GOUT. 



fjflhc Cure. — Perhaps this iiiay be deemed an improper term 

 for the treatment of a difeafe, wliich, on the one hand, has been 

 affirmed to be incurable by medicine, and called the oppro- 

 brium of phyficians ; and, on the other, has been conlldereJ 

 fo falutary, that it ought not to be cured, and could not be 

 cured without the molh ijnmincnt danger to the patient. 

 Nay, farther, as much trouble has bee<i taken to produce 

 and excite the gout, as to relieve or cure it ; and all the 

 evils which arthritics fufFer, are not fuppofed to arife from 

 a lupcnibundance of gout, but becaufe they have not had 

 enough. It would be onlyjultice, liowever, as the intelli- 

 gent writer juft quoted remarks, to the art of pliyfic, no 

 longer to call the difeafe its opprobrium, until the patients 

 lay afide their prt^iidiees and fears, and" 

 be cured. " Utinam," he adds, " tarn in promptu effet in 

 venire, quam tutum adhibere, podagrce remcdium." (Com- 

 ment, p. 43.) 



The treatment, it is obvious, muil be neceffarily very dif- 

 ferent according to the different forms of the difeafe, the 

 different periods of life, and the Rate of ftrength of the pa- 

 tient, &c. We fiiall lirfl fpeak of the practice neceflary to 

 be purfued in the regular gout ; which will refolve itfelf into 

 tlie treatment requilite during the fit, and tliat which is pro- 

 per during the interval. 



Treatment of the Regular Fit. — All aclive meafures, during 

 the occurrence of a regular paroxyfm cif gout, have been 

 prefcribed by writers in general fnice the days of Syden- 

 ham. This phyhciaii remarked, that the moi-e violent the 

 pain and inflamma;ion, the fliorter in general will be the Jit, 

 the recovery moll perfeft, and the interval between this and 

 tlie fucceeding paroxyfm the longer. If this opinion were 

 admitted as jull, it would fnggelt the prohibition of any re- 

 medies which might moderate the inflammation. But againd 

 this doctrine another hypothefis has been advanced by Dr. 

 CuUen, which is at leall eqiiallv plaulible, and better fup- 

 ported by analogy, if not by fail : namely, that the violence 

 "t the inflammation may weaken the tone of the parts, and 

 while it renders them lefs liable to fimilar violent attacks, and 

 the confequent more perfeA recovery, may, by that very 

 debility, invite a return of the difeafe. On the whole, the 

 indications of pracl;ice generally purfued at prefent, are to 

 moderate the violence of the inflammation and tebrile atlion, 

 v.lien it is fevere, without applying any aC'live remedies to 



fu 



jetfts vinous and fermented liquors Hiuuld Lc 



ther abtlained from during the fit ; and the diet fliould to t 



of ligiit aqueou.^ and vegetable inattcri, or thin animal brollis: 

 tlie bowel 1 (hduld be kept open by laxative medicines, and tlie 

 fliin moiil; by diaphoretics of the neutral falts. This is at 

 lealt a palliative fyllem, and the prejudices of men in gene- 

 ral are averle to any more active interference with the dileafiv 

 But in cafe the inflammation is extremely violent, in youn" 

 and hale men, Sydejiham, Cullen, Huxham, and other abli- 

 authorities, concur in recommending the empIovm;nt of 

 blood-letting from the arm. This, however, thev do nut re- 

 commend to be often repeated, on account of the dcbditv 

 which may enfue ; and as the part affected is not an orgaii 

 lave a difpofitjon to important to life, and the inflammation fo purely local, there 

 does not appear to be any good reafon for recurring ta this 

 remedy, except in cafes of extraordinary violence, in verv 

 plethtiric habits, in which the fymptomatic fever itfelf might 

 prove hurtful. I^ocal blood-letting, by means of leeches ap- 

 phed to the foot itfelf, promifes more advantage, and experi- 

 ence itlelf lias proved the efhcacy and fafety of the prac- 

 tice. (See Cullen, Firll Lines, par. 563 — Mufgrave dc 

 Arthrit. regular!, cap. 8. ^ 4) Cupping and fcirifying 



the neighbouring parts have alfo been found beneSciaJ. 



