GOUT. 



th--- fits milJer, and the inttrvah between tliem longer : we. 

 allude to the antadih ; fuch as the alkalis, and abiorbent 

 eartlis. The nature of the chalky matter, produced in in- 

 veterate gout, which is an acid, and denominated lithic or 

 uric acid, (being the fame which is found in the urine and 

 urinary concretions,) has led to the theory, that this acid, or 

 its elements, is the morbiiic humour of the gouty ; and 

 therefore naturally fuggefted the idea of ufmg alkaline me- 

 dicines as remedies for the difeafe. And as acefcent drinks 

 are found to increafe the gouty diathefis, and to increafe the 

 difordered (late of the digellive organs ; fo alkaline medl'.'ines 

 have been found to relieve tb.e fymptoms of indlgeflion, and 

 at the fame time to leflen the difpofition to gout. Thus the 

 cauftic alkalis have been found beneficial ; but not more fo, 

 we believe, than tb.e mild or carbonated alkalis, efpccially 

 potafs ; and the abloi-bent or alkaline earths have likewife 

 afforded relief, and fomcli'.nes fpeedily remoi,-ed fome of the 

 urgent fymptoms of difordered llomach ; efpccially the pre- 

 parations of chalk, lime-water, and magnefia. The mag- 

 nefiu is perhaps ose of the beft medicines of this fort for the 

 gouty, as it not only corrects the acidity of the Itomach, 

 but at the fame time is laxative to the bowels, and thus con- 

 tributes to obviate plethora. When thefe antacids do not 

 fufiiciently open the bowels, or do not prevent coftivenefs, a 

 little rhubarb, aloes, or fome other aromatic purgative 

 fliould be conjoined with them. It appears, from fome ex- 

 periments mads by Mr. Home and Mr. Crande, and recently 

 publifhcd in the Philofophical Tranfaftions, (Part I. for 

 1810) that magnefia has a much more powerful influence in 

 preventing the formation of the uric acid, in the urine, than 

 any of the alkalis ; it is probable, therefore, that it may be 

 more beneficial in the gout. As a warm laxative the tinfture 

 of guaiacuni was much recommended, and as it combines a 

 flimjlaat with anevacuant property, it may be lerviccable 

 in fome conflitutions. 



Cure of the irr'gular Gout. — We have already remarked, 

 that falfe th.^ory has led to much f.ille alarm, and doubtkfs 

 to many mlllakes in practice, efpecially relative to the atonic 

 gout ; all the various fymptoms of dyfpepfia, and hypo, 

 chondriafis being often fuppofed to be gouty, when no aftual 

 gout had ever appeared. Hence fomentations, blifters, ru- 

 befacients, and other local ftimulants to the extremities, the 

 Bath waters, hot pcdiluvia, &c. have been employed to bring 

 on the gout in the feet, inftead of relying on the remedies 

 which might reilore the funftions of the digellive organs. 

 T'^J Bath waters are certainly to be recommended in thofe 

 cafes, as they are pofTefTed of conliderable powers in reiloring 

 the healthful condition of the Romach, efpecially when it 

 has been difordered by irregular and intemperate living ; 

 and of relieving thofe wandering pains, which are deemed 

 gouty, but which, as Dr. Heberden obferves, are the com- 

 mon accompaniments of declining years and a broken co;ifli. 

 tu.ion. 



In thefe cafes of atonic or wandering gout, as it is called, 

 all the means iifually employed to llrcngthen the habit in ge- 

 neral, and the ftomach in particular, are to be reforted to. 

 Moderate, but frequent and regidar exercife on horieback, 

 or walking, mull be purfued ; the diet fnould be a little 

 more generous, and fome wine may be necelTary ; but both 

 ■food and drink of the acefcent kind mull be flumned, and if 

 wine, of whatever fort, fiiould be found to increafe the acidity 

 of the fiomach, fpirits much diluted with water ihould be 

 fubtlituted. At the fame time, for tliepurpofe of fupport- 

 ing the tone of the fiomach, preparations of iron, the Peru- 

 vian bark, bitters, and aromatics in moderation may he re- 

 forted to ; and laxatives, employed only fo as to prevent cof- 

 tivenefs, m.ull be taken. The propriety of frequent gentle 



vomit.'i, where tlic ihdigeflion is trobblefome, id ir.ore than 

 problematical ; .^or, while tiicy give a temporary reliif, by 

 removing a load of undigefted food, they tend to debilitate 

 the organ, and thus to increafe the evil which they were in- 

 tended to remove. At the fame lime, all tlie caufes of debi- 

 lity formerly mentioned, mud be fhuniird, and cxpofure to 

 cold efpccially mufl be carefully avoided : the mofl cfrtain 

 rneans of doing this is by repairing to a warm climate during 

 the winter fealon. 



