best suit his own purposes and infinite wisdom. When I reflect upon several remarkable coincidences in my own fortune; I seem to discern a superior direction in this affair before us, without which in all probability, this extraordinary remedy would have been lost to the world. This no doubt has often happened in like cases, where they have not been properly notify'd to the publick, and supported till their own excellency establishes them in the opinion of mankind, I have reason to say thus much, both from the violent opposition abovemention'd, and from Dr. Rogers the inventor's aversion to make himself or remedy publick. He never had the least thought of doing it: but I persuaded him to permit the World to reap the advantage of his labors, hazard, and pains, and to reward him for it. Providence directed me to the Cure of this parish in the year 1729, in which year in the month of May he first began to put in practise these oyls upon himself. I succeeded his brother, and he himself became my parishioner; but being of opposite partys, we had then no particular friendship. He had labor'd under the distemper in a most deplorable manner, being laid up frequently 6 months at a time with it. Life, he said was become a mere burden to him, and to try somewhat, the only hope left. His father was of great eminence for his skill in pharmacy, and no one will deny him the justice to say the same of him. The success answer'd to his great joy, and but to his own cure, for a year or two. 'Tis difficult to persuade the world to any thing new, till it's become a fashion: especially considering withal, that to give this medicin but its due praise, it appeared to extraordinary, that nought but some of the common quackerys could pretend to deserve it. Some people at length ventured to use it: the event was always so surprizing, that they could scarce induce themselves to think they had the distemper.
Last year 1732. I was seiz'd with a fitt on St. Peter's day, which is June 29. it confined me in the house for 3 months and more. It happened during my tedious and melancholy decumbiture, Dr. Rogers riding abroad to visit a patient, was thrown off his horse in galloping. The horse fell upon his leg and bruised him in a most desperate manner. That leg was swell'd, inflam'd to a high degree, from knee ancle, perfectly black in color, with watry blisters; a frightful spectacle resembling a mortification. The gout the unlucky concomitant of all misfortunes of this kind immediately pour'd upon both feet, knees, hams, and his left shoulder. All the world of his acquaintances expected nothing less than a fatal catastrophe. He had recourse only to his oyls, never lett blood once nor purg'd. In less than a month, that terrible contusion, all the gout and symptoms were intirely vanish'd; and he was restor'd to a better state of health, and use of his legs, than he had enjoy'd for several years before, to the amazement of the whole town of Stamford and the neighborhood.
This extraordinary event alarm'd me, and made me seriously to reflect upon it; the gout at that time still hanging upon me. At length I determin'd to use the oyls, and they instantly reliev'd me, and put a most desireable period to a fitt which commenced at the latter end of June. This was the 11th of December.
When I consider'd carefully the good effect this application had upon my self and others, and its perfect safety, for Dr. Rogers had us'd it 4 years upon himself: I could not omit acquainting the world with it, as soon as possible. He knew not the least of my intentions; nor was there any intimacy between us. They that wish well to mankind will, I doubt not, rejoice, now I can inform them, that I have no need to retract in any wise from that notification. That I am confirmed very much in my opinion, of the excellent use of these oyls in the gout, from innumerable cases since then, where they have been apply'd, in all parts of the kingdom; in which they have not once failed. Those that happen;d near me, I have been particularly curious, in attending and observing, thro' the whole stage of the distemper and the cure; not without great astonishment. But what is most sensible, I had a necessary occasion of trying them again upon my self.
'Tis burthening the reader's patience and my own, to recite many of these cases, and trifle in circumstantial descriptions. The cure is as general as the variety of cafes can he. I have seen where the recent gout has fallen upon persons in full vigor of manhood, upon both feet, ankles, knees and hams at once; and where from no temperate way of living, the podaric matter has been much and furious. I have seen the practise of it in people in years that have labor'd long under the cruel evil. And in rheumatisms of the most severe kind, and in many instances of the sciatica or hip-gout. Sharp has been the engagement between the malady and the remedy; yet in a week's time the fitt is master'd by the unction, all the pain and swelling is gone, and in 10 days or a fortnight they can walk abroad, and ride as well as ever: which fitts ordinarily would last 3 or 4 months. The quantity of ℥ii of the oyls will generally perform this cure. During the operation they make water freely, and have a stool regularly every day; both are fœtid, the water is full of clouds as soon as made, very high color'd and becomes very turbid, and full of sediment of a greasy, sabulous matter. If it stands 2 or 3 days you see variety of colors, and those parts that swim at top become mouldy. The stools are pretty natural and biliose. Their stomach begins to return in 3 or 4 days time; they are entirely quit of pain, and can live after their ordinary manner, and sleep at night. In a common and moderate fitt, where it's not become inveterate, the cure is so easy and pleasant, that it appears rather as a delicacy, than a medicinal application.
This year 1733 just seven days sooner than last year, I was seiz'd again in like manner, in most sultry weather, which was the reason of its hastning. Sydenham says, if a former fitt has treated us hardly, the following one comes regularly, when the year is return'd to the same point. I am as sure as I possibly can be of any contingency in this world, that it would have held me under its barbarous tyranny and confinement, for three or four months at least, had I not us'd this efficacious remedy. It came with great violence and suddenness, pouring down like a torrent, and I have no reason to think it would have been in any degree milder than last year. I had but just then regained any tolerable strength in my feet, since the last conflict. The oyls abated the pain presently. The 2d day, it was so little, that we podagrics may with ease put on the Stoic affectation and laugh at it: notwithstanding my foot swell'd as much as usual, and appear'd as fiery and inflam'd. 3 or 4 days set me in that state of recovery, which scarce less than 3 or 4 months would otherwise have done. In a week's time I was perfectly well. On the 9th day I buckled on my ordinary Shoo, and in a day or two more I walk'd abroad and have continued well ever since. The swelling was perfectly gone in 10 days time, and since that, my feet have been stronger than ever for 5 years last past, and the like is observed by others that have used these oyls. It did not attempt to seize on the other foot, as always was the case before. I observed too, that the skin of the foot never came off as usual, after solution of the fitt. 'Tis not easy to imagine the pleasure I felt, in thus escaping with the thousandth part of the pain which commonly attends us, in this unhappy situation: when I have enjoy'd a most perfect health and free use of exercise for the 6 months last past, which would otherwise have been consum'd in the most irksome confinement.
During my studys in physick I was sensibly mov'd to bend my enquirys more particularly and assiduously toward this formidable Goliath of our Art: Because I had an hereditary title to it, I read all the authors I could meet with, whilst I practis'd in the Metropolis. A large volume I wrote, being an intire history of the distemper, and the practise upon it, from the beginning to our own times; and much sollicited have I been by friends and fellow-sufferers to publish it. But I was too senlible the principal part, the crown-work was wanting, the Cure. Without that, 'tis vain to harangue the world with the formal and formidable pomp of ætiologics, pathognomonics, procatarctics, prognostics: to define, distinguish with subtilty, to ransack nature's recesses, to be elaborate in historys of cases, all the while the poor podagric suffers on. Nor has the distempter lost an inch of ground from Hippocrates's days even to our own. The gout the supreme tyrant still gives sentence as in Lucian 1500 years ago.
Εγω δε τουτοις πασιν οιμαζειν λεγω
I command them all still to roar on.
In this deplorable state of things, where I myself made an unhappy part, from a paternal labes, my thoughts were intent upon the distemper. I was always watchful of relief: I ever had the strongest persuasion in my mind that I should live to see that great discovery. For which reason I thankfully received the great blessing which Providence has vouchsaf'd us. I think it a duty remaining to give the publick an account of what is the' result of my meditations thereon, during the week's operation of the oyls. Now we may advantageously theorize from practise, not practise from theory. We may venture to write on a distemper when we have a sure remedy for it: and when the very cure will enable us to reason upon it. Nor will this be an useless labor, or a speculation of curiosity only: because by searching out the true nature of it, we are instructed best in a prophylactic regimen, and may provide for its extirpation, at least to weaken it very much and make it easy and gentle. No wise man will wish for a fever or willingly stand the chance of it, tho' we have so noble a remedy as the cortex, nor ought we to be careless and intemperate, because we can cure the gout.
As to the history of the distemper, I need observe no more than that the earlyest account we have of it is in the Scripture, and the earlyest we can expect to have. "II. Chron. XVI. 12. Asa in the 39th year of his reign, was diseased in his feet till his disease became exceeding great: yet therein he sought not to the Lord, but to the physicians. And Asa slept with his fathers and dy'd in the 41st year of his reign." It follows, that he was burnt in a funeral pile, as was the Roman custom afterward. It can't be doubted that this distemper was the gout, and coming upon him, when in years, soon put a period to his life. "In I. Kings XV. 23. we read it, in the time of his old age he was diseased in his feet." I don't suppose Asa was the first that had this distemper, but is the first recorded in history, and this is near 200 years before the foundation of Rome. Tho' he was a very good man, yet he fail'd of his duty to his maker, in this instance, that in so great a distemper, he did not consult the Lord, but the physicians. In those times of the first temple, there was a visible shechinah or glory, constantly resident upon the mercy-seat that covered the ark, between the wings of the cherubim in the adytum of Solomon's temple. The pecu1iar deity of this people, the Jehovah was personally present there, and answer'd in an audible voice, when acceptably consulted. And affairs of health were frequently the subject matter of consultation. Ego Jehovah sanans te, says God, Exod. XV. 26. whence the ancients made their Æsculapius. Tacitus hints well IV. hist. "many call Æsculapius God, because he heals the sick. Some hold him for Osiris the most ancient deity, most make him Jupiter the omnipotent, very many Dis pater." Jupiter is no other than the Jehovah of the Hebrews, anciently wrote Jovis, which is a greek termination of the heb. word. Hezekiah being ill, the Lord sent Isiah the prophet to him to apply a lump of figs for a plaister to his boyl, and he recover'd. II Kings XX. 7. Isaiah XXXVIII. 21. The devil in his oracles personated Jehovah, whence we read in the holy Scriptures, II Kings I. 2. Ahaziah king of Israel sent to enquire of the oracle of Baalzebub the god of Ekron, whether he should recover of his disease. Hippocrates de prisca med. says the art of Physick ought to be refer'd to God, for its original. Celsus in his preface says, diseases in the most antient times were thought owing to the anger of the immortal gods, and from them they ask'd relief. In imitation of this method of God almighty's, the heathen by the Devil's encouragement set up their oracles, and at first they were chiefly consulted for remedys in diseases, says Pliny nat. hist. L. 29. And no doubt but that cunning spirit, who could see farther into the powers of nature than man, kept up the credit of these places of enquiry, by now and then performing a cure. And it was the method of people to write a tablet and hang it up in the temple, of the remedy by which they were cured. And by means of these, Hippocrates (who was a most excellent genius withal) arriv'd at his great skill in the profession. However it happen'd, but true it is, that all mankind ever since, have as unsuccessfully consulted the physician in the gout, as king Asa did. God almighty has thought fit to set times to all useful inventions in every art, and now only (I think) we may with sure effect pronounce a remedy for Asa's distemper, in the sacred words of the great Prophet and legislator, which I have quoted in the title page.
