GOUT. 



lof the fluids, but dircclly and folcly upon tliat of the mov- 

 ing po\vc-rs." Dr. Cullon likewifc remarks, that tl;e fiip- 

 poiition of a morbific humour bL'ing the caufe of gout lias 

 been hitherto ufelefs, fince it has not fuggefted any fuccels- 

 ful method of cure: but, on the contrary, that particular 

 iuppofitlons have often corrupted the praftlce, and liave 

 frequently led from thofe views, which might be ufoful, 

 and from that prafticc which experience had approved, 

 (rirlt Lines, pt. 530.) 



Having failed to explain the phenomena of the dlfcafe, 

 on tlie fuppofition of a morbid condition of tlie fluids of tlie 

 body; we might take up the doftrlne of the tuvvons patlio- 

 logUls, and attempt an explanation of the fymptoms, hjkmi 

 the notion of a derangement of the living folid, or moving 

 .fibre, as Dr. Cullen has done. (Loc. cit. §. 533 — 6.) 

 But it is fuffielent to perufe the account given by tliat 

 celebrated phyficlan, to be convinced that it is a mere 

 repetition of the phenomena of the different varieties 

 of the difeafe, couched in a new phrafeology ; and 

 therefore that it is practically as ufelefs as that which 

 tie controverts. It cannot be queflloned, we apprehend, 

 in the prefent flate of our phyliologlcal knowledge, that 

 the prime agents in the operations of the living body, whe- 

 ther in health or difeafe, are the folld, irritable, and mov- 

 ing parts; and that by thefe the fluids or humours are 

 clileily elaborated and modified: but it is likewife obvious, 

 that the follds derive their powers from certain conditions 

 of the circulating fluids, which are varied by refpiration, 

 nutrition, &c. Therefore the difputes between thofe, who 

 confine the origin of gout to the one or other part of the 

 fyflem exclufivcly, mull be deemed frivolous. Our kuou'- 

 ledge Is neccffarily limited to the phenomena of the difeafe, 

 and tlic order in which they occur, and to the effetls of 

 ph) fical agents upon them, as taught us by obfervatlon and 

 experiment. " Nulla tamen adhuc obfcurior quxfllo eft," 

 lays Dr. Heberden, *' quam qua; verfatur de hujus morbi 

 ■caufis, effeftlbufquc, et remedlls." (Comment, de Morb. 

 Cap. 9.) Lut we cannot doubt that thefe luunerous hvpo- 

 thefes, which liave at once diverted tlie minds of phyficians 

 from tlie lubom- of obfervatlon, and have perverted their 

 views of facls, have rendered the fubjeft more obfcure than 

 it wovdd otherwlfe probably have been. 



Before we come to tlie method of treatment, there is 

 another queftien to be noticed, upon which niucli dlfcuflion 

 has taken place, and which has perhaps been popularly 

 folved with confiderable incorreftnefs : we mean tlie quel'- 

 tion, whether regular fits of the gout are fahitary ; ;'. e whe- 

 ther tliey altogether remove or prevent other complaints. 

 Tlie afRrmatlve Is generally maintained: and this opinion 

 has arlfen partly from obfervatlon, and partly from the hy- 

 pothefis, that a paroxyfm of gout eonlUls In an effort of the 

 conftltution, by which the morbific matter is thrown off 

 through tlie part afTefled. In a number uf inllances, be- 

 yond a doubt, tlie various fymptoms of indlgefflon, whe- 

 ther aftecflng the flomach and bowels only, or the lungs 

 and heart by vicinity, and the head by fympathy, are re- 

 lieved or altogether carried off by tlie complete fit. Per- 

 haps Dr. Heberden is fcarcely correft, when he confiders 

 this relief as either, in a great meafure imaginary, like that 

 which many invalids Invariably obtain from a change of their 

 jjliyfician, or frcnn a new medicine; or as not more frequent 

 than fimllar relief from flight indifpofitlon after other violent 

 difeaies: he appeals, however, to an ample experience in 

 fupport of his opinion. He thus writes: (we tranfiate 

 from the Latin edition) " There are fome countries in which 

 the itch is a very frequent difeafe, and tliere this eruption is 

 tlecnu'd falutary. Even an ague was formerly confidered by 



tlie majority of phyficians as a wliolefome affeclion, and i» 

