amber_ may be given with advantage. I once saw it remove for a while a
convulsive cough from the gout.
9. In cases where the stomach will bear the _bark_, it should be given
in large and frequent doses. It does the same service in this state of
gout, that it does in the slow, or low states of fever from any other
cause. Where the gout appears in the form of an intermittent, the bark
affords the same relief that it does in the same disease from autumnal
exhalations. Mr. Small found great benefit from it after discharging the
contents of his stomach and bowels by a dose of tartar emetic. "I do not
call (says this gentleman) a fit of the gout a paroxysm, for there are
several paroxysms in the fit, each of which is ushered in with a rigour,
sickness at stomach, and subsequent heat. In this the gout bears a
resemblance to an irregular intermittent, at least to a remitting fever,
and hence perhaps the efficacy of the bark in removing the gout[67]."
[67] Medical Observations and Inquiries, vol. vi. p. 220.
10. The _warm bath_ is a powerful remedy in exciting a regular and
healthy action in the sanguiferous system. Where the patient is too weak
to be taken out of bed, and put into a bathing tub, his limbs and body
should be wrapped in flannels dipped in warm water. In case of a failure
of all the above remedies,
11. A _salivation_ should be excited as speedily as possible, by means
of mercury. Dr. Cheyne commends it in high terms. I have once used it
with success. The mercury, when used in this way, brings into action an
immense mass of latent excitement, and afterwards diffuses it equally
through every part of the body.
12. Besides these internal remedies, frictions with brandy, and volatile
liniment, should be used to the stomach and bowels. Blisters should be
applied to parts in which congestion or pain is seated, and stimulating
cataplasms should be applied to the lower limbs. The flour of mustard
has been justly preferred for this purpose. It should be applied to the
upper part of the foot.
The reader will perceive, in the account I have given of the remedies
proper in the feeble state of chronic fever, that they are the same
which are used in the common typhus, or what is called nervous fever.
There is no reason why they should not be the same, for the supposed two
morbid states of the system are but one disease.
It is agreeable in medical researches to be under the direction of
principles. They render unnecessary, in many instances, the slow and
expensive operations of experience, and thus multiply knowledge, by
lessening labour. The science of navigation has rested upon this basis,
since the discovery of the loadstone. A mariner who has navigated a
ship to one distant port, is capable of conducting her to every port
on the globe. In like manner, the physician who can cure one disease
by a knowledge of its principles, may by the same means cure all the
diseases of the human body, for their causes are the same. Judgment is
required, only in accommodating the force of remedies to the force of
each disease. The difference in diseases which arises from their seats,
from age, sex, habit, season, and climate, may be known in a short time,
and is within the compass of very moderate talents.
IV. Were I to enumerate all the local symptoms of gout which occur
without fever, and the remedies that are proper to relieve them, I
should be led into a tedious digression. The reader must consult
practical books for an account of them. I shall only mention the
remedies for a few of them.
The theory of the gout which has been delivered, will enable us to
understand the reason why a disease which properly belongs to the
whole system, should at any time be accompanied only with local morbid
affection. The whole body is a unit, and hence morbid impressions which
are resisted by sound parts are propagated to such as are weak, where
they excite those morbid actions we call disease.
The _head-ach_ is a distressing symptom of the gout. It yields to
depleting or tonic remedies, according to the degree of morbid action
which accompanies it. I have heard an instance of an old man, who was
cured of an obstinate head-ach by throwing aside his nightcap, and
sleeping with his bare head exposed to the night air. The disease in
this case was probably attended with great morbid action. In this
state of the vessels of the brain, cupping, cold applications to the
head, purges, a temperate diet, and blisters behind the ears, are all
proper remedies, and should be used together, or in succession, as the
nature of the disease may require. Many persons have been cured of the
same complaint by sleeping in woollen nightcaps. The morbid action in
these cases is always of a feeble nature. With this remedy, tonics,
particularly the bark and cold bath, will be proper. I have once known
a chronic gouty pain in the head cured by an issue in the arm, after
pounds of bark, and many other tonic remedies, had been taken to no
purpose.
