The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

OF THE GOUTE. THE EIGHTEENTH BOOKE. (Book 18)

CHAP. I. The description of the Goute.

THE Goute is a disease occupying and harming the substance of the Joints by the falling downe and collection of a virulent matter accompanied * 1.1 by the foure humors. This word Arthritus or Goute, is generall for e∣very joint so affected; yet it enjoyes divers particular names in sundry joints of the body: as that which falleth upon the joint of the Jaw, is termed Siagona∣gra, * 1.2 for that the Greekes call the Jaw Siagon; that which affects the necke is termed Trachelagra, for that the neck is in Greek termed Trachelos: that which troubles the backe bone is called Rhachisagra, for the spine is termed Rhachis: that which molests the shoulders Omagra, for the joint of the shoulder is stiled Omos: that which affects the joints of the Collar-bones Cleisagra, for that the Greeks call this bone Cleis: that in the Elbow, P••chyagra, for Pechis signifieth the elbow: the goute in the hand is called Chiragra, in the Hippe Ischias, in the knee Gonagra, in the feet Podagra, for that the Hand, Hippe, Knee, and Foote are in Greeke termed Cheir, Ischion, Gony, and Pous. When as there is great abundance of humours in a body, and the patient leads a sedentary life, not some one, but all the joints of the body are at once trou∣bled with the Goute.

CHAP. II. Of the occult causes of the Goute.

THe humor causing the Goute is not of a more knowne, or easily exprest nature than that which causeth the plague, Lues venerea, or falling sicke∣nesse. For it is of a kind and nature cleane different from that which cau∣seth * 1.3 a Phlegmon, oedema, erysipelas, or Scirrbus; for, as Aëtius saith, it ne∣ver commeth to suppuration like other humours, not for that, as I thinke, because it happens in bloodles parts, but through the occasion of some occlut malignity. Here∣to may be added that the humours which cause the forementioned tumors, when as they fall downe upon any part, not then truly when they are turned into pus or mat∣ter, do they cause so sharpe paines as that which causeth the Goute, for the panic thereof is farre more sharpe, than of that humour which breedeth an ulcerated Cancer. Besides these humours, when they fall upon the joints through any other occasion, never turne into knots, onely that which causeth the Goute in the joints,

after it hath fallen thither, is at length hardened into a certaine knotty and as it were plaister-like substance to bee amended by no remedies. But seing it offends not * 1.4 the parts by which it flowes downe, (no more than the matter which creeping up∣wards from the lower parts to the braine, causeth the Epilepsie) as soone as it falleth into the spaces of the Joints it causeth cruell paine, one while with heate, another while with cold. For you may see some troubled with the Goute, who complaine that their pained Joints are burnt, there are others to whom they seeme colder than any ice, so that they cannot bee sufficiently heated to their hearts desire; verily you may sometimes see in the same body troubled with the Goute, that the Joints of the right side will as it were burne with heat, but on the left side will be stiffe with cold; or which is more, the knee in the same side to be tormented with a hot distemper, and the ancle troubled with a cold. Lastly, there sometimes happens a succession of paine in a succession of dayes, as the same joints will be this day troubled with a hot, * 1.5 to morrow with a cold distemper, so that wee need not marvaile to see Physitians prescribe one while hot, another while cold medicines against the same disease of the same part and body. Also it sometimes happens that the malignity of this hu∣mour doth not onely not yield to medicines, but is rather made worse, so that the patients affirme that they are far better when they have none, than when they have any remedyes applyed. For all things being rightly done, and according to reason, yet the disease will come againe at certain seasons by fits: and hereupon it is sayd by Horace:

Qui cupit, aut metuit, juvat illum sic domus aut res, Ut lippum pict ae tabulae, fomenta podagram.

Riches the covetous, and fearefull so doe please, As pictures sore eyes, Bathes the Goute doe ease.

Certainely such as have this disease hereditarily, can no more bee helped and throughly freed therefrom, than those in whom the matter of the disease is become knotty, whereof Ovid thus speaketh:

Tollere nodosam nescit medicina podagram.

Physicke cannot the knotty Goute to heale.

