MEDICINE. 



Trclice. would appear that it depends upon the combined ope- 

 ""Y"* ration of luxurious habits of various kinds, of which, in- 

 dulgence in the gratifications of the table, and the want 

 of a due quantity of bodily exercise, are probably the 

 most important. 



Besides the regular forms of the disease, where it 

 occurs in paroxysms, that alternate with, or succeed 

 to complaints of the stomach, and leave the patient in 

 perfect health during the intervals, there are other va- 

 rieties of the disease, in some of which the different 

 stages exhibit considerable irregularity, both with re- 

 spect to their degree of violence, and the order of their 

 succession ; in one of these, which is called retrocedent, 

 or repelled Gout, after the disease has settled upon the 

 joints of the extremities, it suddenly leaves the part, 

 and attacks some of the internal viscera, the brain, the 

 Jungs, the heart, or the stomach ; and if not relieved 

 by the appropriate remedies, may suddenly prove fa- 



nature, the paroxysm of Gout was considered rather as 

 a curative operation which was to be induced or pro- 

 moted by the practitioner, than as a morbid condition 

 of the system which it was his business to remove. 

 Accordingly, all our attempts were more calculated to 

 increase, than to diminish the inflammation of the joints, 

 by tlie application of warmth, and by the use of stimu- 

 lating diet and medicines ; and even during the inter, 

 vals of the fits, so great was the apprehension of the 

 mischief that might arise from checking the efforts of 

 the vis medicatrix, that nothing was attempted more 

 than a mere palliative plan, which was generally alto- 

 gether inert. Of late, however, we have ventured up- 

 on a more active practice, and we have not hesitated 

 to oppose the regular progress of the disease, or even 

 to counteract the natural actions of the system. We 

 administer brisk purgatives to clear the alimentary ca- 

 nal, we attempt to moderate the inflammation of the 



til, by preventing these organs frt>m performing their joints, if not by the application of cold, at least by the 

 ordinary functions. The regular Gout is not a disease abstraction of heat; and we occasionally employ bleed- 

 which is usually considered as productive of danger to ing, either general or topical, and enjoin the strict an- 



the life of the patient; but it materially impairs his com- 

 forts and utility, for the fits generally increase upon 

 him, both in their violence and their duration, so that 

 at length he is doomed to pass a considerable part of 

 his time under their influence, while the joints, by the 

 repeated attacks of inflammation, become distorted, or 

 nearly immoveable. The irregular Gout, although pro- 

 ductive of less urgent symptoms, and of little or no 

 injury to the joints, has the effect of imbittering the 

 life of the patient, by an almost constant state of in- 

 disposition ; and it has a peculiar tendency to induce a 

 distressing lowness of spirits, and a feeling of despond- 

 ency, which are more intolerable than acute pain. 

 5tteofthe The phenomena of Gout werefoimerly regarded as 

 affording the most direct evidence of the theory of the 

 humoral pathologists, in which a morbific matter exists 

 in the fluids, is capable of being conveyed from one 

 part of the borly to another, and manifesting its pre- 

 sence in them by its appropriate symptoms. Palpable, 

 however, as this conclusion was conceived to be, the mo- 

 dern pathologists have denied the existence of this mor- 

 bific matter, of which it has been said that no evidence 

 exists, except what is derived from the symptoms of the 

 disease ; and these, they have asserted, might be better 

 explained upon other principles. The researches of the 

 modern chemists have, however, given some plausibili- 

 ty to the doctrine of the humoralists, by discovering 

 that gouty urine contains an unusually large proportion 

 of lithic acid; and as the same substance has been 

 found exuding from the joints, in combination with so- 



tiphlogistic regimen. To what extent this plan is to be 

 pursued, must be left to the discretion of the practi- 

 tioner, as determined by the urgency of the case ; while 

 we have ample evidence of its safety, when judiciously 

 employed, we are to bear in mind that the inflamma- 

 tion of Gout is of a specific kind, and that the imme- 

 diate danger of the disease consists in its being repelled 

 from the extremities to the internal viscera. After we 

 have carried the depleting system as far as is thought 

 proper or necessary, opium, cither alone or in combi- 

 nation with ipecacuanha, will be found useful for re- 

 moving irritation, and bringing back the functions in. 

 to their ordinary state. When the fever and inflamma- 

 tion have subsided, we shall probably find a course of 

 bitters and stomachics necessary to strengthen the di- 

 gestive organs, and to prevent the recurrence of that 

 state which lays the foundation for future attacks of the 

 disease. But this object, which is even of greater im- 

 portance than the cure of the individual paroxysm, is 

 to be attempted more by regulating the habits of the 

 patient, than by the employment of any particular ar- 

 ticle of the materia medica ; provided the constitution 

 be not too much impaired, and the alteration be not 

 too hastily adopted, we find that, by exchanging a life 

 of gluttony and indulgence, for one of temperance and 

 activity, we are generally able to accomplish the drsir- 

 ed effect. Simple, however, as this plan may appear, 

 it is but seldom that the practitioner is able to put it 

 into execution ; for so wedded are the patients to their 

 accustomed indulgencies, that they shut their ears to 



da, it would seem to follow, that the general mass of the salutary counsels of their medical attendants, and 

 the circulating fluids are impregnated with it. But voluntarily resign themselves to pain and disease, in 

 although the fact must be interesting,*both in a patho- preference to health and comfort, when they are to 



logical and a practical point of view, it cannot be con- 

 sidered as throwing much light upon the proximate 

 cause of Gout, as we have still to inquire how the pre- 

 sence of the lithic acid can produce the peculiar affec- 

 tion of the stomach, why it is transferred from the sto- 

 mach to the joints, why it particularly attacks the small 

 joints of the extremities, why the general and local 

 symptoms alternate with each other, and, in short, what 



be purchased by the renunciation of their luxurious 

 habits. 



An important circumstance yet remains to be noticed Specific for 

 respecting the cure of Gout, the discovery of a medi- 6 >ut - 

 cine which is supposed to have a specific effect upon 

 the disease, so as to remove it by a kind of operation 

 which we cannot refer to any general principles. The 

 medicine was introduced into practice in the form of a 



connexion or relation it bears to the ordinary symptoms secret recipe, but it appears to be ascertained that its 



<Tfc dlsease> essential ingredient is the colchicum autumnale. This 



tut. J :atment of Gout has. varied very much at dif- is one of those substances which, when taken in a large 



ics, according to the prevalence of particular quantity, prove highly deleterious ; but in moderate 



heories, or the pathological doctrines that have doses it may be taken without danger, and usually 



i entertained respecting the nature of the complaint, operates by producing an evacuation either from the 



iVnile all diseases -were regarded as salutary efforts of bowels, the kidney, or the skin. It affords almost a 