'Tis impertinent to be tedious in giving a description of the gout. The poets study nature, and I cannot take any method so proper to paint the direness of it, as in their words. For which purpose I chuse Lucian's, in his merry and witty play call'd Tragopodagra. He suffer'd under the distemper and dy'd of it. Thus he describes it.
Χειρῶν ἀπ' ἄκρων, εἰς ἄκρας ποδῶν βάσεις
ἱχῶρι φάυλω, καὶ πικρῶ κυμῶ χολής,
Πνεύματι βιαίω τῶδε δια σφίγγον πύρους
ἔστηκε, καὶ μεμυκὸς ἐπιτείνει πόνους.
σπλαγχνων δ' επ' αὐτῶν, διά πυρον τρέχεικακὸν,
δίναισι φλογμῶν σάρκα πυρ πολούμενον,
ὁποῖα κρητὴρ μέστὸς Αἰτναίου πυρὸς,
ἤ Σικελὸς αὐλὼν ἀλιπόρου δια σφαγος,
ὅπου δυσεξέλικτα κυματούμενος,
σηραγξε πετρῶν σκολιὸς εἵλεῖται κλυδών.
ὥ δυστέκμαρτον πᾶσιν ἀνθρὠποις τἐλος!
from hands and feets extremitys
th' impetuous ichor flyes;
a furious spirit thro' every vein
rushes with unrelentive pain.
whilst every member, as it comes,
th' encaustic pestilence consumes.
as the rock Ætna's furnace burns,
and marble into pumice turns;
so by thy chymystry we find
our bones and joints to chalk calcin'd
or knotty made and motionless.
O who can thy dire ills express!
We need not spend time in repeating the great variety of opinions and different hypotheses in Authors about the formal cause of the gout. I see no reason to change any part of the theory of this distemper, which I advanced in my letter, touching the matter that causes it, and the seat of it, which I asserted to be the oyl-glands about the joints and tendons. It seems very plain, that 'tis deriv'd from the salts which abound in all our meats and drinks. 'Tis those which give our flesh, fish, their flavor; our wine, beer, their stength. And they that live well, have a good claim to the distemper; Helmont calls it morbus suaviter viventium; Homer long ago observed this, calling it Μισοπζωχος, it flys cottages and seeks the habitations of the idle and luxurious. There it reigns, L and revels. It passes by hard fare and industry, and subsists in jollity, feasting and midnight debauches. 'Tis not only dominus morborum, but morbus dominorum. All savory things convey into the blood great quantitys of these salts, which are permanent and incorruptible bodys, of great activity, solidity, force, attraction, and withal very fiery and caustic. All these qualitys are heigthned exceedingly and spiritualiz'd, the matter is rectify'd, as we may very properly call if, by various transmissions from one animal to another, from various concoctions, digestions, cohobations, fermentations. So that 'tis no wonder if at last, when they meet in a gouty person who ufes not labor and exercise enough, from the smothness of surface and solidity they strongly attract one another, and assemble too much together; from the sharpness and hardness of their points they lancinate; from their fiery malignancy they burn, and from nature's expelling them as much as she can, out of the habit of the body, they cause what we call a fitt of the gout. Wise nature (as we name the established order of causes and effects, flowing from the Almighty Will at creation) throws off these pestiferous salts, that they may not offend the general œconomy, nor attack the Capitol. She throws them off to the great joints, as much as possible, that they may be extinguish'd by a plentiful affusion of oyl, out of the glands there, which are to lubricate the joints. And we find this is most effectually done in a week or a fortnight's time, in young people, whilst these glands are vigorous. Here nature acts wisely, and loudly calls out to the patient, to take care for the future to avoid her method of life which produces this distemper.
I am thro'ly persuaded, the humor of the gout is much more impetuous and fiery in young people, than in those advanc'd in years, cœteris paribus. And that 'tis a vulgar error to say, the distemper grows worse and worse upon us, in its own nature: unless we grow worse and worse in our way of living, which is not commonly the case. People should become wiser and more temperate with advancing years; if they have been guilty of extravagance in youth. And podagrics generally are more careful in their regimen than other people. But the distemper grows worse upon us, only because the oyl-glands are spoil'd and can't as usual restrain its fury: besides the inconveniences accruing to a constitution weakned from so many tedious months of inactivity, which necessarily follow frequent returns of fitts. Further, the joint-glands themselves grow rigid, and secern less of their proper humour. Hence when the gout falls upon people in years, it proves very wevere, for want of a necessary quantity of that oleaginous matter to extinguish it. And instead of a week or a fortnight for its period, takes some months; and makes quick returns again. So that a fitt of the gout is most undoubtedly a crisis, and a just and useful crisis for a while. But after a few fitts, it ceases to be so. And 'tis hard to say whether we are to blame nature or the patient's own conduct, who scarce hitherto has had it in his power to assist her, for want of knowing what was the real nature of the distemper, Thus I shall explain my meaning. There are thousands of people, who live the most irregular, luxurious and debauch'd lives imaginable and yet enjoy a good state of health for many years, and escape the gout. As many people are obnoxious to it, who lead pretty regular lives, at least many degrees more so than the foremention'd, and yet are plagu'd with the gout; and apparently deserve not so severe a remedy. Ought we not then to change the common sentiments which we have got of this distemper; and call it a false crisis, when it's notorious that in the foremention'd people she finds out a better manner of relieving herself, from time to time, and with less real harm to the animal œconorny, than by that sharp and fearful medicin, and sequentially ruinous to the constitution, the gout? this is not to be call'd beneficial in a proper sense: any otherwise than as a lesser evil is more eligible than a greater. But of this question again hereafter, when we will endeavor to give it a fit resolution.
At present we take it for a fixt principle, that the cause of the gout is the abundance of these animal salts, work'd up with vegetable ones arising from tartar and fermentation. 'Tis very apparent that scurvy and gout are near ally'd. This we see abundantly from all authors, especially Dr. Musgrave but the salts in the gout are much more volatiliz'd, The gout then is the legacy of plentiful living and inactivity. These salts are sharp to create a good appetite, which podagrics generally find; but that creates a wrong balance between in-taking and expending. And we may very well with Dr. Cheyne define the gout to be, an effort of nature to throw off this abundance of salts. I add, she understands chymical mixtures well; so she throws 'em off into the oyl-glands, because nought but oyl can sheath their pointed particles.
In order more plentifully to drain off these salts, which must necessarily be convey'd into the blood, more or less, in all our meat, and drink, Nature has well provided us with two great glandular bodies, the kidneys, plac'd at the extremities of two large blood-vessels, the emulgent vein and artery, derived from the great vein and artery, very soon after their parting at the heart, the fountain of circulation. These large vessels bring and carry back the blood to and from the kidneys near the main stream, where it passes quick. And the kidneys separate these salts from it abundantly in the urine. And because this was not enough, the whole skin is fill'd with glandular pores, as further emunctories of these salts in sweat, after they are blunted and become saponaceous, by a mixture of oyl. And no doubt but the matter of insensible perspiration, which in quantity exceeds all the other evacuations put together; consists chiefly in these salts volatiliz'd. The salivary glands carry off a further part. The vast evacuation of bile takes up a considerable quantity of these salts: every secretion whatever has a share of them: life requires this active principle in every part. Thus we see how anxious nature has been to relieve her self from any ill effects thereof and to lessen the quantity, as much as may be, of those untamable bodies; which yet are very necessary to be admitted into the blood for the sake of their energy; and by their good disposition and management, all vegetable and animal life very much subsists. But the universal frame of nature depends upon action and re-action. The proper measure of it creates a good constitution and harmony of the functions and health; from a preponderancy flow discord and diseases, and particularly the subject of our present enquiry.
These salts being too long retain'd in the circulatory organs become highly volatiliz'd and caustic. All salts are more or less caustic, but most, such as have pass'd thro' an animal; from such urinous salts the phosphorous only can be produc'd. Spanish flys, bees, wasps, ants and all those kind of creatures which blister, are made up, as it were, of these caustic salts. Glow-worms, lanthorn-flys may be call'd a living phosphorous. The sting of bees, wasps, and all poyfons of animals are made of these caustic salts. And they much resemble the pain of the gout, which differs from common pain, and feels like that of a hot coal or hot iron apply'd to the part. And no doubt with great propriety; the matter of the gout may be termed a liquid phosphorous, a subtle poysonous gas which nature exterminates for her relief. What we call a rheumatism is the arthritis vaga of the ancients, 'tis a real gout in another mode; and admits of the same cure.
Hippocrates makes the causes of the gout a flatus or spirit, ἀνεμία he calls it, II. epidem. § 5. and its quick and sensible transitions show plainly 'tis as a subtle aura which passes thro' the whole habit of the body. And that aura as Ten Rhyne says p. 33. de arthrit. is maligna, perniciosa ac quasi venenata. Pareus says 'tis αρρητον, a thing of an incomprehensible nature, no more known than that of the plague, epilepsy, lues venerea. XVII. 2. he makes it subtle and virulent. Cardan makes the cause of the gout to be a spirit. Senertus a sharp, salt, subtle humour, a salt spirit. And when they burn with moxa, a flatus is perceiv'd to hiss out of the wound. If they keep it open like an issue, a thin ichor exsudes, fiery, malignant and very fetid. Platerus de observat. propr. says he has observ'd long sinus's and wormhole-like corrosions in the muscles of those that die of this distemper. Sometimes it appears on a sudden, like a florid boil in the face or any other part, sore and fiery beyond expression, and in all respects like a plague-boil. This being burnt with moxa, or dextrously let out, gives a speedy cure. Parry relates such a story of the a Lady at Bordeaux, Bushoff of a man at Wratislaw; and I have seen the case more than once. Tulpius in his observations, L. IV. 2. tells a story, that the subtle aura of the gout in a patient, would sometimes fly up from the great toe to the brain, and cause an epileptical fitt. Whereupon they ty'd the joint, and hinder'd its ascent to the head: and by caustics, scarifications and the like, upon the part, they so lett it out or alter'd the texture of it, that they made a cure.