These reasons have induced many to believe that the essence of this disease is un∣knowne, for there is a certaine occult and inexplicable virulency, the author of so great malignity and contumacy. Which Avicen seemes to acknowledge, when hee writes that there is a certaine kinde of Goute whose matter is so acute and maligne, * 1.6 that if it at any time bee augmented by the force of anger, it may suffice to kill the party by suddaine death. Therefore Galen himselfe writes that Treacle must bee u∣sed in all Arthriticall and gouty affects, and as I think, for no other reason, than for * 1.7 that it dries, wastes and weakens the malignity thereof. Gordonius is of the same o∣pinion, but addeth withall, that the body must be prepared and purged before wee use Treacle. Therefore the matter of the gout is a thin and virulent humour, yet not contagious, offending in quality rather than quantity, causing extreme paines, * 1.8 and therfore instigating the humours together with the caliginous and flatulent spi∣rits prepared or ready for defluxion upon the affected parts. Therefore as the bitings of Aspes, and stingings of Waspes cause cruell pain with sudden swelling and bliste∣ring, which is by the heat of the humours which the poyson hath tainted, and not by the simple solution of continuity, seeing that we daily see Shoo-makers and Taylors pricking their flesh with aules and needles without having any such symptome. Thus the virulencie of the gout causeth intolerable tormenting paine, not by the abun∣dance, because it happens to many who have the gout, no signe of defluxion appea∣ring in the joints, but onely by a maligne and inexplicable quality, by reason where∣of these paines doe not cease unlesse abated by the helpe of medicines, or nature, or both. The recitall of the following histories will give much light to that unexpli∣cable

and virulent malignity of the matter causing the gout. Whilest King Charles * 1.9 the ninth, of happy memory, was at Burdeaux, there was brought to Chappellaine and Castellan the Kings Physicians, and Taste a Physician of Burdeaux, Nicholas Lambert and my selfe Surgeons, a certaine Gentle woman some forty yeares old, exceedingly troubled for many yeares by reason of a tumor scarce equalling the bignesse of a pease, on the outside of the joynt of the left Hippe: one of her tor∣menting fits tooke her in my presence; shee presently beganne to cry and ••oare, and * 1.10 rashly and violently to throw her body this way and that way, with motions and gestures above a womans, yea a mans nature. For shee thrust her head between her legges, laid her feete upon her shoulders, you would have said shee had beene pos∣sessed of the Divell. This fit held her some quarter of an houre,; during all which time I heedfully observed whether the grieved part swelled any bigger than it was accustomed, whether there happened any new inflammation; but there was no al∣teration as farre as I could gather by sight or feeling, but onely that shee cryed out more loudly when as I touched it. The fit passed, a great heate tooke her, all her body ranne downe with sweat, with so great wearinesse and weakenesse of all her members, that shee could not so much as stirre her little finger. There could bee * 1.11 no suspicion of an Epileptick fit, for this woman all the time of her agony did per∣fectly make use of all her senses, did speake, discourse, and had no convulsion. Neither did shee spare any cost or diligence, whereby shee might bee cured of her disease by the helpe of Physicians, or famous Surgeons; she consulted also witches, wizzards and charmers, so that shee had left nothing unattempted, but all art was exceeded by the greatnesse of the disease. When I had shewed all these things at our consultation, wee all with one consent were of this opinion, to apply a poten∣tiall Cautery to the grieved part, or the tumour. I my selfe applyed it: after the fall or the Eschar very blacke and virulent sanies flowed out, which freed the wo∣man of her paine and disease for ever after. Whence you may gather, that the cause of so great evill was a certaine venenate malignity, hurting rather by an unex∣plicable quality than quantity; which being overcome and evacuated by the Cau∣tery, all paine absolutely ceased. Upon the like occasion, but on the right arme, the wife of the Queenes Coach-man at Amboise consulted Chappellaine, Castella•• and me, earnestly craving ease of her paine, for shee was so grievously tormented by fits, that through impatiency, being carelesse of her selfe, shee endeavoured to cast her lelse headlong out of her chamber window, for feare whereof shee had a guard put upon her. Wee judged that the like monster was to be assaulted with the like weapon, neither were we deceived, for using a potentiall cautery, this had like successe as the former. Wherefore the bitternesse of the paine of the gout is not oc∣casioned by the onely weakenesse of the joints; for thus the paine should be conti∣nuall, and alwaies like it self; neither is it from the distemper of a simple humour, for no such thing happens in other tumours of what kinde soever they be of; but it pro∣ceeds from a venenate, maligne, occult and inexplicable quality of the matter: wher∣fore this disease stands in need of a diligent Physician and a painfull Surgeon.

CHAP. III. Of the manifest causes of the Gout.