The _ophthalmia_ from gout should be treated with the usual remedies
for that disease when it arises from other causes, with the addition of
such local applications to other and distant parts of the body, as may
abstract the gouty action from the eyes.
_Dull but constant pains in the limbs_ yield to frictions, volatile
liniments, muslin and woollen worn next to the skin, electricity, a
salivation, and the warm and cold bath. A gentleman who was afflicted
with a pain of this kind for three years and a half in one of his arms,
informed me, that he had been cured by wearing a woollen stocking that
had been boiled with sulphur in water, for two weeks upon the affected
limb. He had previously worn flannel upon it, but without receiving any
benefit from it. I have known wool and cotton, finely carded, and made
into small mats, worn upon the hips, when affected by gout, with great
advantage. In obstinate sciatic pains, without fever or inflammation,
Dr. Pitcairn's remedy, published by Dr. Cheyne, has performed many
cures. It consists in taking from one to four tea-spoons full of the
fine spirit of turpentine every morning, for a week or ten days, in
three times the quantity of honey, and afterwards in drinking a large
quantity of sack whey, to settle it on the stomach, and carry it into
the blood. An anodyne should be taken every night after taking this
medicine.
A _gouty diarrh[oe]a_ should be treated with the usual astringent
medicines of the shops. Blisters to the wrists and ankles, also a
salivation, have often cured it. I have heard of its being checked,
after continuing for many years, by the patient eating large quantities
of alspice, which he carried loose in his pocket for that purpose.
The _angina pectoris_, which I have said is a symptom of the gout,
generally comes on with fulness and tension in the pulse. After these
are reduced by two or three bleedings, mineral tonics seldom fail of
giving relief.
_Spasms in the stomach_, and _pains in the bowels_, often seize gouty
people in the midst of business or pleasure, or in the middle of the
night. My constant prescription for these complaints is ten drops of
laudanum every half hour, till relief be obtained. If this medicine
be taken in the forming state of these pains, a single dose generally
removes the disease. It is preferable to spiced wine and spirits,
inasmuch as it acts quicker, and leaves no disposition to contract a
love for it when it is not required to ease pain.
The _pain in the rectum_ which has been described, yields to the common
remedies for the piles. Cold water applied to the part, generally gives
immediate relief.
For a _preternatural secretion and excretion of bile_, gentle laxatives,
and abstinence from oily food, full meals, and all violent exercises of
the body and mind, are proper.
The _itching in the anus_, which I have supposed to be a symptom of
gout, has yielded in one instance that has come within my knowledge to
mercurial ointment applied to the part affected. Dr. Lettsom recommends
fomenting the part with a decoction of poppy heads and hemlock, and
advises lenient purges and a vegetable diet as a radical cure for the
disease[68].
[68] Medical Memoirs, vol. III.
For the _itching in the vagina_ I have found a solution of the sugar
of lead in water to be an excellent palliative application. Dr. Lettsom
recommends as a cure for it, the use of bark in delicate habits, and
occasional bleeding, with a light and moderate diet, if it occur about
the time of the cessation of the menses.
Obstinate _cutaneous eruptions_, which are the effects of gout, have
been cured by gentle physic, a suitable diet, issues, and applications
of the unguentum citrinum to the parts affected.
The _arthritic gonorrh[oe]a_ should be treated with the same remedies as
a gonorrh[oe]a from any other cause.
In the treatment of all the local symptoms that have been enumerated,
it will be of great consequence to inquire, before we attempt to cure
them, whether they have not succeeded general gout, and thereby relieved
the system from its effects in parts essential to life. If this have
been the case, the cure of them should be undertaken with caution,
and the danger of a local disease being exchanged for a general one,
should be obviated by remedies that are calculated to eradicate the
gouty diathesis altogether from the system. The means for this purpose,
agreeably to our order, come next under our consideration. Before I
enter upon this head, I shall premise, that I do not admit of the
seeds of the gout remaining in the body to be eliminated by art after
a complete termination of one of its paroxysms, any more than I admit
of the seeds of a pleurisy or intermitting fever remaining in the body,
after they have been cured by blood-letting or bark. A predisposition
only remains in the system to a return of the gout, from its usual
remote and exciting causes. The contrary idea took its rise in those
ages of medicine in which morbific matter was supposed to be the
proximate cause of the gout, but it has unfortunately continued since
the rejection of that theory. Thus in many cases we see wrong habits
continue long after the principles have been discarded, from which they
were derived.