( iVIulgrave. ) 



\\'^e are perfiiaded that hypothefis has had much more in» 

 fluence than obfervatioii and experience, in exciting the gene- 

 ral fears about interfering with the progrels of the goutr 

 Inflammatioii, and of the danger of its b?ing driven to fome 

 internal part by fucii interference. ^V'hen it was believed, 

 that a quantity of morbilic matter cxilled in the inflamed 

 part, it was inferred, of courle, that it could only be removed 

 by expulfion or by re;)ulfion, in which lall cafe it mull fall 

 upon i'ome other organ. "We know very well, that the (ame 

 hypothefis, and the lame fears prevailed no long time a'ni 

 with refpecl to cooling the flcin in fevers, and eipecialiv i:i 

 eruptive fevers, fuch as fcarlet fever and fmall-pox. «« The 

 perlpiration will be cliecked,'' faid the theorill, " if you- 

 allow the fcin to be cooled, and the Ji.earit ii:n//.r mud there- 

 fore be thrown back upon the bowels, or the lungs, or the 

 brain, and the efiect may be fatal.'' But ample, and un- 

 varying experience has now demonllrated, not only ti.at fuch 

 danger was altogether imaginary, but that wafliing the fliiii 

 with cold water, even under the JuU eruption of Icarlatina, 



the foot itfelf. After enumerating the various external ap- and in the eruptive fever of fmall-pox, affords the moft grate- 



lications, fuch as poultices, fomentations, bliilers, linapilms, 

 eai-iiphor, and llimulaling fubltances, which have been occa- 

 honally recommended, Dr. Cullen concludes, that from any 

 1.1 them there is dano-er of renderinsx the crout retroeedent ; 

 " and that therefore the common practice of committing 

 lUe perfon to patience and flannel alone, is eltabliflied upon 



fill relief to the patient, and is the moll effectual moderator 

 of his difeafe. (See Cold, ij^Wir 0/ us a renu-Jy.) Nor is 

 a confiderable experience of the fafety andeiiicacy of a llmi- 

 lar practice, in lubduing the inflammation of gout, wanting. 

 'I'he great Dr. Harvey himlelf, whole name is immortalized 

 by the dileovery of the circulation of the blood, w.is in the 

 i!ie belt foundation." As there is no danger from the lit of habit of immerhng his toot in cold water, as foon as he por- 

 L;out, when regular, in a conllitution not much broken, this ceived the approach ot the gout, and thus removed the dif- 

 lUetliod may be purfued with a certain degree of impunity : order : he lived to the age of eighty- V'an Swieten men- 

 tions an officer oi infantry, who was ijiduced to rub his gouty 

 feet with fnow, and afterwards, emboldened by fiicecfs, wait- 

 ed a little way baretiiot upon the Inow, and returned quite 

 free from jiain: the interval before another lit iias alfo length- 

 ened by this practice. Similar obfervations were likevvife 

 made by tlie ancients. Aetius informs us, that he li.id feea. 

 a perfou labouring under what he calls a bilious gout, " who 

 obtained extraordinary relief from immerlitig and keeping bis 

 foet fome time in cold water.'' And it is an aphorilm of 

 Hippocrates, that " cold water, copioully poun-d upon fwell- 

 ings of the joints,, painful ulcers, ^outy rijfortlerj, and con- 

 vulfed limbs, leli'ens and removes the pam." (Aph. 2j. 

 fee. 5 See alfo Heberden Comment, p. 45. — 'Van Swie- 

 ten, Com. ad Aph. 1^73-) But the molt cxtculivc evidence- 



but it cannot be quellioned, that the loads <.i{ f.dunel, which 

 u'e fometimes uled, often augment the necelhty tor a lupply 

 of patience, by increaflng tlie inflammati.iii and pain in the 

 toot. It is true, that the parts thus fwelled and painful, are 

 more acutely fenlible to cold, as well as to other impreflions, 

 t'nan in health ; but no covering beyond what i., Iiiliicient to 

 prevent a troublefome fenfation of culd, if that fliould oc- 

 ■:ur, can be neceffary. (Heberden.) All poultices, fomen- 

 tations, and wai-m batliing during the inflammatory llage arc 

 pernicious.. 



It is more than probable, that confiderable errors have been 

 committed, upon the hypothetical notion, of keeping the 

 gout in the extremities, at lealt in the younger fubjects of 

 jj'out, by deviations from tlie aniiphlogillic regimen. In 