ALthough these things may be true which we have delivered of the occult * 1.12 cause of the gout, yet there be and are vulgarly assigned others, of which a probable reason may bee rendred, wherein this malignity whereof wee have spoken lies hid and is seated. Therefore as of many other diseases, so also of the gout there are assigned three causes; that is, the primitive, antecedent and conjunct; the primitive is two fold, one drawn from their first originall and their mothers wombe, which happens to such as are generated of gouty parents, chiefly if whilest they were conceived, this gouty matter did actually abound and fall upon * 1.13 the joynts. For the seed falls from all the parts of the body, as saith Hippocrates, and

Aristole affirmes lib. de gener. animal. Yet this causes not an inevitable necessity of having the gout, for as many begot of sound and healthfull parents are taken by the gout by their proper & primary default; so many live free from this disease, whose fathers notwithstanding were troubled therewith. It is probable that they have this benefit and priviledge by the goodnesse of their mothers seed, and the laudible temper of the womb; wherof the one by the mixture & the other by the gentle heat, may amend and correct the faults of the paternall seed; for otherwise the disease would become hereditary, and gouty persons would necessarily generate gouty; for the seed followeth the temper and complexion of the party generating, as it is shew∣ed by Avicen. Another primitive cause is from unordinate diet, especially in the * 1.14 use of meat, drink, exercise and Venerie. Lastly by unprofitable humours which are generated and heaped up in the body, which in processe of time acquire a virulent malignity; for these fill the head with vapours raised up from them, whence the membranes, nerves and tendons, and consequently the joynts become more laxe and weake. They offend in feeding who eat much meat, and that of sundry kindes at the same meale, who drink strong wine without any mixture, who sleep present∣ly after meat, and which use not moderate exercises; for hence a plenitude, an ob∣struction of the vessels, crudities, and the encrease of excrements, especially serous. Which if they flow downe unto the joynts, without doubt they cause this disease; for the joints are weake either by nature or accident in comparison of the other parts of the body: by nature, as if they be loose and soft from their first originall; by ac∣cident, as by a blow, fall, hard travelling, running in the sun by day, in the cold by night, racking, too frequent venery, especially suddenly after meat; for thus the heat is dissolved by reason of the dissipation of the spirits caused in the effusion of seed, whence many crude humours, which by an unseasonable motion are sent into the si∣news & joints. Through this occasion old men, because their native heat is the more weak, are commonly troubled with the gout. Besides also the suppression of excre∣ments accustomed to be avoided at certaine times, as the courses, haemorrhoides, vo∣mit, scowring, causeth this disease. Hence it is, that in the opinion of Hippocrates, * 1.15 A woman is not troubled with the gout, unlesse her courses faile her. They are in the same case who have old and running ulcers suddenly healed, or va••ices cut and hea∣led, unlesse by a strict course of diet they hinder the generation and increase of ac∣customed excrements. Also those which recover of great and long diseases, unlesse they be fully and perfectly purged, either by nature or art, these humours falling in∣to the joynts, which are the relicks of the disease, make them to become goutie; and thus much for the primitive cause. The internall or antecedent cause is, the abun∣dance * 1.16 of humours, the largenesse of the vessels and passages which run to the joynts, the strength of the amandating bowels, the loosenesse, softnesse and imbecility of the receiving joints. The conjunct cause is the humour it selfe impact and shut up * 1.17 in the capacities and cavities of the joynts. Now the unprofitable humour, on eve∣ry side sent downe by the strength of the expulsive faculty, sooner lingers about the joynts, for that they are of a cold nature and dense, so that once impact in that place, it cannot be easily digested and resolved. This humour then causeth paine by rea∣son of distension or solution of continnity, distemper, and besides the virulency and * 1.18 malignity which it acquires. But it savours of the nature somtimes of one, some∣times of more humors; whence the gout is either phlegmonous, or ••rysipilatous, oe∣dematous, or mixt. The concourse of flatulencies, together with the flowing down humours, and as it were tumult by the hinderance of transpiration, encreaseth the dolorificke distension in the membranes, tendons, ligaments and other bodies wherein the joint consists.

CHAP. IV. Out of what part the matter of the Gout may flow downe upon the joints.

THE matter of the gout commeth for the most part from the liver, * 1.19 or brain; that which descends from the braine is phlegmatick, se∣rous, thin and cleare, such as usually drops out of the nose, endued with a maligne and venenate quality. Now it passeth out by the musculous skin and pericranium, as also through that large hole by which the spinall marrow, the braines substitute, is propagated in∣to the spine, by the coats and tendons of the nerves into the spaces of the joints, and it is commonly cold. That which proceeds from the liver is dif∣fused by the great veine and arteries filled and puffed up, and participates of the na∣ture of the foure humours, of which the masse of the bloud consists, more frequently accompanied with a hot distemper, together with a gouty malignity. Besides this * 1.20 maner of the gout which is caused by defluxion, there is another which is by conge∣stion; as when the too weak digestive faculty of the joints cannot assimulate the jui∣ces sent to them.

CHAP. V. The signes of the arthritick humour flowing from the braine.

