GOUT. 



of the cffi.cr.cy of this practice, in niring the paroxyfm of 

 gout, has bjcn adduced by Dr. Kiiijrluke, (fee a DifTerta- 

 tion on Gout, &c. I^oud, 1804,) who brought forward about 

 tliirty cafos, in which tlic apphcation of cold water to the 

 inflamed part, dining the gouty paroxyfm, was invariably 

 and fpecdily fucccl'sft!! in relieving the pani and removing the 

 difeafe, without any untoward circumttantfe enfving. Dr. 

 Kinglakc maintains, lliat the inflamniationof gout is to be 

 treated upon the fame principles as other local inlinmmations, 

 and yields to the fame Ireatmcut. That this propofition is 

 correct, while the conftitution remains unbroken, we fully 

 believe ; but to what extent the principle will hold, in thole 

 vvhofc fvltem is greatly debilitated and decayed, as well by 

 age as by frequent and protraftcd difeafe, remains as yet 

 undetermined by experience. With tlie diminiOied ftrength 

 of the patient, the paroxyfms bec(mie diminifnedin violence, 

 and attive remedies arc, therefore, the lefs required ; but 

 from what we have detailed above, it appears at leaft highly 

 probable that, in the firll attacks of gout, the application 

 of cold, iudicioully employed, fo as to remove the morbid 

 heat and" no longer, would always be fafe, and would con- 

 tribute as well to fhorten the paroxyfm, as to diminiflt the 

 fufferinrr of the patient, and to preferve the joints from the 

 injury, wdiich protracted inflammation and morbid effulions 

 nccelTarily occallon. 



The operation of Jiiir^ulives, which is known to be cfTen- 

 tially ufeful in other inllammations, has been confidered as 

 beneficial in the gout by fome phylicians, but has more 

 commonly been altogether forbidden. Sydenham exprefTes 

 himfelf very ilrongly in prohibition of purging, at any 

 period of the fit, or even in the interval ot health. Had 

 he expreffed his conviction upon this point fimply as the re- 

 fult of experien-ce, we fliould have been dilpoled to bow 

 to his authority : but his theory appears to have had at 

 leaft an equal fliare in producing this convidtion ; and un- 

 fortunately this theory involves tiie moft grofs contradittion. 

 In the beginning of the paroxyiin, we are told that there is 

 great danger left purgatives fliould ftop the inflammation of 

 the foot, " by throwmg back into the mafs of blood that 

 peccant matltr, which nature was protrudiiig to the extreme 

 parts." (Traftat. de Podagra.) But after the termination 

 of the fit, there is extreme danger, " lelt a new paroxyfm 

 in the foot, equally fevere with the former, Ihould be 

 produced by a purgative.'' (Ibid.) So that this theory 

 blows hot and cold, like the fatyr in the fable ; and thefe 

 dangerous purgatives draw the peccant matter out of the foot, 

 when it happens to be in, and are the moft effeftual means 

 of throwing it into the foot after it has been driven out not 

 only from the foot, but from the whole body (according to 

 the hypothefis) by nature ! 



