GOUT. 



charge of urine. But tlis influence of the medicine on the verfity of Edinburgh, is a rcmarkatle example of the ptr. 



I ffouty parents, 

 (ufftred fvveral 



gouty pnroxyfm is not attributed to thcfc evacuations; lince, 

 in fonie inftances, in wliich a fmaller dofc was taken, a llnii- 

 lar relief to the gout was procured, witliout any increafe of 

 the excretions. No untoward circumftance whatever has 

 yet occurred, in confequence of the fpeedy removal of the 

 paroxyfm : but fartlier experience will be requifite to enable 

 us to form a fatisfuCt-Jiy ellimate of its properties. (See 

 an Account of the Eau Medicinale d'Huflon, by Edwin 

 G. Jones. M. D. Lond. 1810 ) 



Trealnifnt in the Interval. — Whatever nwthod is adopted 

 in the treatment of the fit of gout, whether it be merely 

 palliative, or fo active as to fhorten the attack, the coniHtu- 

 tion retains its predifpofition, and is equally liable to fufFer 

 a return of the difeafe. It is not yet afcertaincd, we be- 

 lieve, whether the fits, when warded oft by the eau med'ic'i- 

 r.iile, do not recur more frequently. It is the treatment of 

 the patient in the interval of health, by which alone the dif- 

 eafe oan be cured, i. e. the paroxyfms prevented irom re- 

 turning, and the goutv diathelis eradicated. How this is 

 to be effected, we cannot learn from a view of the ])roxi- 

 mate caufe, or efTential nature of the difeafe ; for upon this 

 point we have no adual knowledge : but, as we pofleis fwme 

 knowledge of the exciting caufes of the difeafe, or of the 

 circuinftances which generate or fofter the predifpofition to 

 its attacks ; fo, by rcm.oving tliefe, we may hope to prevent 

 the production of tint predifpofition, or to diniiniih it, if 

 not to remove it altogether. Now, we have feei; that in- 

 temperance and indolence are the parents of the gouty dia- 

 thcfis, where it is not hereditary, and are the chief agents 

 in exciting it to activity, where it is. The inference, then, 

 is obvious: by ttwpcniv.ce and ndii'it\, and not by medicine, 

 the return of the gouty paroxylms is principally to be pre- 

 vented. 



There is, perhaps, no fubject, on which Enghdimen in 

 general entertain fo many unfounded prejudices, or lillen to 

 argument with fo little attenti<ni or conviction, as that of 

 tinipenmce. It is conceiTed that phyficians, in inculcating 

 the advantages of it, only talk idly about it, in the way of 

 their proftfllon ; and that w hat is called good living, when 

 not carried to actual debauch, is favourable to the fupport 

 and health of the body. It is, indeed, fo univerfally the 

 practice, in this country, to indulge an artilicial ajipetile, 

 beyond the actual wants of nature, that temperance is a 

 thing, as Dr. Cadogan obfervts, of which an Englifliinan 

 can acquire no idea at home. It is, however, altogether 

 comparative with refpecl to individual conftitution ; for 

 ionie perfons will become plethoric to a morbid degree, 

 upon diet which is barely fufficient to fupport life in others. 

 I'erhaps Dr. Cadogan's teft is correct. " As long as a 

 man eats and drinks no more than his itomach calls for,'' 

 /. e. when unexcited by variety of dilhes, by iauces and 

 condiments, or bv interpofing liquor of any kind) " and 

 will bear without the lealt pain, dillention, eructation, or 

 hneafuiefs of any kind, &c. he may be faid to live in a 

 •,'.rv prudent well-regulated (late of temperance, that will 

 robably preferve hiip. in health and fpirits to great old age.'' 1 



^Oii the Gout, p. 31 , 



We know too well, however, the general want of power 

 or inclination to refill the pleafures of the table, with 

 li-.at degree of perfeverance and to the requifite extent, 

 'o expect that many cures of the gout will be effected in this 

 .vay ; but this we may alfert, that the only inilances of the 

 eradication of the difeafe, which are known, have been ac- 

 complilhed by rigid and perfevering teinperance. Dr. 