WHen the defluxion is at hand, there is a heavinesse of the head, a desire to rest, and a dulnesse with the paine of the outer parts, then chiefly per∣ceptible, when the hairs are turned up, or backwards; moreover, the mus∣culous skin of the head is puffed up as swolne with a certain oedematous tumour; the patients, seem to be much different from themselves by rea∣son of the functions of the minde hurt by the malignity of the humour, from whence the naturall faculties are not free; as the crudities of the stomack, and the frequent and acride belchings may testifie.

CHAP. VI. The signes of a gouty humour proceeding from the liver.

THe right Hypocondrie is hot in such gouty persons, yea the inner parts * 1.21 are much heated by the bowell; bloud and choler carry the sway, the veins are large and swoln, a defluxion suddenly falls down, especially if there be a greater quantity of choler than of other humours in the masse of the bloud. But if, as it often falls out, the whole bloud, by meanes of crudities degenerate into phlegme and a wheyish humour; then will it come to passe, that the gout also, which proceeds from the liver, may be pituitous or phlegmatick, and par∣ticipate of the nature of an oedema, like that which proceeds from the braine. As if the same masse of bloud decline towards melancholy, the gout which thence ariseth * 1.22 resembles the nature of a scirrhus; yet that can scarce happen, that melancholy by reason of the thicknesse and slownesse to motion may fall upon the joynts. Yet not∣withstanding, because we speake of that which may bee of these, it will not bee un∣profitable briefly to distinguish the signes of each humour, and the differences of gouts to be deduced from thence.

CHAP. VII. By what signes we may understand this or that humour to accom∣pany the gouty malignity.

YOu may give a guesse hereat by the patients age, temper, season of the yeare, condition of the country where he lives, his diet and condition of life, the encrease of the paine in the morning, noone, evening or night, by the propriety of the beating, pricking, sharpe or dull paine; by num∣ness, as in a melancholy gout or itching; as in that which is caused by tough phlegme, by the sensible appearance of the part in shape and colour (as for example sake in a phlegmaticke gout, the colour of the affected part is very little changed from its selfe, and the neighbouring well parts, in a sanguine gout it lookes red, in a cholerick it is fiery or pale, in a melancholy livid or blackish) by the heat and big∣nesse which is greater in a sanguine and phlegmatick than in the rest, by the change, and lastly by things helping and hurting. And there bee some, who for the know∣ledge of these differences wish us to view the patients urine, and feele their pulse, and consider these excrements which in each particular nature are accustomed to a∣bound or flow, and are now suddenly and unaccustomarily supprest. For hence may be taken the signes of the dominion of this or that humour. But a more ample know∣ledge of these things may be drawne from the humours predominant in each per∣son, and the signes of tumours formerly delivered. Onely this is to be noted by the way, that the gout which is caused by melancholy is rare to be found.

CHAP. VIII. Prognosticks in the Gout.

BY the writings of Physitians the paines of the gout are accounted a∣mongst the most grievous and acute; so that through vehemency of pain many are almost mad, and wish themselves dead. They have certain pe∣riods and fits according to the matter and condition of the humour wherein this maligne and inexplicable gouty virulency resides. Yet they more frequently invade in the Spring and Autumne; such as have it heredita∣rie * 1.23 are scarce ever throughly free therefrom, as neither such as have it knotty: for in the former it was borne with them, and implanted, and as it were fixed in the ori∣ginall of life: but in the other the matter is become plaister-like, so that it can nei∣ther be resolved nor ripened: that which proceeds from a cold and pituitous matter, causeth not such cruell tormenting pain, as that which is of a hot, sanguine or chole∣rick cause, neither is it so speedily healed, for that the hot and thin matter is more readily dissolved; therefore commonly it ceaseth not untill fourty dayes bee past: besides also, by how much the substance of the affected part is more dense, and the expulsive facultie more weake, by so much the paine is more tedious. Hence it is, that those gouty paines which molest the knee, heele and huckle bone, are more con∣tumacious. The gout which proceeds of a hot matter, rests not before the fourteenth or twentieth day. That which is occasioned by acride choler, by the bitternesse of * 1.24 the inflammation and pain causeth a difficulty of breathing, raving, and sundry times a gangrene of the affected part, and lastly death; and healed, it often leaves a palsie behinde it. Amongst all the gouty paines, the Sciatica challengeth the prime place, * 1.25 by the greatnesse of the paine and multitude of symptomes; it brings unquietnesse and watching, a feaver, dislocation, perpetuall lamenesse & the decay of the whole legge, yea and often times of the whole body. Now lamenesse, and leannesse or de∣cay of the part are thus occasioned, for that the decurrent humour forceth the head of the thigh-bone out of the cavity of the huckle-bone; this being forced out pres∣seth the muscles, veines, arteries, and that notable and large nerve which runs alongst