A man cannot without horror think upon this diery pest got into his veins, preying upon his carcase alive, freely ravaging every limb like a conquer'd and triumph'd province. They that have felt it, know the pain. But how is the prodigious evil doubled, when we know no remedy? The great Agippa Augustus's friend, his General, his admiral, his son-in-law, the second man in the empire, wife, valiant, fortunate, under the agonys of the gout, chose rather to want the sense of feeling, than to feel such torment; and by the advice of one of his physicians, put his legs into hot vineager, which destroy'd his nerves and kill'd him. Pliny, nat. hist. ccxxxi.
Varro relates that Servius Caludius a Roman knight, constrained by the greatness of the pain, anointed his legs with poyfon and thereby depriv'd 'em of all sense. Pliny, xxv. 3.
How many great men do we dayly read of languishing out their lives under the hopeless yoke of this malady, how many do we daily see? Lucian mentions many of the famous heroes of old among the Greeks. Such as king Priamus, Achilles, Oedipus, Proesilaus, Ulysses, Bellerophon, Plesthenes, Philoctetes.
Charles the great, the emperor, who us'd to conquer all, was at last overcome by the gout, as Sennertus tells us. So the great prince of Conde. Nor does it make less havock in the learned world. The famous Tyrannion the grammarian dy'd of it.
Ennius ipse pater, dum pocula siccat iniqua,
Hoc vitio tales fertur meruisse dolores.
The learned Vossius, and innumerable more, nay, it spares not the professors themselves. Even Radcliff the great genius of our age, as Sydenham of the preceding, both compos'd themselves with inevitable patience at its approach. They who repel'd death all around them, tamely awaited his last stroke, when armed with this dart.
Thus from all ages it has appear'd an equal difficulty to bear and to remove the gout. Sydenham, a great glory to our country and art, sagacious in all other distempers to a wonder, after 40 years, suffering, observing, studying it, at last complains there's no remedy: lyes calmly down, ' Tityus like, for the fierce vultur to prey upon his bowels, fortifys himself with the cold comfort remaining, of stoical apathy. Nullus dubito (says he) prudentissimos quosque eorum, qui cum hoc morbo diu conflixere, de omnimoda curatione desperantes, Choro qui istius dramatis (sc. Luciani Tragopodagra) catastrophen facit, suffragaturos. Lenem O obique gentium celebrata afferas nobis dolorem, O podagra, levem, facilem, non acutum, brevem, haud sœvientem, &c. Hippocrates the father of the greek medicin says the inflammation ceases in 40 days. This we would suffer contentedly, were it but a single decumbiture in a man's life. But alas in our clime, 'tis not content with that allowance, and even then will make but short intervals, before it repeats its unwelcome visit.
If we examin curiously into nature's arts, in forming the bodys of animals, which are design'd for motion and action, we may remark, one of them provides for the slipperyness of every part, where any motion is performed. This is in order to prevent grating, heat and friction. Thus the membranes that cover the inner cavity of the chest, and belly, which we call pleura and peritonœum, the membrane that incloses the heart call'd pericardium, are altogether glandular; the one to favor the ceaseless motion of the lungs, the other the peristaltic motion of the intestines, the third that of the heart. Likewise all lesser and more particular membranes belonging to the viscera are of like structure. All the common membranes which cover the muscles, which are the ropes of the body; all the membranes which cover the joints, the pullys of those ropes, partake of like artifice. The little glands abounding over their whole surface spew out continually an oyl, to keep them moist and smooth. More particularly still, in the joints themselves are certain cavitys contriv'd, wherein great glands are inferred, as in a secure corner, not to be press'd upon by the bones in action: yet so as to gently touch'd and sollicited to pour out their oleaginous contents, upon every action. Likewise upon every great tendon of a muscle, there is a gland to moisten it and keep it from breaking. Thus in that cavity for the head of the thigh-bone is a great gland, as big as a nut, the largest of this sort in the whole body as the largest joint: in the knee-joint are 4 or 5, in all the joints of the hands are considerable glands, well provided by wise nature for that organ of organs. So upon every tendon of the hands, especially those of the musculi perforantes; upon the shoulders: upon the feet, on every joint and tendon of the toes, tarsus, metatarsus, particularly on the great tendon of the muscles which extend the foot, and those of the perforantes on the ancles, and so of all the rest, according to their action and exigence. Beside this, there is a continual exsudation of the oil of the marrow, which is contain'd within the bones, thro' their foraminous extremitys, upon the joints themselves as the learned Dr. Havers shows, p. 172. of his osteology. 'Tis very evident that without this excellent contrivance, upon extraordinary action of any joint, the ends of the bones would be wore away, or at least they would be fir'd with heat.
The liquor which thus abounds in the joints is a delicate, pellucid, oleaginous subistance, of an incomparable smoothness, something like the white of an egg, a natural balsam to prevent the injurys of action. This is seen to run plentifully out of the joints of calves feet when cut. The use of all this is apparently,the same as grease to coachwheels. 'Tis an oyl thicken'd by the saline particles in our blood and the nitre of the air, as Havers shows from Dr. Grew: this is to actuate it and render it useful. The oyl of the marrow and the oyl of the joint-glands continually bedew the joints and fit them for action. Both concur in that important office of an animal, and in a proportion agreeable to the exigency of the whole and of each limb. This oyl and this mucilage he compares to the artifice of carters and coachmen, who make in imitation thereof a composition of grease and tar, with which they besmear the inside of the naves of wheels and the extremitys of the axis upon which they move. Without this their swift rotation and continued action would set them on fire, as well as wear them away.
This smooth composition is useful not only to the extremitys of the bones and cartilages upon their articulation, but to the ligaments likewise, the bandages that keep them together. It preserves them from dryness and rigidity, plyable and conform to all the variety of necessary action.
The glands are small and numerous upon every membrane about a joint: likewise upon some particular parts of a membrane, where 'tis convenient. And in the sinus's of the bones in the joints, these glandules are so conglomerated, as to form remarkable glands. In some of the large joints there is only one and large as in the acetabulum of the thigh bone: in some, as in the knee, there are 4 or 5. the fabrick of them consists in several membranes superstrated one over another, set thick with small round bladders, which not only lye contiguous, but tenaciously adhere together; as the several membranes likewise do. All these glands have excretory ducts into the joints. There are of these glands upon the first vertebra of the neck of the atlas; on which the head turns; on the articulations of the ribs to the spine. In the shoulder joint there is a considerable one; so in the cubit are several. So upon the radius and ulna, the wrist upon the patella of the knee, and in short upon every joint, cartilage, membrane and tenon of the whole body. For which reason these very parts are all the seat of the gout.
I find that from time to time, mankind has made some approaches toward discovering both the nature of the disease and the cure. The happy completion of it was reserv'd to our times. Among the innumerable dreses, which they have put the humor of the gout into, we may observe all along, they make it of a very subtle, burning and deleterious nature. Tho' there are great variety of opinions concerning the origin of it, some attribute it to one of the 4 fancy'd humors predominating, phlegm, b1ood, bile, melancholy; some to a straitness of the capillary vessels at the extremitys, or to their rigidity; some to the nerves and nervous fluid, some to indigestion, wind and the like; still the matter it felt that causes it, they thought contagious and inflammatory. Sydenham more than once pronounces the constitution of podagrics to be luxurians & virosa, which we may translate poysonous, that is, their blood is of a rich nature apt to secern a juice of a poysnous quality, in other words the gout. Havers makes the matter of a Rheumatism or running gout acrious, subtle, hot and volatile, of a burning and fiery quality, saline, pungent, lancinating, corroiive. That it falls upon the mucilaginous glands in the coats of the muscles and coagulates their juices, just as spirit of nitre does, and the like acids when pour'd upon them.
They had reason enough even from the observation of sense to say so much. I add, that this is not to be understood in a poetical or figurative sense only, but literally and strictly. For I scruple not to affirm the matter of the gout is a true poyson. These are some reasons that justify me in the affirmation. 1. I argue the gout is an actual poyson from the violent inflammation, swelling, pain, heat, thirst, and all the concomitant symptoms; the very fame to all intents and purposes, wherever it fixes, as in a venomous bite: and the humor probably is as little in bulk. We see how terribly the sting even of at wasp or bee will swell and inflame a whole limb; and produce a most fiery pain. Hippocrates aphor. 47. § 6. observes the gout is a true inflammation. And when it seizes on the stomach it produces the same symptoms as poyson swallow'd. 2. I argue that 'tis a poyson from the juvantia & lædentia, heat enrages it, the warmth of the bed and warm flannels do no more good, than keep it where it is fix'd upon the part. The cool air or cold water sensibly abates the inflammatory heat and pain, but then the drive it out of the part, as uselessly as the former method, but more dangerously; because it recurs somewhere else. Neither the heat makes any evaporation of that humor, nor does the cold any ways extinguish it. These bare qualitys have no useful effect. Again, 3. The 2 only methods of cure, the moxa and our oyls, both confirm my position. 'Tis not to be doubted that the moxa has often cured the gout: but 'tis a tremendous remedy. It will not be easy to persuade patients to bear the slow fire of a wooly plant burning upon their flesh for a minute or two. Nor is the cure so infallible. But certain it is, that where burning whether actually or potentially, cures the gout; it cures it merely as a poyson: the fire of the poyson submitting to the greater fire, as a hot iron cures the is bite of a viper, by ruining and destroying the texture of the poyson. 'Tis to be observ'd that the little wooly cone or moxa which is to burn the part, must be set with great exactness upon the very point where the gouty drop lyes. For if you set it but an inch off that place, it produces no effect. This shows 'tis by the fire, which kills this poyson that the cure is perform'd, rather than by any quantity of humor deriv'd from the burning. And this shows too, that the humor how small soever in quantity, is a real poyson. The same thing we infer from the Indian practise of lighting the moxa with little aromatick flicks prepar'd for that purpose. These in burning, emit a very grateful smell, good against the poysonous damp and fume of the distemper, which the fire draws out of the wound; and which is very prejudicial to the patient and byestanders, as well as to the operator that performs the burning. The suddenness of the relief here proves the same thing, for tho' we are not able to stir our foot for several days without lifting; upon letting out that envenom'd steam by the moxa, we can walk instantaneously; and the cure of the gout by our oyls proclaims the same truth. These oyls introduc'd upon the poysonous gas in its recesses, effectually disarm and subdue its virulence; as unctuous things likewise cure venomous bites, if timely apply'd, and before the poyson has diffus'd its self into the blood. Our oyls are but a succedaneum to nature's oyl in the joint-glands, too little in quantity to perform the cure; either naturally where the gouty matter exceeds the antidote in one joint, or where these oyl-glands have been much debilitated, shrivel'd, and injur'd thro' frequent lifts, in which case our oyls come as a timely auxiliary, and effectually turn the fortune of the battle, to the patient's advantage.