I have known several instances in which art, and I have heard and read
of others in which accidental suffering from abstinence, pain, and
terror have been the happy means of overcoming a predisposition to the
gout. A gentleman from one of the West-India islands, who had been for
many years afflicted with the gout, was perfectly cured of it by living
a year or two upon the temperate diet of the jail in this city, into
which he was thrown for debt by one of his creditors. A large hæmorrhage
from the foot, inflamed and swelled by the gout, accidentally produced
by a penknife which fell upon it, effected in an Irish gentleman
a lasting cure of the disease. Hildanus mentions the history of a
gentleman, whom he knew intimately, who was radically cured of a gout
with which he had been long afflicted, by the extreme bodily pain he
suffered innocently from torture in the canton of Berne. He lived to be
an old man, and ever afterwards enjoyed good health[69]. The following
letter from my brother contains the history of a case in which terror
suddenly eradicated the gout from the system.
[69] Observat. Chirurg. Cent. 1. Obs. 79.
"_Reading_, _July 27th, 1797_.
"DEAR BROTHER,
"WHEN I had the pleasure of seeing you last week, I mentioned an
extraordinary cure of the gout in this town, by means of a _fright_. In
compliance with your request, I now send an exact narration of the facts.
"Peter Fether, the person cured, is now alive, a householder in
Reading, seventy-three years of age, a native of Germany, and a very
hearty man. The first fit of the gout he ever had, was about the year
1773; and from that time till 1785, he had a regular attack in the
spring of every year. His feet, hands, and elbows were much swollen and
inflamed; the fits lasted long, and were excruciating. In particular,
the last fit in 1785 was so severe, as to induce an apprehension, that
it would inevitably carry him off, when he was suddenly relieved by the
following accident.
"As he lay in a small back room adjoining the yard, it happened that
one of his sons, in turning a waggon and horses, drove the tongue of
the waggon with such force against the window, near which the old man
lay stretched on a bed, as to beat in the sash of the window, and to
scatter the pieces of broken glass all about him. To such a degree was
he alarmed by the noise and violence, that he instantly leaped out of
bed, forgot that he had ever used crutches, and eagerly inquired what
was the matter. His wife, hearing the uproar, ran into the room, where,
to her astonishment, she found her husband on his feet, bawling against
the author of the mischief, with the most passionate vehemence. From
_that_ moment, he has been entirely exempt from the gout, has never had
the slightest touch of it, and _now_ enjoys perfect health, has a good
appetite, and says he was never heartier in his life. This is probably
the more remarkable, when I add, that he has always been used to the
hard work of a farm, and _since_ the year 1785 has frequently mowed in
his own meadow, which I understand is low and wet. I am well informed,
in his mode of living, he has been temperate, occasionally indulging
in a glass of wine, after the manner of the German farmers, but not to
excess.
"To you, who have been long accustomed to explore diseases, I leave the
task of developing the principles, on which this mysterious restoration
from the lowest decrepitude and bodily wretchedness, to a state of
perfect health, has been accomplished. I well know that tooth-achs,
head-achs, hiccoughs, &c. are often removed by the sudden impression of
fear, and that they return again. But to see a debilitated gouty frame
instantly restored to vigour; to see the whole system in a moment, as it
were, undergo a perfect and entire change, and the most inveterate and
incurable disease _radically_ expelled, is surely a _different_ thing,
and must be acknowledged a very singular and marvellous event. If an old
man, languishing under disease and infirmity, had _died_ of mere fright,
nobody would have been surprised at it; but that he should be absolutely
cured, and his constitution renovated by it, is a most extraordinary
fact, which, while I am compelled to believe by unexceptionable
evidence, I am totally at a loss to account for.