the thigh even to the furthest joynts of the toes, and by the way is diversly dispersed over the muscles of the whole leg. Therefore because the head of the thigh is put out of its place, the patient is forced to halt; because the vessels and nerves are op∣pressed, the nourishment and spirits doe not freely flow into the parts thereunder, whence proceeds their decay. Yet it sundry times happens, that the head of the thigh being not displaced, many halt because the viscide humour, which is natural∣ly implanted in that place and continually flowes thither, both for the nutrition of these parts, and the lubrication of the joynt for quicker motion, is hardened by heat and idlenesse, and the other unprofitable humours which flow downe do there con∣crete, and so intercept the liberty of motion. A grosse and viscide humour into what joint soever it falleth and stayeth, doth the same. For by concretion it turnes into a plaister like nature at or neare the joynt, possessing the cavities thereof, and it depra∣veth the figure of the part, making it crooked and knotted, which formerly was streight and smooth. Furthermore every distemperature caused by the defluxion of humours, if it shall lye long upon any part, depraves all the actions, and oft-times wholly abolisheth them; so that there may bee three causes of the leanenesse or de∣cay * 1.26 of the joint by the gout, the obstruction or compression of the vessels, idlenesse and a hectick distemper: but two of lamenesse, dislocation and the concretion of an adventitious humour impact in the joynt. If contrary to custome and reason the paines of the gout doe not goe away or returne at their accustomed periods, most grievous and dangerous diseases thereon follow; for the matter accustomed to flow downe into the joints, if it seaze upon the substance of the liver, causes a Phlegmon; if it stay in the larger veines, a continuall feaver; if it flow into the membrane inve∣sting the ribs, a Pleurisie; if it betake it selfe to the guts and adhere to their coats, the Collick or illiaca passio; and to conclude, it produceth divers other symptomes, according to the diversity of the parts whereto it flowes and abides. For thus sun∣dry * 1.27 that have beene troubled with the gout, become paralitick, because the matter which formerly flowed downe into the joints, stayes in the substance and pores of the nerves, and so hinders the spirit that it cannot freely in its whole substance passe though them: hence therfore comes the resolution of the part, whereinto the nerve is inserted. Old men can never be quite or absolutely cured of the gout, for that the masse of their bloud is so departed from its primary & native goodnesse, that it can no more bee restored, than dead or sowred wine. The gout which proceeds from a cold cause, invadeth slowly and by little and little, and is helped by the use of hot things; that which is from a hot matter, quickly shewes it selfe, and is helped by the use of cold things. Now, although the gout more frequently returnes in the spring * 1.28 and fall, yet it comes in the midst of winter, the nerves being weakened by the ex∣cesse of cold, and the humours pressed out; otherwhiles in the midst of summer, the same being diffused and dissipated. Lastly, it comes at any time or season of the year, if those who are subject to this disease feed plenteously, and do all things according to their owne mindes and desire. Those who are troubled with the gout, feele and perceive change of weather, stormes, raines, snowes, windes and such like, before they come. A southerly constitution of the aire, for example, fils the body with humidities, and stirs up the humours that lye quiet in the body, and therefore cause defluxions upon the weaker parts, such as the joints, both by nature, as being without bloud and flesh, as also by accident, for that they a long time have been ac∣customed to bee so tormented; therefore their paines are increased in a wet season. Many of these that are troubled with the gout, desire venery in the bitterness of their * 1.29 paine, because the internall heat wherewith they then are inflamed doth not dissi∣pate into spirits and aire, as the feaverish heat doth, but dissolves, and as it were melts downe the seminall humour, which dissolved, flowes to the genitalls, filleth and distends them. The same thing befalls carryage and running horses, for in these by labour, much heat sends flatulencies to the bottome of the belly. Yet venery is ve∣ry * 1.30 hurtfull to such as are troubled with the gout, because it dissipates the spirits and native heate, and encreaseth the unnaturall heat; whereby it commeth to passe that the nervous parts are weakened, and the paine exa••perated. Rich men, that is, such as feed riotously on variety of dainties, and in the meane space live idlely and lazily

are more frequently and cruelly tormented with the gout than poore people, who live sparingly and hardly: Wherefore there have been seene not a few of such rich and riotous persons, who having spent their estates, have therewith changed their health, together with their fortune and diet, and so have been wholly freed from the gout.

CHAP. IX. The generall method of preventing and curing the Gout.