4. I argue the matter of the gout is a poyson from that Common appearance of the skin coming off, after a long fitt of the gout. Nature has been strugling for months to subdue this internal poyson, by dint of time and patience, by affusion of blood and humors upon it, to quench this fiery venom, and at last, and with her best endeavors; 'tis but imperfectly and partially done. 'Tis quieted, not extinguished. Like embers it lyes lurking, till additional strength enables it to break out into another fitt. But that part of the humor which nature by long time and force drives out thro' the skin, so taints its emunctorys, as Virgil's harpys, so leaves its pestiferous sordes behind, that nature is forc'd to throw it off and form a new skin under it, and well we may say of if in the poet's words,
Tristius haud illis monstrum, nec sœvior ulla Pestis, & ira Deûm Stygiis sese extulit undis.———————— contactuque omnia fœdant Immundo —————. Æneid. III.
And this is a thing common in all poysonous cases, and surfeits, as the country people call them. The whole skarf-skin comes off wherever the venom has touch'd. But I observe when we perform the cure of the gout by means of our oyls, taking it very early; the skin does not come off. The poyson is extinguished. What little of substance there is in it, gives nature no trouble, she probably carrys it away in that very turbid water which we make during the operation. And if we suppose the salts are not absolutely and entirely blunted by the oyls, we may justly think they have but activity and pungency enough left, the better to conduct them to the urinary organs. And thus the excellent Sydenham in the end of his terrible pathology of the gout says, "a most intolerable itching, in the foot affected, comes upon the fitt retir'd; especially between the toes, scaly parts then come off; and the feet are stript of the skin, as if we had taken poyson, quasi epoto veneno." As we read his pathology of it, we cannot but see all along that the humor is a poyson which nature is curing as well as she can, by plunging it into the oyl glands; every plunging is the paroxysmulus which he mentions, many of which make a paroxysmus. For as 'tis impossible in a great fitt that the oyl glands of one joint should be sufficient to extinguish that poyson, she is forc'd to divide the onsetts or fitts into little ones, to give time for the glands to recruit, and for the fame purpose she throws the humor alternately from one foot to another, and when those two limbs are not sufficient she takes in more.
5thly, The universal appearance of the gout, and what all authors write about it; that by continuance of time, it turns all the humours in the body to its own likeness, shows evidently 'tis a poyson, and that when we have long labor'd under it, the remnant of our unhappy life is but a continual struggle of nature to drive of that poyson from the first vital principle, and fight it as long as it is able. So again that common observation in it, that the sharper the fitt, the severer the pain; by so much the shorter it is, and the sooner we recover; shows likewise that 'tis a poyson. As Sydenham observes, pain is nature's most bitter remedy in the case, which the more vehement it is, so much it shortens the fitt, makes the intermission longer and more perfect. The crueller has been the conflict, so much more oyl and labor has nature expended to procure a victory. Would we then know the nature of the gout, we need only read Dr. Mead's book of poysons, and be fully appriz'd of the matter. I doubt not but the poysonous drop of the gout is similar to that of a venomous bite, as Dr. Mead observ'd it upon a microscope glass; a parcel of small salts nimbly floating in a liquor and striking out into crystals of incredible tenuity and sharpness, he calls them spicula and darts. Such likewise in the drop emitted by the sting of a bee, and in the common nettle. He found by experiments that 'tis of an acid nature. He solves the symptoms by the pungent salts of the venom acting as stimuli, irritating the sensile membranes, deriving a greater afflux than ordinary, of the animal juices that way. In speaking of the poyson of vipers being swallow'd without harm, he attributes it to the balsam of the bile, which proves an antidote to those saline spicula. And treating of the cure from the axungia viperina, he says it consists of clammy and viscid parts, which are withal more penetrating and active than most other oyly substances, and that they involve, and as it were sheath the volatile salts of the venomous liquor, and prevent their shooting out into those chrystallin spicula which cause the deadly mischief. In the next chapter he says, the oleum scorpionum, or the oyl wherein scorpions have been infus'd, is a present remedy for the sting of this creature, as the axungia viperina for the viper. He says the viperine venom is the quintessence or most active part of those animal juices, with which the viper is nourish'd, and so of the scorpion and other poisonous animals: the like we may suppofe of the matter of the gout, being the quintessence or most active part of the rich blood of arthritics unbroke by labor.
I have known several instances of people obnoxious to the gout, that have been seiz'd with a sudden and most violent inflammation in the face, a small tumor arising like a plague sore immensely fiery, which breaks and runs with a scalding water or sanies, and then heals up. No doubt but this happily discharges a fitt of the gout, and sufficiently shows the poysonous nature of that humour which causes it. So that Lucian not improperly compares the pain of the gout to the gnawings of the hell-hound Cerberus, to the poysonous bite of Echidna a hell-snake, and to Nessus the centaur's poysonous garment, which he gave to Hercules. The analogy goes so far, as that after the bite of a viper the swelling continues some time, and the inflammation; and often more considerably upon the abating of the pain and other symptoms. And as Dr. Mead observes, one good drop of a viper's poyson does all she cruel execution: so by what we can observe, one drop of the gouty poyson is enough for a limb or joint. Again, there is the same timourousness induc'd from the spirits snd nerves which Sydenham so much complains of in the gout; as 'tis one symptom of the bite of a tarantula. Hic accedit, says he, miserarium culmulus, quod durante paroxysmo animus etiam ceu contagio afflatus, eo usque corpore compatiture, ut haud facile sit dictu, utro horum æger calamitousius doleat. Non enim rectius podagre quam iracundiæ paroxysmus omnis dici potest: cum mens & ratio usque adeo ab infimatio corpore enerventur, ut vel livissimo affectuum motu impellantur & vacillent: unde non magis ipsi quam aliis gravis est. Quid quod & cœteris quoque passionibus est obnoxius, tmori, viz. sollicitudinique atque aliis id genus: a quibus pariter torqueter, donec morbo evanescente animus quoque pristina transquillitate recepta una convalescet. These observations are agreeable to the effect which actual fans have upon us. And in the bite of the mad dog a proneness to anger is one of the symptoms, as Dr. Mead takes notice. He supposes that poyson to be fiery, saline particles thrown from the boyling blood into the saliva. He says, the dressing the wound of this poysonous bite with unguentum ægyptiacum scalding hot, and this alone timely apply'd has happily cured it. At the end of his account of poysonous minerals and herbs, he gives the indication of cure, such things as are of a smooth oily, lubricating substance. Thro' the whole course of his book, we find he assigns corrosive salts for the particles of infection and poyson. He makes animal juices of a fermentative, active nature, fiery and corrosive, and those of human bodies ranker and more abounding in active salts than those of other creatures, which are continually repair'd and nourish'd by the juices of animals. And I may reasonably add, that of those creatures juices, such are least corrosive and fiery as are nourish'd by vegetable substances only. But from the Doctor's reasoning much may be obtain'd to illustrate the nature of the gout, and much towards its relief and cure, its retardation or eradication.
In the cure of the gout, I likewise observe, mankind has very much insisted upon an an external and an oyly application. The peculiar nature and property of the evil which affects the joints, seem'd to indicate, that it was thrust out of the habit, like an unwelcome guest; it was turn'd out of doors as far as might be, and wanted somewhat that should either lead it safe out of the purlieus of the body, or destroy it where it was; that it might not make a fresh return inwardly, to disturb the family. More particularly we may discover, that unctuous applications have been a frequent intention in arthritic remedys. Nevertheless time was not mature for the exact recipe in the case. Since I have enter'd upon this argument, I have met with many relations that I can depend upon for fact, of accidental cures by external applications. And I find, they, all consisted of volatile, unctuous substances; but none so certain, convenient, cheap, easy and well appropriate to the case, and effectual as our preparation. I mention the thing only as a confirmation of the rationale upon which I proceed and of the true intention to be regarded in the cure. And tho' before, authors have been in the right track, yet they did not persevere, as is a common case in practise. If we see not an immediate effect produc'd we change our method, and know not what it will produce. And thus no doubt, many excellent medicins have been lost. Indeed at first sight an external remedy carrys the best pretence for success here, where it has given no previous trouble to the stomach, at that time its self very languishing, and ill able to bring it into action, if any thing useful that way could be given, which I wholly disbelieve. What ever we give inwardly must receive great alteration by passing thro' all the concocting and secretory organs and thro' the blood, before it can arrive at the part where its work is. But I observe in reading authors, where they have accidentally done any considerable service inn the gout, it was by some clumsy, operose, outward application and that oyly. Thus Galen, L. II. ad Glauc. c. 4. commends oyl of Sabin, and II. de simpl. med. f. c. 18. he much praises a saponaceous mixture of salt and oyl. Cælius Aurelianus commends oyntment of squills, and wild cucumer, euphorbium, adarce, likewise to foment the part with warm water and oyl apply'd with spunges. Euonymus in antidotario says, bones burnt and extinguish'd in oyl, app1y'd outwardly; are useful. Pliny, XXVI. 10. speaks of Verbenacea, cicuta, erigeron, these must be beaten with axungia. Poppy feed with milk, XX. 18. the feed is a mere oyl without any hypnotic quality. The nettle feed beaten with old oyl, or the leaves with bear's grease, XXII. 13. Panos helxine beat with goat's sewet and cyprus wax. XXII. 17. the root and leaves of heliscopium boil'd with goat's sewet. XXII. 21. Ægineta says wonders of thymus, oreganum, satureia, calamintha, and those herbs full of a hot penetrative, volatile oyl, in the case. Aetius gives the history of one cured by application of the flash of oysters with litharge and henbane leaves beat together in old oyl. tetrab. 3. serm. 4. c. 28. he much recommends salt mixt with oyl. tet. 3. serm. 4. c. 21. Trallian us'd mustard seed. Fonseca commends the oil lapis lazuli. The late learned Physician and Antiquary Dr. Musgrave in his Belgium Britannicum, p. 165. mightily commends distill'd oyl of Gatates lapis, apply'd to the gout. Dioscorides mentions the like before, V. 9. Hidanus cent. 1. epist. 35. wonderfully praises an unguent made of salt, oleum lumbricorium and vulpin. Colbatch uses and commends much a balsam of oyl of olive ℥viii. and oyl of vitriol ℥ii mix'd, and says it deserves to be written in letters of gold, being the balsamum rubicundum: the balsamum arthriticum of Dr. Quincy; 'tis taken from Schroder but he adds adeps humanum to it. Colbatch says he has known it take off a fitt without any internal medicin, and that without repelling. So Lucian in Tragopodagra after naming a thousand things try'd vain, introduces two Syrians, who cur'd it with an unguent deliver'd to them from their father, which is not unworthy of a particular remark. It seems to me that the progress of these oyly experiments upon the gout has been retarded, from a mistaken notion of such things stopping the pores and hindering transpiration; Riverius declares as much, after he had commended neats foot oyl in our case, and gives a recipe for making it. And we find at last, that what they have attempted to do from all ages, with remedys horrid, such as caustics, cauterys, issues, setons, moxa, with a thousand superstitious fancys, with medicins awkward, nauseous, uncertain; what they have been aiming at imperfectly, is fully and adequately accomplish'd in our oyls. And the highest reason, we have to adore Providence for so great a blessing.
