G O U T. 



irfembliiig melted gl:ifs, which remaining in the joints, pro- 

 duced the cretaceous matter. Aretxus, one of the moft 

 able of the Greek writers, is the only one who pafies over 

 the efiential caufe of the difeafe, a knowledge of which he 

 airigns to the gods alone ; the evident caufes, he fays, are 

 apparent to man. Themifon, Crelius Anrelianns, and the 

 methodic feci, attributed gout to relaxation or Urieture of 

 the parts ; fume, however, imputed it to the one ilate, and 

 others to tiie oppofite. The Arabians followed clofely in 

 the path of their maflers, and taught that one or other of 

 the humours was predominant, or that thev were varioudv 

 combined, in cafes of gout. >So luminous and inllrudtive 

 were the doctrines of tiie ancients ! 



In the dawn of modern fcience, the humours were almoft 

 baniflied by the liypothefes of the chemilts ; but although 

 we hear httle more of bile, phlegm, and melancholv, or 

 black bile, all dileafe was neverthelefs attributed to a mor- 

 bific or peccant matter, and falts, earth, or tar.'ar, were 

 de?:red th.- immediate cuufe of gout and other maladies ; 

 and Paracelfus, Van Helmont, and others, arc very abufive 

 of tlie ancients for pronudgating lo many abfurd docftrines ! 

 When the mathematical and mechanical phyilciaiis arofe, 

 they took up the hypothetical dortrines of their predecef- 

 fors, and reafoned concerning the adlion of thefe fuppofi- 

 titious humours, lalts, tve. upon mechanical principles; the 

 chemical doctrines predominated, however, over the ancient 

 humours. Thus, to ufe the.words of Dr. Wirner, " accord- 

 ing to Sydenham tlie arthritic matter confiils of the putrc- 

 f)";ng heat and acrimony of indigelled juices: Boerhaave 

 gives it the appellation of an acrimony or over-tougluiefs of 

 the liquid which waters the nervous parts: Liller makes it 

 to be a crude and vilcid ferum become ichorous and corro- 

 five: Bennet defines it an acrimony that is invariably of the 

 putrid, volatile alkaline nature: Quincy fays that it con- 

 lills of rigid particles, fuch as approach near to tlie faline, 

 of the nature of tartar, and not much unlike that which 

 forms itfelf into concretions in the urinary paiTages: Chcyne 

 in one place calls it tartarous, urinous, or otlitr falts: In- 

 gram will have it to be a coagulation made by a mixture of 

 ialine particles with the oil of the adipofe membrane. As 

 every one of thefe writers makes the gouty matter to be an 

 acrimony taken in with our aliment, which tliey call either 

 putrid, vifcid, corrofive, Ialine, urinous, or tartarous, to 

 Dr. James, wiiole name needs no addition, diiagreeing with 

 them all, hath judged this acrimony to be earthy." (Sec 

 Warner on the Gout, p. 91. — See alfo a fi nlible and learned 

 difijuiiition on this topic, in " An Hiltorical, Critical, and 

 Praftical Treatife of the Gout, by Thomas 'I'homfon, M D. 

 Lond. 1742.) But fuch liypothefes did nut die with Dr. 

 James; for in a treatife on the gout, publiihed in 1SC5, we 

 lind the following itatement: "The proximate cauie of 

 gon' appears to be, a peculiar faline acrimony cxilHng in 

 the blood, in fuch a proportion, as to irritate and excite to 

 morbid action, the minute terminations of the arteries, in 

 certain parts of the body:" (See Obfervations on the 

 Nature and Cure of Gout, &c. by James Parkinfon,) a 

 ftatement, which is equally indelinite, iiypothetical, and 

 prai'tically ufelefs, with thofe that liave preceded it. 