THose who desire to prevent the gout, must not glut themselves with meat, must be quick to labour, and abstaine from wine and Venery, or certainly must not use them, unlesse for their healths sake, must vomit and purge at certaine times. Hippocrates writes, that boyes are not troubled with the gout before the use of venery. Yet at this day many Eunuches are seene to have the * 1.31 gout, but especially those who abound with idlenesse and pleasure, yet these we have heretofore mentioned are very effectuall, not onely for the prevention, but also for the cure of the present disease. Yet wee must diligently distinguish the causes, what they be, & whence they may proceed, & oppose thereto remedies contrary in quan∣tity and quality. There are absolutely three distinct causes of the gout; A tainture from the parents; a corruption of the humours by diet and aire; a native, or adven∣titious weakenesse of the joints. Against these there is a twofold indication; the first * 1.32 is the evacuation and alteration of the peccant humours, the other the strengthening of the weake joints. These two shall be performed by diet conveniently appointed, purging, blood-letting, provocation of the haemorrhoids, courses, vomit, sweat, u∣rine, and fit application of locall medicines. Therefore, when the time shall come, wherein the gout accustometh to returne by course, the patient shall have a care of himselfe by a diligent manner of diet, hee shall lessen the matter of the disease by phlebotomie (if that the gout shall arise from the blood) from the opposite part, * 1.33 that by the same meanes revulsion and evacuation may bee made; as if the upper parts bee inslamed, blood shall bee drawne from the lower; if on the contrary the lower, out of the upper, alwayes observing the streightnesse of the fibres. Thus the right arme being troubled with a gouty inflammation, the Sapheia of the right legge shall bee opened, and so on the contrary; but if this generall blood-letting being premised, the paine shall not cease, it will be requisite to open the veine next to the paine, which I have often performed with happy successe.

Yet phlebotomi•• hath not the like effect in all, for it is not availeable to such as are continually and uncertainly troubled with gouty paines, or whose bodies are * 1.34 weake and cold, wherein phlegme onely is predominant. Wee may say the same of purging, for though it bee oft-times necessary, yet too frequently re-iterated, it proves hurtfull, futhermore, neither of these remedies is usually very profitable to such as observe no order in meate and drinke, which use Venery too intemperately, who abound with crude and contumacious humours; whose joynts by long vex∣ation of the disease, have contracted a hectick distemper and weakenesse, so that they are departed from their naturall constitution, and suffered a great change of their proper substance. Wherefore as often as these greater remedies shall be used, a Physician shall be called, who according to his judgement may determine thereof. * 1.35 For oft-times diet proveth more availeable than medicines: therefore the Patient (if the matter of the gout bee hot) shall either drinke no wine at all, or else very much allayed, that is, as much as his custome and the constitution of his stomacke can endure. A fit time for purging and bleeding is the Spring and Autumne, be∣cause, according to the opinion of Hyppocrates, gouts reigne chiefely in these sea∣sons; * 1.36 in Autumne, for that the heate of the precedent Summer debilitareth the di∣gestive faculty, the native heate being dissipared; as also the eating of Summer fruits hath heaped up plenty of crude humours in the body, which easily flow downe into the passages of the joynts opened and dilated by the Summers heate:

adde hereunto that the inequality or variablenesse of Autumne weakeneth all the nervous parts, and consequently the joynts. But in the Spring, for that the hu∣mours forced inwards by the coldnesse of the winter, are drawn forth from the cen∣ter to the circumference of the body, and being attenuated, fall into the joints upon a very small occasion. Therefore there is great both necessity and opportunity for evacuation, which if it shall not avert the accustomed fit, yet it will make it more gentle and easie.

CHAP. X. Of Vomiting.