I am your sincerely
affectionate brother,
JACOB RUSH."
These facts, and many similar ones which might be mentioned, afford
ample encouragement to proceed in enumerating the means which are proper
to prevent the recurrence of the gout, or, in other words, to eradicate
it from the system.
V. I shall first mention the means of preventing the return of that
state of the disease which is accompanied with _violent_ action, and
afterwards take notice of the means of preventing the return of that
state of it, in which a _feeble_ morbid action takes place in the
blood-vessels. The means for this purpose consist in avoiding all the
remote, exciting, and predisposing causes of the gout which have been
mentioned. I shall say a few words upon the most important of them, in
the order that has been proposed.
I. The first remedy for obviating the _violent_ state of gout is,
1. _Temperance._ This should be regulated in its degrees by the age,
habits, and constitution of the patient. A diet consisting wholly of
milk, vegetables, and simple water, has been found necessary to prevent
the recurrence of the gout in some cases. But, in general, fish, eggs,
the white meats and weak broths may be taken in small quantities once
a day, with milk and vegetables at other times. A little salted meat,
which affords less nourishment than fresh, may be eaten occasionally.
It imparts vigour to the stomach, and prevents dyspepsia from a diet
consisting chiefly of vegetables. The low and acid wines should be
avoided, but weak Madeira or sherry wine and water, or small beer, may
be drunken at meals. The latter liquor was the favourite drink of Dr.
Sydenham in his fits of the gout. Strong tea and coffee should not be
tasted, where there is reason to believe the habitual use of them has
contributed to bring on the disease.
From the disposition of the gout to return in the spring and autumn,
greater degrees of abstinence in eating and drinking will be necessary
at those seasons than at any other time. With this diminution of
aliment, gentle purges should be taken, to obviate an attack of the
gout. In persons above fifty years of age, an abstemious mode of living
should be commenced with great caution. It has sometimes, when entered
upon suddenly, and carried to its utmost extent, induced fits of the
gout, and precipitated death. In such persons, the abstractions from
their usual diet should be small, and our dependence should be placed
upon other means to prevent a return of the disease.
2. _Moderate labour_ and _gentle exercise_ have frequently removed
that debility and vibratility in the blood-vessels, on which a
predisposition to the gout depends. Hundreds of persons who have been
reduced by misfortunes to the necessity of working for their daily
bread, have thrown off a gouty diathesis derived from their patents, or
acquired by personal acts of folly and intemperance. The employments
of agriculture afford the most wholesome labour, and walking, the most
salutary exercise. To be useful, they should be moderate. The extremes
of indolence and bodily activity meet in a point. They both induce
debility, which predisposes to a recurrence of a fit of the gout.
Riding in a carriage, and on horseback, are less proper as a means of
preventing the disease than walking. Their action upon the body is
partial. The lower limbs derive no benefit from it, and on these the
violent state of gout generally makes its first attack. In England,
many domestic exercises have been contrived for gouty people, such as
shuttle-cock, bullets, the chamber-horse, and the like, but they are
all trifling in their effects, compared with labour, and exercise in
the open air. The efficacy of the former of those prophylactic remedies
will appear in a strong point of light, when we consider, how much the
operation of the remote and exciting causes of the gout which act more
or less upon persons in the humblest ranks of society, are constantly
counteracted in their effects, by the daily labour which is necessary
for their subsistence.
3. To prevent the recurrence of the gout, cold should be carefully
avoided, more especially when it is combined with moisture. Flannel
should be worn next to the skin in winter, and muslin in summer, in
order to keep up a steady and uniform perspiration. Fleecy hosiery
should be worn in cold weather upon the breast and knees, and the feet
should be kept constantly warm and dry by means of socks and cork-soaled
shoes. It was by wetting his feet, by standing two or three hours upon
the damp ground, that colonel Miles produced the gout in his stomach and
bowels which had nearly destroyed him in the year 1795.
