to be done by blood-letting; the warmer cathartics which are not violent in their operation; alexipharmacs; and above all, by epifpaftics laid on the limbs, with regard always had to the place affected. For nothing is more defirable, than that the evil fhould fix for feveral days on thofe parts of the extremities of the body, which it has first taken poffeffion of; because, when it once returns into the habit, it is with great difficulty driven out again: fo that, perhaps, it may be justly faid, that the gout is the only cure of the gout.

The feat of this difeafe is in the ligaments of the joints, the tendons of the mufcles fubfervient to their motions, and the membranes furrounding the bones. And when the acrimonious humour has fallen on these parts, it irritates and frets them: hence arifes an inflammation, and a painful tumour is formed by the oozing of the thinnest part of the juices out of the minutest ramifications of the arteries and nerves. For nature makes use of pain as an inftrument; and the fharper it is, the more fpeedily and fafely the finishes her work. Sometimes, indeed, fhe does it flowly, as if the neglected her duty; and in fome habits of body fhe protracts the torture a longer time than ufual, as if her intention was to divide her medicine. But when the tumour fubfides, part of the extravafated humour, which could not perfpire through the pores of the fkin, (and there is but a small portion of it, indeed, that is exhaled this way), is absorbed into the veins and lymphatics; while the thickeft part of it fticks to the membranes and fresh quantities of it being lodged there in every fit of the gout, it fometimes concretes into hard maffes, commonly called

chalk.

chalk-ftones, which by degrees ftuff the joints, and deftroy their action.

As to the medical treatment, different methods are to be pursued in the fit, and out of it. Quiet is not only indicated, but enforced by the very incapacity to motion. In cafe of a fever, the diet fhould be the fame as in acute difeafes; otherwife, common food of eafy digeftion may be allowed. For great care must be taken of the ftomach and strength. And this circumftance, which I have fcarcely ever remarked in any other diftemper, is here to be obferved; that when the gout has feized the ftomach, this organ becomes fo cold and torpid, that wine feems no stronger than water; and it requires, and easily bears the hottest liquors, fuch as spirits drawn from wine. Wherefore, not only generous wines are to be given in pretty large quantities, but alfo vinous fpirits, rendered more efficacious by the infufion of fnake-root, ginger, or garlick. And if thefe fhould not prove powerful enough, it will be proper to order the powders of fnakeroot, ginger, and long-pepper, mixed with the cordial confection, to be taken by the mouth.

It has been difputed among physicians, whether or not a vein may be opened, when the pain in the joint is extremely fevere. Now, to fettle this point, we ought never to forget, that this pain is highly neceffary for tumefying the part, and therefore ought to be borne with patience. This however notwithstanding, (feeing it is certain, that exceffive heat is an obftacle to the natural fecretions from the blood, which are neceflary for health), if the fever run very high, and especially, if it be attended with a delirium, or difficulty of breathing, blood letting will not only

leffen

leffen the pain, but likewife happily promote the iffue of the humour*. Nay, it will be requifite to repeat the operation, when there appear figns of a comatofe difpofition. For I have very frequently obferved phy. ficians to be too timorous with respect to this evacuation, from a notion, that it would prevent the gouty humour from being thrown upon the joints. Upon the whole, one effect of blood-letting is generally to make the disease abandon the place where it was lodged; and the great benefit of this removal in feveral cafes is manifeft. But as for anodynes, they are not to be allowed, excepting in vomiting and looseneffes. Nor do gouty people (to say it once for all) bear cathartics well, till the paroxyfm is over; and then they may be given, to carry off the remains of the morbid humour, which raised the tumour.

Of greater difficulty and moment is the queftion concerning the regimen, whereby a perfon may entirely rid his conftitution of this tormenting diforder, and keep it off for the future. Upon which, the first confideration ought to be, whether that can be done with fufficient fafety and advantage to the patient. For, as to elderly people, who have been accustomed for many years to returns of the disease, if the fits come on no more, their bowels are attacked instead of their joints; and befides, they are feized with fuch weaknefs in their legs and feet, that the remainder of their life is quite miferable and of this I have seen more than one inftance in perfons, who had abfolutely confined themselves to a milk and vegetable diet.

:

Therefore, if any one be defirous of trying the ex* See discourse of the fmall-pox, chap. iii.

periment,

periment, and running the risk of its confequences, let him remember, that he ought to be young, and not to have had above two or three fits of the gout. Then let him obftinately abstain from wine and all other fermented liquors, and for drink, confine himfelf to water. Let his food be milk, and things made from it, and vegetables; befides which, he may make one meal a day on flesh of the tender fort, fuch as that of chickens, fowls, and rabbits, and now and then on fresh-water-fifh. Let him ufe daily exercise, but with moderation. By this course of living, I have known fome live comfortably to a good old age, without the leaft attack of the gout. Of fuch confequence it is to live according to nature, that is, to practise temperance. And a trial of this courfe of life is in a peculiar manner adviseable for those who may expect to be punished for the irregularities of their parents, not for their own, by a hereditary gout; in order to prevent its feeds, fown in their blood and nervous fluid, from producing difagreeable fruits in time.

I fhall close the prefent chapter with this admonition, that although I faid above with great truth, that this disorder is rather to be deemed a crifis of the disease, than the disease itself; yet fometimes, efpecially in old age, it is a very fevere evil; when the ftrength is fo decayed, and the limbs fo weakened, that bodily motion is loft, and with it a confiderable fhare of the comforts of life. However, this, like all other calamities, is alleviated by patience. And perhaps, it may be fome confolation to others, as well as it was to Sydenham, in the midst of tortures, that great monarchs,, potentates, generals, admirals, philofophers,

lofophers, and many others like them, lived, and at length died in the fame manner

T

CHAP.

*

Of pains in the joints.

Hofe pains of the joints, which are accompanied with inflammation and tumour, have an affi nity with the gout. The proper method of curing them is by bleeding, bliftering the parts affected, and, unless the fever runs high, by purging. If there be no fever, or but a flight one, a mixture of equal parts of gum-guaiacum and cinnabar of antimony will prove a very good medicine, both to open the body, and correct the acrimony of the humours. It should be given fo as to procure two stools at least every day.

Of all thefe pains the most severe is that which the Greeks name irxias, (and we corruptly fciatica), because it feizes the hips; and it is attended with the greater difficulty, because it is most commonly the confequence of chronical diseases, by the morbid matter being thrown on this part. This disease, when grown inveterate, weakens the thigh and leg, and makes the patient lame: and fometimes alfo, the head of the thigh-bone flips out of the focket, and then the thigh foon wastes away.

In this disease, little is to be expected from cupping or bliftering the part; for the acrid humour lies too deep fixed in the membrane furrounding the bone, to be drawn out by these means. More efficacious is the volatile epithem, or a plaster composed of Bur• Tract. de podagra, ed. I. page 24.

gundy