380 DISEASES CIASS IV. 1. 2. 15. 



periods may depend on the succession of great vicissitudes of 

 cold and heat, and the diurnal ones on our increased sensibility 

 to internal sensations during sleep, as in the fits of asthma, and 

 of some epilepsies. See Sect. XVIII. 15. 



In respect to the pre-remote cause or disposition to the gout, 

 there can be no doubt of its individually arising from the potation 

 of fermented or spirituous liquors in this country; whether opium 

 produces the same effect in the countries where it is in daily use, 

 I have never been well informed. See Sect. XXI. 10. where 

 this subject is treated of; to which I have to add, that I have 

 seen some, and heard of others, who have moderated their pa- 

 roxysms of gout, by diminishing the quantity of fermented liquors, 

 which they had been accustomed to; and others who, by a total 

 abstinence from fermented liquors, have entirely freed them- 

 selves from this excruciating malady; w r hich otherwise grows 

 with our years, and curtails or renders miserable the latter half, 

 or third, of the lives of those who are subject to it. The remote 

 cause is whatever induces temporary torpor or weakness of the 

 system; and the proximate cause is the inirritability, or defective 

 irritation, of some part of the system; whence torpor and conse- 

 quent inflammation. The great Sydenham saw the beneficial 

 effects of the abstinence from fermented liquors in preventing the 

 goui, and adds, " if an empiric could give small-beer only to 

 a gouty patients as a nostrum, and persuade them not to drink 

 " any other spirituous fluids, he might rescue thousands from this 

 u disease, and acquire a fortune for his ingenuity." Yet it is to 

 be lamented, that this accurate observer of diseases had not reso- 

 lution to practise his own prescription, and thus to have set an 

 example to the world of the truth of his doctrine; but, on the 

 contrary, recommended Madeira, the strongest wine in common 

 use, to be taken in the fits of the gout, to the detriment of thou- 

 sands; and is said himself to have perished a martyr to the dis- 

 ease, which he knew how to subdue! 



As example has more forcible effect than simple assertion, I 

 shall now concisely relate my own case, and that of one of my 

 most respected friends. E. D. was about forty years of age, 

 when he was first seized with a fit of the gout. The ball of his 

 right great toe was very painful, and much swelled and inflam- 

 ed, which continued five or six days in spite of venesection, a 

 brisk cathartic with ten grains of calomel, and the application of 

 cold air and cold water to his foot. He then ceased to drink 

 ale or wine alone; confining himself to small-beer, or wine di- 

 luted with about thrice its quantity of water. In about a year 

 he suffered two other fits of the gout, in less violent degree. HP 