Hitherto we have treated of the history of the distemper, and of its cause: wherein we have shown that 'tis a really poysonous, fermentative humour thrown out of the blood. We are next to speak of the remedy, or antidote for this poyson, as we may now properly call it. The oyly preparation which Dr. Rogers has made, is as sure and specific a cure for it, in all respects repects, as the cortex peruvianus is for agues and fevers; or any other the most specific remedy in all Medicin. This I may with confidence affirm, from innumerable experiments. But a person of true judgment, in the animal œconomy, in philosophy and the operation of medicines, cannot but see, that if the gout be a poyson, this active and penetrative oyl is incomparably well adapted for its antidote: and so we find by experience. As soon as ever 'tis introduc'd upon the matter of the distemper, it kills and extinguishes it. It so invelops and blunts those pungent, fiery salts, that for ever after they are perfectly harmless. It immediately curbs that outrageous swelling, and pain; and restores very expeditiously the limb to its pristine shape and office. That contagious quality that would draw in a great quantity of humors to partake of its own nature and diffuse itself thro' the whole constitution (as one grain of gunpowder inflam'd fires all the circumjacent heap,) soon disappears, as if it had never been. And surprizes the patient that has been us'd to these fiery, tryals; like a prisoner who beyond his hope escapes a capital sentence; this I can speak very truly, because very feelingly. I shall give the reader my observation upon a week's tryal.
When nature is in a disposition to separate this humor from the blood, which we call a fitt, she separates it continually in a certain equable tenor, till she has reliev'd her self as perfectly as she can. She does not separate it all at once, because she knows one joint cannot supply the remedy at one onset. The secretion of glands is a gradual thing and matter of time. This humor thus thrown out, according to my former theory, upon the oyl-glands of the joints, is extinguish'd by the oyl whether natural or artificial, as fast as it comes: if the oyl be sufficient in quantity. The humour is generally detach'd to the most distant joints of any considerable bulk, first. I gave a reason in the first part, why it so frequently begins with the great toe. When the area of one joint gives it not scope enough to display its colors, it retires to the next and so on, according to the quantity of its forces. And thus the tragedy becomes more or less extensive. Since the cruel pain is the only remedy in the ordinary way, nature is oblig'd to divide her tortures and quarter them upon different limbs, to save the life, which is her chief care. And as 'tis impossible that the joint-glands, in a great fitt of the gout, should instantaneously find oyl sufficient for a remedy, she is oblig'd to accomplish her purpose by long time; by bringing a huge afflux of blood and humors, to damp and quiet for a while, that flame which she cannot quench. So at length after a tedious struggle and inhumane butchery, the fitt is solv'd, the matter is imperfectly extinguish'd, the poor Sufferer crawls out of the shambles for a while, as by a day-rule of the Fleet, till the merciless tormentor summons him again to equal misery. This is the blessed situation of a podagric! a happy occasion for the congratulation of friends. The pretended earnest of threescore. Well may he cry out as in Lucian, which I shall give in latin, because beautifully turn'd, and may be styl'd,
ODE in Podagrum
O Triste nomen, o diis odible,
Podagra, lachrymosa, Cocyto sata,
In Tartari specubus opacis edita!
Erinnys utero quam Megæra suo tulit,
et uberibus aluit; cuique parvulæ,
amarulentæ, in os lac Alecto dedit.
Ergo quis abominabilem Te dæmononum
produxit in lucem, exitio mortalibus?
Quod si luunt errate mane mortui,
Si luce commissi rationem nox petit;
nec Tantalus siti, nec Ixion rota
volubilis, nec Stygii fuit Ditis domo;
tuis sed omnes omnium soclerum reos
aptare decuit membrifrages cruciatibus.
O nymphaa ingenium adamantinium habens!
quam Jovis horret pernix telum.
quamque profundi fluctus pelagi
terdidant, quam quoque trepidat, sceptra
qui gerit infera, Stygis Pluton!
O gaudens nodis, lectigrada
cursivetans, talorum tortrix,
calcicrematrix, malehumitanga,
ossitremenda, genufraga, insomnis,
articulos cruciandi cupida,
curvi-genu-flexa, potens Podagra!
O hideous name, hateful to Gods and men,
O gout, calamitous, hell-born I ween,
sent from Tartarean deepest, darkest den!
whom from her direful womb Megæra accurst
brought forth, and the fell froward bantling nurst
what fury else could thy dread mother be?
to mortals baneful, Stygian malady!
but if the conscious shades our actions know,
and this wor1d's crimes are punish'd there below!
nor Tantalus's thirst, Ixion's rack,
nor Sisyphus's stone still rolling back;
is equal doom; rather to each be sent
the gout, more adequate a punishment,
hence let thy member — breaking tortures fall
on every crime and every criminal.
O nymph of adamant, relentless Dame!
even Jove's hot thunder trembles at thy name;
Neptunian surges cannot quench thy flame.
Hells squalid Monarch dreads thy power divine,
his scepter drops, and weaker owns than thine.
Thee joints nodose and throbbing ancles please,
and solemn pace and couches void of ease.
Thee frying heels and burning knees adore,
Rent bones, crackt sinews, nights incessant roar:
sighs are thy incense, groans the melody,
and yelling shrieks; to hymn thy Majesty.
Thro' a course of years under this severe discipline, every joint in the body is visited; as it passes from one to another for proper pabulum, is exhausted and ruin'd. When all the outworks are demolish'd, it makes an approach to the citadel. It certainly spoils all the joint-glands in the body, it licks up all the fat of the flesh, membranes and every thing that is oyly; so that the limbs waste and shrivel, whilst the joints protuberate with nodes and chalk-stones. That fiery acid in the blood being never thro'ly extinguish'd, it perverts all the juices, every fecretion, every admission of new chyle, into its own kind: the vital fluid is thro'ly podagric. The constitution by a long series of confinement becomes utterly overthrown, all the solids by frequent swellings, pittings and relaxations are weakened, lyable to every descent of humors, all the hinges of the animal frame are subverted, every animal function is vitiated; the carcass retains but just life enough to make it capable of suffering.
In a case where there is an extraordinary quantity of matter, in people that indulged their genius much; upon the accession of a fitt, it plays a bolder game. After you have extinguish'd it in the toe and tarsus, it takes the ankle, then the knee, and perhaps the like in the other leg. If there be quantity enough, it will enlarge its province with hands, elbows, sholders &c; in this most horrible case the oyls cure as it goes. As fast as you pursue it, so surely you subdue it. Dr. Havers observes in the cure of a rheumatism that mucilaginous and oyly pectoral medicins are aptly prescrib'd. He says 'tis imitating nature's composition, correcting and restoring the mucilaginous juices she provides for the muscular membranes, in whose glands the seat of the distemper lies: substituting an artificial mixture which supplys the defect of that which the morbific matter has vitiated. And this I find by experience to be true. In the most severe rheumatism, where the humor has attack'd every joint from the head to the toe end; we have follow'd it with unction: and in a fortnight's time totally subdu'd that frightful distemper; which otherwise in the ordinary manner of treatment would have lasted some months, and kept the patient in exquisite torture all the while. And this shows incontestably that the humor of the rheumatism is the same as that of the gout; and that both is of a truly poysonous nature, This operation then must not be ca11'd repelling. Every one that knows the gout, remark, 'tis usual for it in common instances, to make quick transitions from one part to another, and after it has extended one limb, as much as may be, it flys to another. Repelling is a word to be taken in a double sense, properly and improperly but in neither sense can I admit of our oyls repelling. Strictly and properly by no means must that be said to be repell'd from a certain part, which never was in that part. To say the humor would have come into the part, had not the oyls been supply'd is but a guess. And be it fact, 'tis a happiness to divide the field of battle and spread the enemy's troops thin, that they may the easier be circumvented and attack'd on all sides. 'Tis a happiness to hinder an enemy from retiring a part already weakned and incapable of resistance or resisting with difficulty: and to meet him bending his forces against a fresh wing unbroken. And this is assuredly the case in the application of the oyls. The enemy retires continually weakened with real loss of its virulence and quantity upon every unction. And which plainly shows that there is not the least danger to be apprehended, of the gouty humor falling upon the noble parts. The very warmth of the oyls attracts that humor to them, as well as deadens it when attracted; they are the proper pabulum. Just as any salt is slrongly attracted by the water which dissolves it. And nature determins it to them, for the same reason as she sends it to the oyl-glands. And this all experience confirms. In the case of rheumatisms where they have been the most violent and inflammatory that is possible, we have follow'd the pain with unction thro' every joint of the body from the neck to the toe ends. The consequence is a most certain and speedy cure, without any translation of matter inwardly and upon noble parts, or any ill consequences whatever. And thus a fitt of this distemper which would otherwise have tortured the patient for 2 or 3 months or more, has been happily and gently solved in a fortnight. I forbear naming particular instances. The fact is notorious with us at Stamford: and the like in the Sciatica. I have seen instances where thro' extreme weakness of nature and furiousness of the distemper, when the morbific matter during a long fitt has reverted upon the noble parts and a hickup with the like violent symptoms of evil prognostic has prevail'd: in this deplorable circumstance, upon a plentiful application of the oyls, the patient has recovered in two days time in the most surprizing manner. There is little need to make long harangues and observations upon this and like cases. They speak for themselves. And if you kill an enemy as fast as he advances, it may be call'd repelling him, but very improperly. Polyænus would not wish for a better stratagem: I am sure 'tis a safe one, either in war or in the practise of physick. So that if upon using the oyls, the part swells exceedingly, or if you find it begins upon a new joint, be not discourag'd; it shows only a large quantity of the morbific matter, and requires an immediate application there.