VOmiting is by all the Ancients exceedingly commended, not onely for * 1.37 the prevention, but also for the cure, especially when as the matter floweth from the braine and stomacke; for the phlegmatick, serous and cholericke humours, which usually flow from the joints, are excluded and diverted by vomit, and also there is attenuation of that phlegme, which being more thicke and viscide, adhereth to the roots of the stomack: yet you * 1.38 must consider and see that the patient bee not of too weake a stomacke and braine, for in this case vomiting is to bee suspected. For the time, such as have excremen∣titious humours flowing downe to the stomack through any occasion, as by exercise and motion, must vomit before they eate; on the contrary, such as are overcharged with an old congestion of humours, must vomit after they have eaten something. Certainly it is safer vomiting after meat, then it is before. For the dry stomacke cannot, unlesse with great contention and straining, free it selfe from the viscide humours impact in the coats thereof; and hence there is no small danger of brea∣king a veine or artery in the Chest or Lungs, especially if the patient bee strait che∣sted, and long necked, the season cold, and hee unaccustomed to such evacuation. I remember that with this kind of remedy I cured a certaine Gentleman of Geneva, * 1.39 grievously molested with a cruell pain in his shoulder, and thereby impotent to use his left arme; the Physicians and Surgeons of Lions seemed to omit nothing else for his cure. For they had used purging, phlebotomie, hunger, a Diet drinke of Gudia∣cum and China (although his disease was not occasioned by the Lues Venerea) and divers other to pick medicines, neither yet did they any thing availe. Now learning by him that hee was not apt to vomit, but that it was difficult to him, I wished him * 1.40 to feed more plentifully, & that of many & sundry meats, as fat meat, onions, leeks; with sundry drinks, as beare, ptisan, sweet and sharpe wine, and that hee should as it were overcharge his stomack at this meal, and presently after get him to his bed; for so it would happen, that nature not enduring so great confusion & perturbation of meats & drinks, wherof some were corrupted already in the stomack, & othersome scarce altered at all, nature not enduring this confusion and perturbation, would ea∣sily and of its owne accord provoke the stomack to vomit; which that it might the better succeed, he should helpe forward natures endeavour, by thrusting his finger or a feather into his throat, that so the thick and tenacious phlegme might by the same meanes be evacuated: and not content to doe thus once, I wished him to doe the like the second & third day following, for so it verifieth that saying of Hippocra∣tes: The second and third day exclude the reliques of the first: afterwards, that hee * 1.41 should vomit twice a moneth: chaw mastick fasting: rub his necke and the pained part with aqu•• vitae, stengthened by infusing therein lavender, rosemary, and cloves grosly beaten: confirme his arme by indifferent exercise: hee performed all this, and so became free from his paine, and recovered the use of his arme. Those who do not like such plentifull feeding, shall drink a great quantity of warm water wherein radish roots have been boiled, and they shall have a care lest by using their stomacks to this excretion by vomit they weaken the digestive and retentive faculty thereof. Wherefore such as can naturally, shall thinke it sufficient to vomit twice a moneth.

CHAP. XI. The other generall remedies for the Gout.

THe defluxion of serous humours is very ••itly diverted from the joints by * 1.42 the urine by the use of diureticke medicines. Therefore the roots of Sorrell, parsly, ruscus, asparagus, and grasse, and the like, shall bee boyled in broth, and given to such as have the gout: for when the urine flow∣eth much and thick, the paine is lessened. Many have found benefit by * 1.43 issues; for the Arthritick malignity flowes forth of these, as by rivelets: experience shewes it in such as are troubled with the Lues Venere••, for in those that you cannot overcome the malignity by the proper antidote, that is, Quicksilver, they feele no greater ease of the pain, than by application of Causticks, and making of issues. They shall bee made in sundry places according to the difference of the pained joints, * 1.44 to wit, in the beginning of the neck, if the defluxion proceed from the braine, and fall into the joints of the Collar-bones or shoulder; if into the Elbow or hand, under the muscle Epomis; if into the hip, knees, and feete, some three fingers breadth under the knee, on the inside: for thus there will follow more plentifull evacuation, by reason that the Saphei•• runneth downe that way. Yet if the patient bee troubled with much businesse, and must travell much on horse-back, then shall they be made * 1.45 on the outside of the legge, betweene the two bones thereof, that so they may trou∣ble him the lesse in riding. If any had rather use an actuall cautery, let him take such an one as is triangular and sharpe, that so hee may with more speed and lesse paine performe that which hee intends, and let him thrust it through a plate of iron which hath a hole therein, and let the place bee marked lest hee should ••rre; the ulcer shall be kept open by putting in a pill of gold, silver, lint, of the root of orris, hermoda∣ctiles, gentian, waxe, wherewith some pouder of vitrioll, mercurie or allum shall be incorporated, lest it should fill up with flesh sooner than the Physician shall thinke * 1.46 fit. In the meane space, the head, oft-times the originall of the evill, shall be evacu∣ated by taking in the winter the pills cochiae, and de Assa••ereth; but in summer sine quibus, or Imperiales, before the Full of the Moone. ℞. pul. hyer•• simp. ʒi. agar. re∣cent. troch. & rhei an. ʒii. myroball. chebul. ʒss. tamarind. ℈ii. cum infusione senae, fiat massa de qu•• formentur pill. vi. pro drachma; let the patient take two before supper every eighth day; the day after he shall drinke some broth of the decoction of Ci∣cers and the Diureticke roots. Also these following pills will bee good to purge the phlegmaticke and serous humour. ℞. pillular. foetid. & de hermodactil. an. ʒss. for∣mentur cum succo vel syrup. rosar. solut. Or else, ℞. al••ës. ʒiii. agarici trochis. & rhei, an. ʒi. massae pilul. arthrit. & de hermodact. an. ℈ii. diacrid. ℈i. cum me••••e rosat•• fiat massa, capiat pondus, ʒi. as the Physician shall thinke fit, by whose advice these shall be used and changed as occasion shall offer it self, and the nature of the humour cau∣sing the disease. The day after the purging, the patient shall take three houres before meat half a dram of Treacle, to strengthen the entrailes: pils are preferred before li∣quid * 1.47 medicines, for that by their long stay in the stomack they easily attract the noxi∣ous humor from the brain, & the other more distant parts. I have known some Phy∣sicians who mixing with ordinary pils a good quantity of scamony, as 7. or 8. grains, with a little ginger, lest it should hurt the stomack, have purged by stool a great quan∣tity * 1.48 of serous humours; the day following they gave barly creame to correct the harme which the scamonie may have done to the stomacke. Others for the same purpose give treacle, which doth not onely strengthen the entrailes, but also wea∣kens the virulencie of the gouty malignity; the orifice of the ventricle must be shut after meate, that so the vapours ascending to the braine may bee restrained: for this * 1.49 purpose common Drige powder, Marmelate, or conserve of roses are good. In a wet season use Cephalicke perfumes thus made. ℞. thu••is, vernicis, & mastich. an. ʒi. granorum juniperi, baccarum lauri, an. ℥ss. ligni aloës ʒii. ass•• odora•••• ʒi. ss. Let them bee grosly beaten; let the fume be received in row or carded Cotton, and so applyed to the head. Also the excrementitious humours shall bee dried up by the follow∣ing powder strowed on the patients head for fifteene dayes. ℞. fol. ros. rub. senae, staechad. utriusque an. m. ss. milii, ℥iiii. furfuris loti in vino albo, ℥ iii. florum chamaem.