4. Great moderation should be used by persons who are subject to the
gout in the exercise of their understandings and passions. Intense
study, fear, terror, anger, and even joy, have often excited the disease
into action. It has been observed, that the political and military
passions act with more force upon the system, than those which are of a
social and domestic nature; hence generals and statesmen are so often
afflicted with the gout, and that too, as was hinted in another place,
in moments the most critical and important to the welfare of a nation.
The combination of the exercises of the understanding, and the passion
of avarice in gaming, have often produced an attack of this disease.
These facts show the necessity of gouty people subjecting their minds,
with all their operations, to the government of reason and religion. The
understanding should be exercised only upon light and pleasant subjects.
No study should ever be pursued till it brings on fatigue; and, above
all things, midnight, and even late studies should be strictly avoided.
A gouty man should always be in bed at an early hour. This advice has
the sanction of Dr. Sydenham's name, and experience proves its efficacy
in all chronic diseases.
5. The venereal appetite should be indulged with moderation. And,
6. Costiveness should be prevented by all persons who wish to escape
a return of violent fits of the gout. Sulphur is an excellent remedy
for this purpose. Dr. Cheyne commends it in high terms. His words are,
"Sulphur is one of the best remedies in the intervals of the gout. In
the whole extent of the materia medica, I know not a more safe and
active medicine[70]." Two cases have come within my knowledge, in which
it has kept off fits of the gout for several years, in persons who had
been accustomed to have them once or twice a year. Rhubarb in small
quantities chewed, or in the form of pills, may be taken to obviate
costiveness, by persons who object to the habitual use of sulphur.
Dr. Cheyne, who is lavish in his praises of that medicine as a gentle
laxative, says, he "knew a noble lord of great worth and much gout, who,
by taking from the hands of a quack a drachm of rhubarb, tinged with
cochineal to disguise it, every morning for six weeks, lived in health,
for four years after, without any symptom of it[71]."
[70] Essay on the Nature and True Method of Treating the Gout, p. 36.
[71] Page 30.
I have said that abstinence should be enjoined with more strictness in
the spring and autumn, than at any other time, to prevent a return of
the gout. From the influence of the weather at those seasons in exciting
febrile actions in the system, the loss of a pint of blood will be
useful in some cases for the same purpose. It will be the more necessary
if the gout has not paid its habitual visits to the system. The late Dr.
Gregory had been accustomed to an attack of the gout every spring. Two
seasons passed away without his feeling any symptoms of it. He began to
flatter himself with a hope that the predisposition to the disease had
left him. Soon afterwards he died suddenly of an apoplexy. The loss of
a few ounces of blood at the usual time in which the gout affected him,
would probably have protracted his life for many years. In the year
1796, in visiting a patient, I was accidentally introduced into a room
where a gentleman from the Delaware state had been lying on his back
for near six weeks with an acute fit of the gout. He gave me a history
of his sufferings. His pulse was full and tense, and his whole body
was covered with sweat from the intensity of his pain. He had not had
his bowels opened for ten days. I advised purging and bleeding in his
case. The very names of those remedies startled him, for he had adopted
the opinion of the salutary nature of a fit of the gout, and therefore
hugged his chains. After explaining the reason of my prescriptions, he
informed me, in support of them, that he had escaped the gout but two
years in twenty, and that in one of these two years he had been bled for
a fall from his horse, and, in the other, his body had been reduced by a
chronic fever, previously to the time of the annual visit of his gout.
As a proof of the efficacy of active, or passive depletion, in
preventing the gout, it has been found that persons who sweat freely,
either generally or partially, or who make a great deal of water, are
rarely affected by it.
An epitome of all that has been said upon the means of preventing a
return of the gout, may be delivered in a few words. A man who has had
one fit of it, should consider himself in the same state as a man who
has received the seeds of a malignant fever into his blood. He should
treat his body as if it were a Florence flask. By this means he will
probably prevent, during his life, the re-excitement of the disease.
Are _issues_ proper to prevent the return of the violent state of gout?
I have heard of an instance of an issue in the leg having been effectual
for this purpose; but if the remedies before-mentioned be used in the
manner that has been directed, so unpleasant a remedy can seldom be
necessary.