I know full well it will be objected to this method of cure, which we are inculcating: that all kinds of tampering with the gout are pernicious and deadly. That many instances are known of it, in every body's observation. That both internal and external remedys have cur'd the gout, but the cure has been attended with consequences worse than the distemper; and such persons cur'd have generally wish'd they had never medled with it. These kind of objections are very obvious, and will be made to our method, as well as the rest; and have been the great discouragement in all ages from attempting relief in this disease; and if admitted will hinder the world from reaping the benefit of this method, tho' we suppose only, 'tis an effctual one. Nevertheless it behoves mankind to distinguish, to exercise judgment and to look at a distance. Possibility of danger is not to affright us from necessary and noble attempts. There is a real difference between calming this humor of the gout, or repelling it into the blood and totally extinguishing it; as much as there is in quieting a febrile flame, and extinguishing it. A foolish caution, an injudicious fearfulness in the practise of physick, is as much to be discommended as rashness and boldness.
I know full well, the danger of tampering in this or any other distemper: and I hear Sydenham pronouncing, that in the gout, 'tis nature's high prerogagative, to exterminate the morbific matter in her own way, and to throw it upon the joints, thus. "In podagra nihilominus Naturæ quasi prærogativa est, materiam peccantem suo modo exterminare, & in articulos deponere, per insensilem transpirationem difflandam". He is only mistaken in the last sentence, "per insensilem transpirationem difflandam." For the gout will by no means spend its self that way, nor can that be wise nature's intention, in throwing it upon cold, extreme parts. The practise of physick dictates to us, that we are not to oppose nature, but assist her; and in that consists the excellency as well as safety of our remedy; It is exterminating the morbific matter in nature's own way; not opposing but assisting her. 'Tis not to be call'd tampering, there will be no after reckonings, the cure is compleat, nature leads the way her self; and therefore 'tis perfectly safe.
If insensible perspiration would have done the feat, a cure would have been found out ages ago; from the 10000 warm administrations both internal and external, which have been found intirely useless; Sydenham says himself, immediately after the. forecited passage, that a diaphoresis or sweat has been altogether unprofitable, and so I have experien'd it.
I have this to add, as a great confirmation of the certainty and safety of our cure; that whereas we find by experience, that even a gentle purge given towards the end of an ordinary fitt of the gout, is so far from being useful, as may be thought, in carrying off the dregs of the distemper; that it generally brings a new fitt not at all milder than the full. Whereas after the use of the oyls, a gentle purge is very profitable and accelerates your recovery, without danger of bringing a new fitt, as I have try'd by experience. This notoriously proves, 1st. That in the ordinary method, the crisis of nature is by no means compleat, when a fiit has run its whole course, without moleslation. 2. That in our cure the crisis is compleat, and perfectly agreeable to nature's purpose, therefore certain and safe. Lastly, the author of this medicin has us'd it 5 years compleatly. The returns of fitts are much seldomer, they come without any ill symptoms or irregularity. He always subdues them with great ease and expedition; has the use of his limbs, and enjoys a much better state of health than he did for many years, before he began the unction. So that we must ever answer to these kind of objections, by denying that our cure is tampering, is removing, repelling, translating the humor of the distemper; but deadning it and effectually disarming it. Nor need we seat its repullulating in any other place, for this fitt.
I cannot forbear, in this place, mentioning the late worthy and learned Dr. Walter Harris my Collegue and Friend. He honor'd me a young man with a particular intimacy. His memory is dear to me, and will live to the world, as long as his book of the diseases of children: And latest posterity will revere him, who was the first that discover'd the true method of treating those tender years with medicin. He dy'd in July 1732. aged 85. This sagacious author thus wrote, just 50 years ago, in his treatise call'd Pharmacologia antiempirica, printed 1683. "The gout, says he, is an habitual disposition in nature to throw off offensive humor, critically upon the joints. The cure of the gout and the cure of the fitt are two very different things. If instead of a fitt, that would, according to the course of nature, hold him 6 or 8 weeks in pain and weakness: he should be reliev'd of his pain in a few hours, and deliver'd of his weakness in a few days, he has reason to thank God for this assistance of art, and to embrace it with joy."
"The first thing therefore, and the chief that is to be done in the fitt, is to take away the pain in each part, where the defluxion has fallen, by proper outward applications: and to free the parts, as well as may be, from that load; which within swells and dilates præternaturally the fibrils. The pain being often so great, as to cause a symptomatic fever with it, we ought diligently to apply our selves, to remove this grievous pain. And a man may as well maintain that it would be injurious to the body, to part with a quartan ague, before it has been shook with it for a full year, as that it would not be safe, to lose the pain of the gout, before so many weeks are over: and nature it self has, as it were, in pity to the diseas'd at last given them a convenient respite. The benefit of outward applications when properly administer'd, in a raging fitt of the gout, is as great as the freedom from pain in any other part, is ease and comfort, in respect of that part,
Thus does our judicious author in the fulles't manner, say all that can in strongest terms establish the practise, we are recommending to the publick: tho' all the while he was ignorant of the great remedy which Providence put into our hands, immediately after his death. From mere judgment he pronounc'd, what is the appropriate cure of the gout, tho' he saw not what could answer all his intentions of cure; and could scarce hope that it would ever be accomplish'd by one application only, and that so simple and easy. He saw too, that it must be by some what external. Even the learned Dr. Pitcairn, in his division of diseafes, reckons gout and stone diseases extra animal. But how well does Dr, Harris distinguish between the cure of the Gout, and the cure of a fitt of the gout? How does he tacitly reprehend the present way of thinking in this distemper, of wishing joy upon the access of a fitt: as if a long and most miserable life was a blessing? As if it really gave along life, or was a truly judicial and salutary crisis. When at best it must be call'd such a goal-delivery only as consigns the prisoner to the executioner. Senseless must those be that maintain the pain of the gout is useful, and by no means to be rebated. 'Tis a high absurdity, and no other than a cloak of ignorance of the cure. The gout from the beginning has been deservedly call'd the opprobrium medicorum, and in good measure owing to our selves, who childishly discourage any attempts upon it. And even at this day, there are found some of little and low minds both in the Town and Country, who are willing enough to oppose Dr. Roger's remedy, because they were not the inventors themselves, when they cannot pretend to any cure of their own, or because they envy mankind so great a comfort. Such must be strangers to the generous and noble principle of philanthropy, that highest vertue our nature is capable of arriving to, an imitation of the supreme Being, the το αγαθον, an endeavor to do all the good we can: but especially to so great a part of mankind laboring under this formidable affliction: which must needs excite the highest degree of compassion from those who profess humanity. A savage soul would be touch'd at the sight of a wretch lying but one hour under a Spanish rack; yet this is nothing in comparison of a severe fitt of the gout.
How well has Dr. Harris defin'd this distemper? That 'tis an habitual disposition in nature to throw off offensive humor upon the joints. 'Tis properly the joint disease, arthritis, and 'tis nonsense to divide it into podagra, chiagra, mentagra, gonagra, talia and the like ridiculous names, as if it were not terrible enough, unless split into 100 terrors. 'Tis all one and the same humor and disease. Yet why should nature chuse to throw' it off upon the joints, but for sake of the oyl-glands? The disease is truly a habit, but a very unlucky one, before our remedy was discover'd; a miserable crisis which nature by constraint chufes. The gout is not only so far habitual, as at stated times of the year, once or twice to attack us, but will often make a supernumerary and irregular visit; a most incomplaisant officiousness! And then it will hold us as tediously and cruelly, as in its ordinary executions. 'Tis no security, that you have so lately undergone the question. And for this purpose it will lay hold on the most trifling occasion, any evacuation, a wrench, treading awry, a small blow, bruise, wound, a cold, excessive hot weather or cold, an easterly wind, an alteration of weather, a sitting up in the night, a little change of dyet, liquor, constitution, bad wine, French wine, stale drink, walking. From any of these the gout will frequently break forth. Upon a small variation in the crasis of the blood, these volatile salts that hitherto had been held asunder, cluster together, and fly off like an unforeseen explosion. By lessning the quantity in venæfection, by violently hot weather evaporating some fluid parts of the blood, by cold weather constringing the pores and preventing an expulsion of the salts in sweat or perspiration, by any thing that happens to the renal glands, or hinders the ordinary separation of urinary salts, by purging, which diminishes some of the fluidity of the blood, squeezing it thro' the intestinal glands and many more such causes, the salts are more strongly attracted to one another, than by the blood they swim in, and so they open the scene of this wretched tragedy. And those that are obnoxious to it are generally people of good sense, capable of reflecting upon their unhappy situation in life, which does but double their misery.
So much the more ought we to congratulate our selves for a remedy. These accidental fitts which I call the contagion of the gout, are certainly quell'd by one or two anointings, which without it, would produce regular fitts. And whenever we find the veins turgid and the part begin to look red and hot, the signs of an approaching fitt, we are instantly to apply to the remedy: which like pouring water upon fire extinguishes it. No words can paint out the pleasure we feel,when we so easily escape. When we are reliev'd from it, in as many weeks shall I say, rather in as many days, as otherwise months: if left to the ordinary course of nature. When we escape nor only the cruelty of all the pain, the lancinating tendinous twitchings, the wakeful nights, the languishings, faintings, sicknesses, febrile heat, nausea, the dread of the least motion; the fitts of anger, despair and violent disorders of the mind; but the ill consequences too which are worse, if possible, than the primary case, in so unreasonable a confinement from air and exercise, which alone would he very prejudicial to our constitutions, without those former associates. And what is still a greater advantage, thro' this excellent remedy, we escape the melancholy prospect of a life exquisitely miserable, to those that have constant returns, the more unhappy the longer it is in killing. Hence we may banish all the formidable apparatus of bed-cradles, chairs, couches and automata, shoes of cloath, cutt or lac'd, gloves, stockings of various dimensions, sticks and crutches, springs and wheels, and a thousand contrivances of machinery for ease, motion and carriage. Instead of the old Egyptian, Scythian, Chinese, Japanese burnings, needles, moxa's; instead of the directions of horror among the old Greek and Latin writers, secato, urito, we need nothing but to anoint. A prescription so soft and gentle, that were it not for a distemper, we should reckon it a delicacy, a revival of antient luxury. And did we practise the athletic sports of the antients, we should use it every day for pleasure: it gives such a vigour, such an easyness of motion to the joint, sinews, and tendons, that new Adam-like in Milton, we wonder as we walk. We say as he,
With fragrance and with joy my heart o'er-flowed;
My self I then perus'd, and limb by limb
Survey'd, and sometimes went, and sometimes ran,
With supple joints and lively vigour led.
