G o u r. 



c^nfirmeJ, on the one kand, by tlie tcllimoiiy of isgcs in tlie 

 affirmative, it is corroboiated alfo, on the; other hand, by 

 obicrvation in the nec!;ative. Dr. CuIIcn remarks that gout 

 feldom attacks thoie wlw are employed in bodily labour, 

 or who live much upon vegetable aliment, orthofe who make 

 no life of wine or other fermented liquor?. Indeed, the gout 

 is faid to be altotrether unknown where thefe licjuors are not 

 iifed, as among the common people of Turkey. Among the 

 lower orders of people, even in this countrv, the difeafe is 

 very rare, and llill more rare in Seotland and Ireland, where 

 animal food and ftrong ale and beer are leis ufed. Van 

 .Swicten obierves, that iome people who, from comfortable 

 circumllances, have been reduced to labour for their fulle- 

 iiauce, and to exchange a luxurious table and indolence for a 

 ipare diet and activity, have loll their gout. He mentions 

 particularly the inftancc of a certain priell, who enjovcd a 

 rich living, and had been an old and conftant fufl'erer from 

 the gout ; but happening to be taken by the pirates of Bar- 

 bary, he was kept conftantlv at work in the galleys for the 

 fpace of two years : " which had this good etfecl, that after- 

 wards, when he was ranfomed from captivity, having loll 

 all his troublefome and moijllrous fatnefs, he never once had 

 a fit, though he lived feveral years after the event." (Van 

 Swieten, Comment, ad Aph. 1255.) Several anecdotes of 

 a fimilar natiu-e are related by the indullrious Schenckius. 

 (Obf. Med. Rarior. lib. v. p. 657. edit. 1644.) In a word, 

 much exercife, wl\ich will often counteract tlie influeuco of 

 intemperance, will, when combined with temj)erance, coun- 

 tera6l even the hereditary difpolltion to the difeafe. 



The cfteft of full living and indolence, in producing the 

 gouty diathelis, is alfo manifell from the form and tempera- 

 ment of the perfons in whom it occurs. Tliefe are cfpecially 

 men of robufl and large bodies with large heads, and of full 

 and corpulent habits. They have commonly alio a coarfer 

 (kin ; and if, with the ancients, we might denote the tem- 

 peraments of men by certain terms, we Ihould fay that the 

 gout efpccially ahails men of a clmUncn-faii^u'mc tempera- 

 ment, and feldom attacks the purely fanguine or melancholic. 

 "Women are not very liable to the t;ont, prohaljly from their 

 lefs intemperate mode of life, in general, than that of men : 

 but thofe females whom it attacks are g;enerally of robuil 

 and full habits. It is faid not to occur in them commonly 

 till after tlie ceffation of mcnftruation ; which perhaps only 

 implies that it is a difeafe of advanced life. For as Dr. Cul- 

 len jullly remarks, " it often happens to fuch 1 the robuil) 

 long before the menflrual evacuation has ceafcd," and lie 

 had "found it occurring in feveral females, whole menllrual 

 evacuations were more abundiuit than ufual." (Firll 

 Lines, J 494) A fail, which we may explain, with Dr. 

 Gregory, by obfcrving, that thofe women wlio indulge 

 much in vinous and fermented liquors, are more liable to 

 inenorrhagia than others. 



It is obvious, tlien, that the experience of all ages con- 

 'Urs in aiiigning intemperance and indolence as the principal 

 "unves of tiiat habit of body, in which the gout is liable to 

 lecur. This habit, or predifpoiltion, feems to be tufricient, 

 1 many cafes, to produce the difeafe itlelf, or at leail to re- 

 quire the application of flight and imperceptible exciting 

 . aufes to bring it forth. The difeafe, indeed, depends fo 

 much upon predifpofition, that it is difficult to allign the 

 oecafional caufes ; the fame agents api)ear to be lometimes 

 the generators of a predifpolition to it only, and at other 

 times aclually to excite the difeafe. 



Tlie c.xc'it'ui^ciuifcs which often fuddenly bring on a fit of 

 the gout, in thofe who are predifpofed to it, are, in the firil 

 place, thofe circumllances which induce a fudden debility, 

 elpecially of the llomach. The concurrence of imli^fjlion, 



and the local tnflummalion in goiit, is one of the clia>. 

 racterillics of the difeafe ; and, as we lia\c already dated, 

 the latter is iifiial'y preceded for fome time by the' former. 