 fllU fo confidered by fome perfons: its occurrence was there- 

 fore a fubjeft of congratulation both with the patients and 

 their friends, and every precaution was taken not to get rid 

 of it too foon. But tliefe notions are ahnoft exploded in 

 this country ; and if we fliall difcover a remedy equally 

 effcAual for the gout, as thofe with which we cure the dif- 

 eafes juft mentioned, we fliall at length learn with what per- 

 feft fafety and advantage the gout may likewife be eradi- 

 cated.'' — " I coiifefs,'' he adds, " that I liave feen fome 

 perfons who i-ejolced on the firft attack of the gout, as if it 

 afliired to tliem all future happinefs, and who, dreaming 

 only of the moft pcrfefl; health to come, eafily perfiiaded 

 theinfelves that this firft fit had been wonderfully beneficial 

 Tills Is a common difpofition with mankind, as often as they 

 have recourfe to new phyficians, or to remedies not before 

 tried. But, pafFing by fuch perfons, let us Inquire the 

 opinion of tliofe, who have fuffercd under long and frequent 

 paroxyfms, and who are better acquainted with the difeafe. 

 Of a very great number of patients whom I have feen, and 

 whole cafes I have committed to writing, more than twice 

 as many, to fay the leaf!, have found no relief whatever 

 from their previous complaints, in confequcnce of the regular 

 fit, or have even fuffercd an increafe of them, as have feemed 

 to derive any benefit: and, in niv opinion, the evils which 

 Were attributed to the difeafe, more certainly originated 

 from that f jurce, tlian the fuppofed advantages. Occafion- 

 ally. Indeed, we find that other complaints have ceafed on 

 the fupervention of the gout ; but the fame thuig alfo hap- 

 pens after acute fevers, after palfy, afthma, fmall-pox, and 

 infanlty, of all which I have witneffed many examples; 

 yet no one will call thefe difeafes falutary. On the other 

 liand, gout frequently occurs to perfons affedfed with ver- 

 tigo, aflhnui, indigelllon, and melancholy; where, fo far 

 from alleviating thefe diforders, it produces a confiderable 

 aggravation of their fymptoms. Befides, in fome patients, 

 all thefe complaints confiantly accompany the paroxyfm of 

 gout, and continue during the wliole of Its courfe.'' (Loc. 

 cit. p. 36.) 



At all events, If we look at the life of the gouty In gene- 

 ral, we find ultimately but little ground for congratulation. 

 In fome, it is true, the difeafe occurs at dlflaiit intervals, 

 and foon goes off, and therefore occafions very little, it any, 

 obvious Injury. Even epileply Ilfelf, when its attacks are 

 rare, does not prevent the patient from reaching old age. 

 But this is far from being the cafe frequently with either 

 difeafe. In many perfons whom the gout attacks, the 

 health fuffers from the time of the firll fit, and gradually 

 grows worfe, until it is greatly broken, er falls altogether. 

 It may pofhbly be doubted, in fuch cafes, whether the gout 

 caulcd thefe evils; but we are very certain that it has not 

 been the remedy for them, nor in any way falutary. 



We may julily wonder, therefore, with Dr. Heberden, 

 how it has come to pafs, that the gout is held in fo much 

 honour in England ; uiilefs it be that It is a difeafe, which 

 feveral great men have fuffercd, and which ciilefly attacks 

 thofe liajipy perfonages who enjoy leifure and affluence, 

 and all tlie good things of life. Louis XIV. of France 

 happened to labour under a fillula in the anus, and the fur- 

 geons of that time were confiantly called in by his fafliion- 

 able fubjetls to adniinlllcr relief to imaginary fiflulx; which 

 royal difeafe they perfuaded themiclves had attacked them : 

 and It is probable, as Dr. Heberden luggefls, tluit had there 

 exllled a>iy medicated waters in France, capable of produc- 

 ing fiihila, they would have been vlfited with tlie fame anxi- 

 ety with which our countrvnien haflen to thofe of Bath, in 

 the hope of returning with the gout. 