P. L. VIII.
There are many instances, where people have had one fitt of the gout and no more; nature some way or other finding means totally to exterminate the disease and its feeds. Pliny observes this, sponte desiit N. H. XXVI. 10. There are a few instauces, where they have escap'd with two or three fitts, the constitution being chang'd. Bur most generally the crisis is so imperfect, that the first fitt ensures its self for life, and is the earnest of the future. When those deleterious miasms are once got into the blood, we find by too frequent and sad experience, that in the ordinary way of treatment in this distemper, by which I mean no treatment at all, they are never totally extirpated. And this the excellent Sydenham confirms, "morbi fomes nunquam per hoc omne intervallum perfecte dissipatus." Again in another place, "perraro materia morbifica omnis a paroxysmo quantumlibet diuturno & crudeli, ita plene egeritur, ut nullæ prorsus in corpore reliquiæ sint, eodem jam elapso." But I have the greatest confidence that by early and seasonable application of the oyls which compleatly deadens the matter of the fitt, there will be thousands of instances, (where great irregularity of living hinders not) of the distemper taking a final leave after a visit or two. And since gout and stone proceed from the same principles and constitution, 'tis highly probable the use the oyls will prevent the growth of gravel, the general attendant of the last stage of the gout, both by curing the gout and by taking off the confinement and sedentary life. All this reasoning is highly confirm'd by what we observe from the short experience we have yet had of these oyls: we all find that after the use of them, our feet and other parts that have been affected, recover their strength to an extraordinary degree, and are restor'd to a firmer state than they have been in for some years before.
What I have further to say on this argument is only to delineate a method of treating the arthritic, when in a fitt, and under the operation of the oyls: And likewise a method after recovery, whereby I conceive he may best subdue the tendency in his constitution, of producing these pungent, poysonous salts. Certainly, the regimen to be used during the use of our oyls, must be moderate. Upon the onset of a fitt of the gout or rheumatism, there is no need to recommend moderation, the patient has no stomach: but when he recovers his appetite, he is to eat sparingly of light things. A glass or two of wine or mild ale, is to be indulg'd. Those who have liv'd freely may double it. Nor will they find such an exacerbation of the pain immediately after a slight meal, as in the ordinary way of leaving it to nature. As their strength is never so much overthrown, because of the shortness of the disease in our method: so they are better able to last out the whole progress with a temperate dyet. There is no need of strong Barcelona wines or pernicious fiery spirits, under the mistaken notion of keeping the gout from the stomach. Warm water and a little wine does well for ordinary drink. Warm milk morning and night is highly useful. Chearful company alleviates the pain, invigorates the spirits, the better to support the conflict.
As for internal things to be prescrib'd during a fitt, if Dr. Havers's judgment be just, of giving mucilaginous and oyly pectorals usefully in a. rheumatism, it must doubtless be good now. His intention in it, is to impress a balsamic character upon the blood, to supply nature with that mucilaginous oyly juice which is proper to extinguish the fiery salts that cause the distemper. Therefore milk, flummery, creams of barley, rice and the like, must be very appropriate to this intention. Nor need we be afraid of a little mild, soft ale.
The presence of a Physician is useful in a severe fitt. The victory tho' with this powerful remedy is a matter of care. The patient then has no stomach for some few days, and is feverish; he must have some cordial to support his spirits. And if the pain be violent, some opiate must be administred at night when going to bed. This will soon be render'd unecessary; but they that refuse the use of poppy juice in pain; reject one of the greatest gifts of Providence; that divine relief from pain, which gives strength as well as ease, which promotes a gentle perspiration, which is as appropriate, and as absolutely necessary then, as food to the hungry, drink to the thirsty. After the cure, a gentle purge or two is highly necessary, and to get into the air as soon as we can. Furious as a lyon the fitt comes one, but retires gentle as a lamb. Your strength returns very speedily, and you find your self in perfect health with pleasure and surprize.
The great indication for a regimen during the intermission of fitts, is to prevent, as much as may be, the growth of these rich, sulphureous and inflammatory salts, in our blood. First, Temperance above all things is necessary, and with that, there is little need of distinction in our meats and drinks, where the vessels are not o'erloaded, but the fibres vigorous. Where they vibrate orderly, the wheels of life go right, Nature expends all she takes and keeps open all the salutary outletts. A starving regimen in a gouty constitution is prejudcial: because there wants fat and oyl for a remedy. It lessens the quantity of salts indeed, but weakens nature in expelling even those that are form'd, and quite subtracts the oyly cure. So that in all things temperance is best. A good stomach which is a blessing, and podagrics generally have it, is like a knife too sharp, may do mischief, without restraint. Cicero in his his epistle to Herennius, says you must eat to live, not live to eat. And so Socrates said of himself Muson. ap. Stobeum. Seneca in his II epistle, forbids us to taste of many dishes at a time. And in 95, he says many daintys create many diseases: I add more especially the gout, which is equivalent to many. Have a care of intemperance immediately after recovery from a fitt, when Areteus observes people are apt to live fast; like those escap'd ab inferis: they are for repairing the lost time and constitution too, but erroneously. Temperance must be inculcated at all times, for tho' we conquer in every fitt, yet the fewer battles, the better for our natural strength. A habit is always growing better or worse. Better it will be if we cure the gout without oyls. Porphyry in vita Plotini tells us of Rogatianus a Roman Senator. He was cripled with the distemper, and was carryed in a chair daily, to hear Plotinus, the Platonic philosopher. Becoming his disciple he grew exceedingly abstemious, and lost his gout. Let not the doctrines of Christianity be less influential on our lives than the hopeless Lectures of Plotinus. Take Hippocrates his authority, II de prædict. that the gout is not to be cured without temperance. Oribasius says, if people be slaves to their appetites, we ought not to undertake their cure. I doubt not but if we be so complaisant to the ordinances of our Church; as now and then to keep a fast day, we shall find our present account in it. However by all means compotations and feastings must be laid aside. At least used at rare intervals, with great caution and as in a medicinal way, as a counterpoize to fasting. That constitution is best which will bear extremes. Temperance is the great sauce to all other human felicitys. This only satiates but never cloys. This is a pleasure that refines they mind, invigorates the body, preserves the estate, renders us superior to fortune, out of the reach of adversity. This is a vertue which is its own reward; the parent of regular passions, of sweet contentment, of healthful progeny, of happy youth, of vigorous old age and long life. If excess in our thoughtless, juvenile days, or a habit of it in more advanced age, has been the occasion of the distemper, let us amend of it. But especially let not this noble remedy be, the occasion of our continuing therein, least a worse evil come upon us, than the gout. 'Tis a vast, invaluable happyness, with the moderate use of the good things of life, to be cur'd of this distemper, when it comes. But if we presume too much upon it, we are unworthy of the remedy, and will probably find other instances of the divine displeasure. The antient heathen, who under the notion of Apollo the God of Medicin, pictur'd out that person in the deity, to whom the fabric and regimen of the World is committed, attributed darts and arrows to him, as well as the art of healing.
To observe a true measure of temperance, exactly to hold the golden medium is the prerogative of a few. Therefore I shall set down some useful rules to be observed in eating and drink, which may answer the indication' propos'd. From the whole of what we have already written, 'tis very obvious, that there is a necessity of avoiding as much as possible, all very savory, saline and spiced foods, rich soups and sauces, French compositions. These things must accumulate noxious salts, they acuate the appetite unnecessarily and provoke us to eat what is prejudicial, both in quantity and quality. I look upon it to be a vulgar error, when we order podagrics to white meats and things of easiest digestion: rather their stomachs require the coarsest, hardest food. Their juices are corrosive like aqua-fortis and ought to be dampt with fat and oyly things, and with what affords less nourisment. And for this purpose, I believe, testaceous powders taken now and then in milk, Bath waters &c. and the Diacorallion which Trallian so much commends in the gout, may prove useful. Both in food and drink we must have a particular regard to those things that afford least of the salts, that dilute and disunite those salts, already in the blood. Can we doubt that vegetables ought to make a considerable proportion in our meals? all such being of a loosening, diuretic nature. Sprouts, brocoli, borrocole, spinage, mercury, parsley, artichokes, carrots, turneps, parsneps, cabbage, lettice, selery, endive, cucumbers. Areteus in a fragment commends radishes. Ægineta speaks well of a cooling, moistning dyet, flummery and the like. Galen de att. vicr rat. says many arthritics have been wholly cured, at least much beter'd by an attenuating dyet. Pliny, XX. 9. says the use of brassica coleworts, has kept people free. Beans, pease, all kind of garden stuff is good. Spanish-nuts, filberds and wallnuts among fruit seem useful. In my former letter, I recommended the frequent use of milk, I cannot but repeat it. The notion of its curdling upon stomach is commonly erroneous. It ought to be drank once a day at least.