 Hence whatever fuddenly deitreffes the ihgeftivc power, i* 

 liable to induce the local and conlHtutional difeafe. Thus * 

 paroxyfm of gout lias frequently been exeiicd by an occa- 

 fional excefs in the ufe of wine or fpirits ; by overloading the 

 llomach with food, or by eating fuch as is not eafily digellible 

 in its nature ; by the co))ious ufe of vcgctalilc acids or 

 acefcent matter, efiK'cially by weak accfcent wines, punch, 

 &c. ; all of which tend to debilitate the digc(li\e organs cither 

 diredly or indirectly. In the fame way, excefs of vcncr%-, 

 which powerfully influeiiccs the flomacli, (Van Swieten, 

 Aph. 586, and 125J,) has often brought (ni a fit. This feem^ 

 to liave been univerfally underftood by the ancients. Wc 

 have alrea ly noticed the obfervalion of Hippocrates ; an4 

 Actius, in recounting the general caufes of gout, fays, thefe 

 are, " abounding crudities, frequent drunkenncfs, and, above 

 all, an immoderate ule of venery." (Sermon xii. Cap. 6.)' 

 Sydenham and Van Swieten add their tellirnony to tlie faft. 

 Inieiife lludy, night-watching, exceffive anxiety and atten- 

 tion to bulinefs, all of which greatly deprefs the power of 

 the body in general, and of the llomach in particular, de- 

 llroying the appetite, and producing a fenfe of uiieafinefs, 

 linking, or weight about the region of the llomach, arc 

 likewile enumerated among the occafional caufes of the 

 gouty paroxyfm. The fame is true w ith refpeC^ to the vio- 

 lent emotions and paffions of the mind, more particularly of 

 anger. " Ira oblletrix arthritidis" is part of the adage above 

 (|uoted : and the three caufes of gout, infilled on by Dr. 

 Cadogan, are intemperance, indolence, and ViWtilion. The influ- 

 ence of violent mental emotions on the funclions of the body 

 is, indeed, very manifell, and more cipecially on the function 

 of digellion ; the dillurbance ot which, we have alreadr 

 obferved, is exceedingly inllrunieiital in the production of 

 gout. " The firll immediate ciVecl of violent grief or vex- 

 ation," lavs Dr Cadogan, " is to take off the aclion of 

 the ihnnach entirely. Let us fiippole a man in the b.."ft. 

 health, the hlghell good humour and fpirits, as well as good 

 llomach, fitting down to dinner with liis friends, receive* 

 fuddenly fome very afflicting news. Inllantly his appetite 

 is gone, and he can neither eat nor fwallow a morlel. Let 

 the fame tiling happen after he has made a hearty cliecrful 

 meal, as fuddenly the aJlion of his llomach, the whole 

 ])ouer of digellion is cut off totally, as if it were become 

 jKiralvtic, and what he has eaten lies a moll onpredive h)ad. 

 I'eriiaps as the excefs of weaknels is often convulfion, it 

 may be rejected by a violent vomit, or do greater miiciiief : 

 for which reafon fuch Ihokes of dillrefs are lefs hurtful 

 received upon an empty than a full tloinach." 5;c. (Loc. cit. 

 p. 55.) The gouty liabit, indeed, is often an irritable habit ; 

 and Sydenham obferves, that a lit of gout may be called a 

 fit of anger. (See alfo \'an Swieten. }" 1258.) 



.Among other exciting caufes of'gout, the fudden ceallng 

 from the cullomary cxercifes or labour is commonly men- 

 tioned, and its principal effect is probably upon the funclioa 

 of digellion, whicli is fo much under the influence of exorcifc. 

 Indolence, in general, as contributing to induce th"? gouty 

 difpolltion, is well iniderllood ; and tlie fudden ceffation of 

 aclivily, like all other fudden changes, is apt to produce a 

 fudden acceffion of the paroxyfm, in thofe who are pre-<lif- 

 pofed to the difeafe. In a fiinilar manner, a fudden change 

 in the mode of hving, the oppofite to excels, namely, from 

 hio-Ii feeding to a very fpare and abilemions diet, is liable to 

 induce the paroxyfm of gout. That fuch a fudden abllrac- 

 tion of the powerful lUmulus of a copious fujiply of food 

 and ftrong liquors, mnll neceffarily induce a coufiderable 

 2 T 2 dirocl 