 Janus Gregory, the prefent profeffor of medicine in the uiii- 



Vw,. XVI. 



fe(ft cure of the gout by fiich means. Corn of £ 

 he was attacked (everely when young, and 

 paroxyfms, which, after being banifhed by abltetnious livinn. 

 recurred on a (liort indijgence on reviliting Oxford ; but hr 

 has fincc that time entirely kept the foe at a diflaiice for about 

 thirty years, by extreme temperance and much txercife, and 

 is now liale and fining, llnnigli advanced fevcnil years be- 

 yond the age at which his f.ilhir died, brokvn d<iwM l>y the 

 gout. This he repeats annually to liis pupils with no fmall 

 exultation. His diet has buen chiefly broth, or a fparing 

 quantity of plain anim::l food, with littl" or no wii^c. Dr. 

 Cadogan affords another inllance of the benefit of rigid tem- 

 perance in his own perfon, "having not only got rid of the 

 gout," he fays, "of which I liad four fevi-re fits in my 

 younger days, but alfo emerged from the lov.ell ebb of life, 

 that a man could polfibly be reduced to bv colic, jaundice, 

 and a complication of complaint;, and ri.c(;vered to iM-rftd 

 health, which I havL- now uniiiterrnplediv enjoyed above I'-n 

 years." (Loc. cit. p. 83.) Dr. Heberden likewife ob- 

 ferves, that alth<nigh complete curi-s of the gout are ex- 

 tremely rare, yet he has feen more than one inllance in which. 

 by a total abllinence from animal food and wine, the patieot« 

 were reilorcd from a flate of extreme debility and miferv, fr» 

 fuch a degree of health and flrength, as rendered their lifr 

 no longer ufelefs to others, nor painful to tliemfclvei. 

 Coinm. J) 44. 



It can icarcely be doubled, indeed, that a complete cure 

 of the difeafe might, by a rigid plan of life, beH.ccomplifhcd 

 in mofl cafes, when the patients are not above tlie age of ^o 

 or 35 years, even if they fhonld already have experiL-nced 

 two or three paroxyfms. In older habits, where the dileaie 

 is of longer (landing, a c(«ii]jkte cure cannot he fo confidently 

 anticipated ; but experience has Ibewn that the feveritv and 

 the conlcquent evils of the difeafe mav be cfiecluallv miti- 

 gated by temperance, even under fuch circuinllances. It i> 

 a moil dangerous and miitaken notion that the gont is to be 

 encouraged; for its tendency is to increafe in frequencv, 

 and in duration, to cri))ple tlie limbs, and to render the body 

 liable to a variety of diforders, which tend to render life 

 both fliorter and nuire niilerable than it w&jld otherwii'e 

 be. 



The fear of the pernicious confequences of rigid tempe- 

 rance is an unfounded piTJudic, very prevalent 'n this 

 country ; but it there be any danger, it can oejv originate 

 in general from the iuddennefs villi which an extrJinc clianwe 

 is made. We have feen, in the cafe of the l*t miller of Bd- 

 lericay, however, what a fmall quantity of nutriment is al>- 

 folutely requifite for the wants of the conllitution, and how 

 beneficial even an extreme change of diet lomctimes proves. 

 (See Ci'Ki't'l.i.xcE.) 



The next point of management in the iaterral, whicl;» 

 together with temperance, conduces to the prcvtution of 

 the recurrence of gout, is exercijc. This tends to obviat* 

 plethora, on the one hand, by promoting the circulation and 

 all the fecretions, and to thvngthen the ftomach, on the other 

 and, and promote the function of digeflion ; and plethora 

 and indigeilion, as we have already Itated, commonly pre- 

 cede the gouty paroxyfm, and are connected w ith the goutif 

 diathcfis. 15y thote who cannot walk, which is the licil 

 mode of exerciie for the gouty, riding on horfeback, o^ 

 even in a carriage, Ihould be fubflitut.d. Even frictioi\, 

 w here thefe modes of exerciie cannot be retorted to, mav br- 

 an ufeful fuccedaneum. Dr. Cadogan's directions on this 

 head are worthy of attention. If t!ie pa'ient "can nriiher 

 walk nor ride ;it all, he muil by dejjrecs be brought to do 



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bo!j» 