Sydenham, however, lived long enough to retraft, in part, 

 his opinion refpefting the injurious influence of purgatives 

 in the gout, eipecially if the milder ones arc ufed, and an 

 anodyne given afier the operation. (Differt. de Mictu San- 

 guineo, &c. 1686.) Van Swieten obferves, " many phyfi- 

 cians are of opinion, that part of the gouty matter may 

 be carried off by purgatives, and the fit rendered much 

 more m.ild, efpecially if it be occafioned from errors in 

 diet ;'' and he quotes Hoftmann, who recommends gentle 

 purgatives in all cafes of local pain, and has mentioned an 

 inflance in his own perfon of tlic moft ftriking benefit deriv- 

 ed from a purgative taken immediately before the fit of 

 gout. An inftance has been related to us, in which the 

 gout was completely baniflied, during a fpace of nearly 

 twenty years, by the ufe of a briilc purgative, taken when 

 the firlt fymptoms of the fit began to appear ; the medicine 

 employed in this initance confiiled principally of fcammouy, 



in the dofe of about fifteen grains. We have ieen thi5 

 medicine ufed in a few cafes, with fome relief, in fnialler 

 dofes, and without any untoward confequences. That pur- 

 gativeB, as well as cold apphcations, may be reforted to 

 with advantage in the beginning of the paroxyfm of gout 

 wherever the conftitution is unimpaired, ue confidcr as tc- 

 Icrably well eitablillied on tlie grounds of obfervation ; al- 

 though we do not doubt that many of the cafes of repelled 

 gout, which have been attributed to fuch caufes, may have 

 really occurred, under circumitances of broken and feelvle 

 conftitution, or of peculiar idiofyncrafy. But the accidents 

 arifing from a carelefs or injudicious abufe of any pradtice, 

 afford no juft argument againft the rational and cautious ufe 

 of it. 



We apprehend, however, that many diforders have been 

 very erroneoufly attributed to repulfion of the gout, which 

 might be more correftly explained upon other grounds. 

 For every inflammatory difeafe that occurred, even at the 

 diftance of feveral months from the celfation of the fit, has 

 been confidered as the refult of tlie premature cure of the 

 gout : whereas, it is next to impoifible that io long an inter- 

 val could have taken place between the caufe and its efieCt ; 

 and, on the other hand, as gout is moft frequent in pletho- 

 ric habits, which are alfo moft liable to inflammatory dif- 

 eafes, the occurrence of pleurify or apoplexy, in fuch cafes, 

 is doubtlefs to be attributed to the plethora, and not to 

 the previous gout. Dr. Cullen mentioned that he had 

 known about twenty perfons die fuddenly, more than lialf 

 of whom were of gouty habits. 



The violence of the pain, in the paroxyfm of gout, 

 would naturally fuggeft the ufe of opiates : but experience 

 has fliewH that opium, in any form, when adminiftered in 

 the beginning of any inflammatory difeafe, witli whicfi 

 much heat of ikin and great febrile excitement are connected, 

 generally fails to give relief; on the contrary, that it tends 

 to increafe the heat, fever, and reilleffnefs, and, with them, 

 the pain likewife. When, however, the violence of the 

 paroxyfm is fomewhat abated, yet continues to return, fo 

 as to occafion painful and reftlcfs nights, opiates may then 

 be given with fafety and with advantage, efpecially in the 

 cafe of perlons advanced in hfe, and who have been often 

 affected with the difeafe. Tlie liypothetical objei^tion to 

 the ufe of opiates, that they tend " to lock up the morbid 

 matter," ii altogether groundlefs. Dr. Warner fpcaks with 

 delight of the toothing influence of opium in the fits of 

 gout, which he fuffered in the latter periods of his life. 



(P. ..S3-i3^-) 



Hitherto we have feen that the praftlce, generally pur- 

 fued in the paroxyfm of gout, is merely palliative; an actual 

 cure being deemed a deiideratum by moft perlons, and a 

 thing improper to be attempted by others. Of late, how- 

 ever, a medicine has been introduced into this country from 

 France, which is faid to poffefs a fpeclfic power over the 

 goutv paroxyfm, which it removes " cito, tuto, et jueunde." 

 The compofition of this medicine is at preient unknou-n, 

 but it has been afccrtained that it is a vegetable matter, and 

 it is faid by the inventor to be a plant lieretoforc not ufed in 

 medicine. It is called eau nieilicinale (V Hujfon. It has ap- 

 peared, in many Inftances in winch it has been employed in 

 this country, and that in perfons of the firil rank and cha- 

 racter, to poflefs the power of removing the ])aroxyfm of 

 gout in the courfe of twenty-four hours, leaving the patient 

 in a ftate of good health, and in pofleflion of the fame ufe 

 of his limbs wiiich he enjoyed before the fit. It is faid that, 

 in general, it increafes the various excretions confiderablv, 

 if taken in the full dofe, producing feveral loofe motions 

 from the bowels, a free perfpiration, and an increafcd dif- 



tharjjc 