Cure cf rnifplaccd or rdrocrJent Gcul.- Tlicfc, like the ato- 

 nic gout, are in a confiderable degree the bugbears of medi- 

 cal Ipeculation, more efpecially the mifplaced gout ; tlify 

 do, we believe, occaiionally occur in caf^s of old and inve- 

 terate gout, but certainly much more rarclf than ii gene- 

 rally believed. This opinion Dr. Heberden Aates from his 

 own experience. (Comment, p. 41. — See alfo " Letters on 

 the Caufe and Treatment of Gout," by Dr. Robert Ha- 

 milton, Lynn, 1809.) The lafl mentioned phytician, who 

 had employed bleeding and other antiphlogillic remedies, 

 both upon himfelf and feveral of his friends for eighteen 

 years, never faw any thing like a retrocefTion of gout ; and 

 Dr. Cullen never faw an inllance of mifplaced gout. 



When the gout has dilappeared in the extremities, the 

 fiomach and bowels are fometi.nes attacked with moil acute 

 pain, which is of a fpafmodic nature, and to be relieved 

 oijly by flrong difTiifive llimulants, and opium in full dofcs. 

 Opiates arc doubtlefs the moll cffeclual antiipafmodics ; but 

 their operation will be aided by combining with them the 

 ethers, volatile alkali, the free ufe of 'Irong wines, and aro- 

 matics, given warm, or ardent fpirits, if thefe are not elTec- 

 tual. Camphor, muflv, aflafoctida, and other flrong fr..eUinz 

 fubflances, may be employed as adjuvants, efpecially m lets 

 violent cafes. External heat to the region cf the ftomach, 

 hot pediluvia, or the warm bath, will contribute by their 

 flimulant powers to overcome the fpafms and pain. If the 

 fiomach is known to be loaded, as by a previouj rcpafl, its 

 contents may be evacuated upwards, by draughts oi warm 

 water, with wine, or of chamomile tea, or downwards by 

 means of fome of the cathartic tirclurcs, as of ionoa, or 

 rhubarb. 



As thofe perfons, who are fubjcil to paroxvfu.s- of the 

 gout, are generally plethoric in their habits, fo ih.-y are lia- 

 ble to inilammatory difeafes : and it cannot be doubted, 

 that ordinary attacks of inllammation of the lungs, of palfy, 

 and apoplexy, have been deemed gouty, and have proved fatal 

 from the oniiiTi-jn of blood-letting. When the fymptoms o« 

 pleurify, or pcripneumony, or the acute pain cf head, verti- 

 go, loninolency, threatening apoplexy, or the actual fymp- 

 toms of apoplexy and palfy occur ; we ought not to delay 

 the exhibition of the ufual remedies for tliofe 4ifeafc.', or be 

 induced to be fparing in the ufe of the lancet, becaufc wc 

 apprehend a gouty diathefis ; for death may be producetl iti 

 a few minutes. And, as Dr. Heberden ju!lly oblerws, 

 " where the danger is imn\inent, from the violeiice of the 

 fymptoms, and wo are doubtful whethir they be gouty or iii- 

 flamniatory, we incur much gre.tter rifk by oniitling blood- 

 letting in a difeafe arillng from inllamnvation, th.in by di-aw- 

 ing blood in a difeafe arifmg from gout."' Indeed tbcfe 

 very phyficians, who condemn blecdi.ng and other OT.ciia- 

 tions in gout, in, the extremities, gravely prefcribe the prompt 

 admiwiilMtion of tliefe remedies, when the lungs, head, or 

 other vifcera are atia.ked with it. In a word, when the 'c- 

 ternal vifcera are affecltd with unequivocal fymptoms ol in- 

 flammation, the fame treatment by local and general evacua- 

 tion, blillering, &c. nnul be reforted to, as in all other cafe* 

 of inllammation, regard being bad at the fame time (an cb- 

 fcrvatioa, indeed, which applies to the practice of medicine 

 3 U 2 univerfallvj 