On reviewing theie opinions of men, nho have been de- 

 fervedly efteeiv.ed the ornament of their profefiion, fome 

 readers may exprcfs their furprife that fuch an extraordinary 

 difference fhould be found among them, and tliat lo much 

 error (for of oppofite opinions one half at leall mull be 

 wrong) ihould exiil in the fcience. But the only r.itional 

 ground for wmder is, that fo many men of lound under- 

 rtanding Ihould have employed themfelves in inquiries beyond 

 the reach of their faculties, and ftiould have iuv.igincd that, 



in framing hypothetical fuppofitions, they had acquired any 

 adual knowledge, or had advanced one ftep in the praAieal 

 improvement of tiieir art. If a number of piiilofopheri 

 were engaged in invelligating the nature of light and heat, 

 and fhould not only execute a feries of experiments on tlic 

 reflection, refraction, and divilibility of the one, and on the 

 properties of expar.lion, inflammation, vaporization, &c. 

 of bodies, which belong to the other; but fliould likewife 

 think it neceffary to form conjectures relative to the nature 

 and qualities of the fun, which is the fource or proximate 

 caufe of both; tliCfe conjectures, like the medical hypo- 

 thefes jufl quoted, however tlicy might amufe us, would 

 add not a tittle to our knowledge, nor would the want of 

 them be any diminution of our information, or of our prac- 

 tical powers. 



The great fource of thefe hypothefcs, refpeCting the 

 cxillence of a morbid humour in the goutv habit, is, no 

 doubt, the appearance of a palpable matter, of a peculiar 

 nature, in the joints dii'eafed. This chalk-like matter, how- 

 ever, will be found to afford no ground for fuch a conclu- 

 fion, if the circumihmces are duly examined. In the (irll 

 place, the produdion of this morbid matter mav be the 

 f^-fl of the difeafe ; and that it is fo, is apparent from its 

 not occurring in all cafes of gout, and from its feldom or 

 never accompanying the lirfl attacks of the difeafe, but 

 only appearing after repeated paroxyfms. Nor have «e 

 any direct evidence, from experiment or obfervation, of the 

 fmaUell difl'eicncc in the blood or other humours of gouty- 

 people, from thofe of other perfons. On the other hand, 

 we know that tiie veffels in particular parts acquire the 

 power of ferreting or otherwife producing new fluids, when 

 inflammation is induced. Thus a blow in a flelhv or mem- 

 branous part ihall occafmn inflammation, and a conliderable 

 quantity of pus lliall afterwards be accumulated or dif. 

 charged, as in a common abfcefs: jet no one fuppofes that 

 this^.w V, as contained in the mafs of the circulatiiio- blood, 

 any more tiun he fuppofes that urine and bile are contained 

 in th.at mafs, and not elaborated by the kidnies and liver. 

 The appearance of the chalky matter, or urate of foda, iiv 

 the parts attacked by gouty inflammation, is therefore to 

 be confidered as the refult of that inflammation, and not as 

 its caufe. If the general mafs of blood were contaminated 

 with this morbid matter, or any peculiar acrimony tending 

 to produce it, why is it never depoilted on the vifcera ami 

 other internal parts? yet no fuch depontion was ever ob- 

 ferved: thofe parts remain invariably free from it in the 

 mott inveterate forms of the gout, and the appearance of 

 ciialk-flones is confined exclalively to the membranous and 

 ligamentous parts which exhibit inflammation exterr.aUy. 

 In the next place, the frequent and fudJen tranllatioii of 

 the difeafe from one part to another is net conlillent with 

 the iuppolition of its dependance on the prefence of a mor- 

 bid matter: but analogous changes or i/u-ru/Li/rs of other in- 

 flammations, in which no peculiar matter is produced, are 

 exceedingly common. Belides, upjn the fuppofitioii of 

 fucii a traiulation of morbid matter, its operation fhould be 

 llmilargii every part: whereas it feems to be very diffeivnt, 

 being Himulant and exciting inflammraion in the joint.s, but 

 feda.ive and dellroying the tone or energv of the Itomach. 

 Farther, as Dr. CuUen jullly obferves, " the fuppotition of 

 a moibilic matter is quite fuperfluous; for it explains no- 

 thing, without fuppoling that matter to produce a change 

 in the flate of the moving powers; and a cliange in tjie llate 

 of tlie moving powers, produced by other caules, explains 

 every i Ircumllance, without the fuppofition of a morbific 

 matt.r: and to this purpofe it may be obfcrved, that manv 

 of the caufes exciting gout do not operate upon the llate 