Next, for drink, water whether simple or medicinal drank in small proportions is exceeding useful. 'Tis the noblest diluent and digester in the World. Zacheus commends a draught of warm water (we may say a glass) before dinner: before him Piso and Alexander. This will usefully blunt the keenness of the stomachic ferment. With like view Baglivi advises tea and milk and the caring of melopepons, and drinking the water distill'd from the pulp. Thus milk-water is a fine liquid. Nevertheless those who have been used to live well, must not be so cynical as to confine themselves wholly to this watery course. Wine too is a blessing of Providence, appropriate to the necessary cares of human life. All the difficulty consists in being innocently merry and wise: so to adjust the quantity that shall give mirth to the heart, and no fewell to the gout. That if it comes unfought for, by means of our oyls we may meet it, not without a cheerful countenance, as a sickness easily to be subdu'd, as now, an earnest of health and long life. Immoderate drinking of wine, Galen deservedly reckons one source of the gout, L. VI. aph. comm. 20. Hippocrates too, III de temp. 2. and L. VI. aphor. 28. Avicen XXII. 3. tract 2. c. 7. cum multi aliis. Thus speaks Bacchus himself in Eubulus a poet, Athen. Deipn. II
Τρεῖς γὰρ μόνους κρατῆρας ἐγκεραννύω
τοῖς ευφρονούσι. τὸν μὲν ὑγείας ἕνα,
ὃν πρῶτον ἐκπίνουσι; τὸν δε δεύτερον,
Ἔρωτος, ἡδονῆς τε: τὸν τρίτον δ' ὕπνου.
Three cups only I give to the wife. The first for health, the second for pleasure and friendship; the third for sleep. Wines growing on a sandy soil said to be best for podagrics, as having the least tartar, thus Madera, & vinum pucinum and the Gornbergensian wines good. Dr. Cheyne speaks much in praise of malt liquors; that such as drink them only, are not so severely handled with gout or stone as wine-bibbers. Dr. Sydenham has the same opinion as to wine, forbids suppers, and allows in lieu of them a handsom draught of ale not too strong. And he thinks it particularly profitable against the stone and gravel. My opinion is, a pint of warm milk will be a good supper, beside the ale. Drinking them at an hours distance. But our late leaving off malt liquors, and drinking wine more copiously than formerly, may perhaps, be the reason of the great increase of this distemper, observ'd within these few years. Since among other fashionable follys imported from abroad, 'tis become ungenteel to use malt liquors, because the product of our own country. We may with great confidence pronounce thus far: mild, midling, soft and fine ale may be us'd with most safety. French, Rhenish, Moselle wines, those of Hungary, Moravia, Bohemia, Austria, are to be avoided. And remember that all fermented liquors must be drank with great prudence and caution. Now we have so noble a remedy, I think we need not absolutely forbid with Dr. Sydenham, the use of those liquors, which to such people as have been accustomed to them, sounds as harsh as bidding them not live. But the prejudice wine brings in particular to gouty constitutions, is well illustrated by Dr. Haver's experiments upon the mucilage of the joints (Osteolog. p. 219) for they coagulate it strongly like to a jelly.
Arthritics are slow of making water, and can sit long in company a drinking without that evacuation: which shows an unaptitude in the salts of the blood to separate; and indicates diuretics to be used
A proper administration of physick now and then will be extremely serviceable by way of prevention. Wherein 'tis most advisable to consult the professors of that art, who can accommodate it to particular constitutions and circumstances. I take an emetic to be very profitable; once of twice a year, never to be omitted. For the biliose salts help forward the distemper. Hence Hippocrates de passion. intern. attributes the gout to the bile and dryness of the joints, i.e. the want of oyl: the injury of the oyl-glands in our modern way of speaking. Sylvius § 155. says, he has cur'd a fitt by one vomit only. I have experienc'd the like in my practise in London London and it has protracted the return. Purging too at proper intervals and seasons of the year, must be exceedingly advantageous. Perhaps it will not be unufeful if I mention what my worthy friend Sir George Savile has told me: than he has more than once carry'd off a fitt of the gout by Dr. Woodward's oyly purges; upon which I observ'd, that probably, the cure was owing as much to their being oyly, as to their being purgative. Petrus Bayrus pract. XVIII. 1. praises the Electuarium Caryocostinum of Galen, not without reason. He says, he kept off the gout for 26 years, by taking a drachm or more of it, 3 or 4. times a year, whenever he perceiv'd signs of a repletion., It was undeservedly left out of the last edition of our College Dispensary. I judge it advisable for the podagric, to keep it, by way of Confection, thus,
℞ Hermodactyl. alb. a cortice superior. mundat. Diagrydij ana ℥ ss. costi candidi sive Zedoariæ, caryophillor. Zinzib. sem. cardamom. min. ana ℨi. Ms. fi. Confectio cum syrup. mellis in vino albo coct. q. s. s. a.
Hippocrates observes that a critical dysentery or diarrhea has solv'd the fitts. Celsus II. 8. commends any flux of the belly, as useful in our case. Gilbertus Anglicus affirms, he has cured many with sharp clysters, the pain going off immediately.
Smoaking tobacco has been thought part of the prophylactic regimen in this distemper. Sir Theodore Mayern gives a recipe for it. Doubtless it draws off some of the salts. The late Mr. Sturt the eminent engraver told me, that in a violent fitt of the gout, which lasted him for many months; he took a fancy to smoak as a relief to the tediousness of solitude. It made him very sick at first, but persisting in it, it caus'd a vast salivation to the quantity of 3 pints a day; he mended apace and never had a fitt after.
Riding must be affirmed an excellent exercise for podagrics, tho' we have not Hippocrate's consent. Walking must be prais'd with moderation, only to provoke the oyl-glands to throw out their juices, and to invigorate them.
There are two things practis'd by the ancients very commendably, well worthy our imitation in the present case. The first is dayly bathing and oyling: the other dayly exercise. We find by innumerable remains of hypocausts in our island, that the Romans: were extremely careful of bathing here, and the more so, probably, because of its northerly situation, One would imagin among all the refin'd politeness of our age it should have been
The Manner of Roman hypocausts.
introduc'd, were it only to show our taste in Architecture. Amidst the affected imitations of antient temples, obeliscs, columns, theaters, &c. why should not the very delightfulness of the thing have tempted them to build baths, if there were no respect to the healthful part of it? And how easy might they be supply'd with hot water in countrys where coals are cheap; which is half the island? Here is latitude enough to show a taste, to mix ornament and use. Very commendable is the publick charity of the easterns, in building Baths for publick use. Some of our charitably dispos'd people that are at a loss how to dispose of their money, would do well to imitate it. To assist them therein I shall present the reader with a plate to show the method of the Romans in building their hypocausts.
For this purpose they made certain bricks, hollow like conduit pipes, but square, about a foot long. They are open at both ends, and likewise have an equal square aperture in two opposite sides. These bricks too have a shoulder at each end, so as that they may joint commodiously into the sides of their neighbours, and receive the ends of other bricks into their sides. When they are dispos'd in the manner that I have represented, upon a floor, and the joints well cemented: 'tis obvious, that square paving-bricks of a proper dimension and equal, will stretch themselves over half of those conduit-bricks, quite round; very aptly taking in the half of 4 bricks. And so they cover the whole floor. These must be laid too with good cement to keep the steam in, and thus you finish the floor of a room, handsom and useful. The heat of a furnace or chimney properly plac'd, is by this means drawn in an equable manner quite thro' the whole floor of the room, and may be convey'd upwards too by the sides of the room. Whence the air of the room is kept in what degree of warmth we please. The lines drawn upon the bricks are made with a tooth'd bit of wood, for no other purpose than to roughen the surface, that the mortar may take the better hold, and confine the steam. These bricks are found in innumerable Roman citys, towns and villa's in Britain. My Lord Hertford has of them, among his antiquities, found at Froxfield in his neighborhood.
For exercise, I must recommend it with the greatest earnestness. All podagrics must have a very particular regard to be constant therein and practise it dayly. All the antients, the easterns, the Greeks, Romans, &c. set apart a certain quantity of time every day, as regularly for exercise as for meals or business. And they were as careful in the one as the other. And good reason there is for it. What were joints and muscles and tendons and oyl-glands given us for, but motion? Life consists in it, and health is not to be expected without it. Motion contributes exceedingly to hinder the coalition of these salts in the blood, to break them in pieces, to expell them by sweat, urine, perspiration, and to keep the whole animal machine in due order. And this should be done at least till sweat is provok'd. No doubt the intermission of manly exercises so much practis'd by our ancestors, is one reason of the increase of the gout. Areteus, Cap. II. 12. speaks, how one in the olympic games by running put off a fitt of the gout and got the victory. Celsus II. 11. says, you must oppose a vehement evil with a vehement remedy. 'Tis happy for us we have in our hands a gentler method. Nor henceforth will it be necessary to put nature upon so great a stress, as the quack in Galen, method. XII. 1. who cur'd dysenterys. Those that were able to bear it escap'd with a cure; but the rest dy'd.
Lastly, I recommend the antient method of oyling with sweet oyl at least once a month, the oftner the better: And at least upon the feet and joints, that have been affected. If that oyl be impregnated with warm oyly herbs, and be heated in a spoon over live coals when used, it will be still more servicefable. This will exceedingly strengthen the cuticular glands that have undergone such severe treatment, and the joint-glands likewise. Great will be the use of it, and the pleasure attending it not less.
I find that unction was part of the most ancient practise of physick mention'd in Æschylus's Prometheus vinctus, of which we may read a learned account in Bishop Pearson on the Creed, p. 80. "Prometheus pretends to be the inventor of the art of physick, that before him there was no medicin neither to be taken internally in a solid or liquid form, nor externally by way of inunction". As the Scholiast well expounds it. Atheneus, deipn.
I have nothing to add, but the directions in the use of the oyls, as drawn up by the Preparer himself.
Heat in a silver spoon, ladle or porringer, as much only as will serve for one using, and for one joint at a time, because the volatile parts evaporate. Shake the bottle first, embrocate the part affected with your hand, warmed, for a quarter of an hour before the fire or a chafing dish of coals, rub the oyls well in, and them wrap the part up in flannel. This is to be done once or twice a day as the nature of the case requires, and so upon every joint affected: and to be continued till the cure is wrought, heating fresh oyls for every joint.
After a great fitt, now and then anointing will take off the weakness to admiration, and strengthen the parts.
After cold taken or any other disorder: which seemingly threatens a fitt of the gout, use the oyls immediately for 2 or 3 times, and you are safe.
So by riding in cold weather when your feet are benum'd, 'tis highly serviceable to embrocate as soon as you get home. No one obnoxious to this distemper should travel without them. They will retain their virtue for ages, and may be carry'd to any part of the world.
If from long use of them in a severe fitt the skin ulcerates, wash the part with warm milk. Likewise in a long fitt in using the oyls, 'tis proper in the afternoon to wash the part anointed with warm milk or water, to open the pores, than upon anointing again at night, the oyls may the better penetrate.
In the sciatica the like method is to be observ'd as in the gout.
In a rheumatism you must persue the pain and inflammation in every part with anointing.