melil. an. p 1. sem. anisi, ℥ i. salis com. ℥ ii. fiat omnium pulvis. Let it be put into linnen * 1.50 bagges, with which, being warmed at the fire in a frying-pan, and kept with stirring, the head shall bee rubbed. Let the following medicine bee chawed, and kept in the mouth in the forme of a masticatory, in the time of the falling downe of the defluxi∣on. ℞. cubelarum, nucis moschat. glycyrrhiz. anis. an. ʒ i. pyrethri, ʒ ii. mastich. rad. * 1.51 st••phisagr. eryngii, an. ʒii. Let them all be made into pouder, and mixed together, & tyed up in a little taffaty to the bignesse of a hasell nut, and let them be rowled up and downe the mouth with the tongue to cause spitting or salivation. Working with the hands, and frictions of the armes, especially in the morning after the evacuation of the excrements, are good for such as are troubled with the Gout in the feet, for so, it not onely causeth revulsion from the feet, but also the resolution of that which is unprofitable.

CHAP. XII. What Diet is convenient for such as have the Goute.

AFTER the body is once fed, they must not returne to meat before that the concoction be perfected in the stomacke, lest the liver be forced to draw by the mesaraicke veines that which is yet crude and ill digested, and as it were forced thence. Whence the depravation of the nutri∣ment of the whole body; for the following decoctions doe not amend * 1.52 the default of the first. Let them make choice of meate of good juice and easie di∣gestion, rosted for such as are phlegmaticke, but boiled for such as are cholericke: as they shall shun much variety at one meale, so must they eschew the use of pulses, milk-meats, sallads, and sharpe things, as verjuice, vinegar, the juice of oranges, and citrons. They shall not eat unlesse they be hungry, and shall desist therefrom before they be fully satisfied, if it be but for this, that whilest the native heat is busied in the digestion of meat plenteously eaten, it is diverted from the concoction of the noxi∣ous humors. The flesh of great fowle, as swans, cranes, peacockes are not of laudible juice, and are with more difficulty digested in the stomacke. Some of the antients have disallowed of the eating of Capons, and the like birds, because they are subject * 1.53 to bee troubled with the Goute in the feete. Fishes are to be shunned, for that they heape up excrementitious humours, and are easily corrupted in the stomacke, yea & relaxe it by continuall use. Of the flesh of beasts veale is most to be commended, for that it breeds temperate blood, and laudible juice, and is easily digested. Neither in the meane time is mutton to bee found fault withall. But the like hunger or absti∣nence must not be appointed to all men troubled with the Goute, for such as are of a sanguine and cholericke complexion, because they are endued with much, and * 1.54 much wasting heate, are to be refreshed with more plentifull nourishment; for hun∣ger sharpens choler, and so augments their paines; neither in the interim must they bee fed with too moist meates, for too much moisture, besides that it is the au∣thor of putrefaction, will cause defluxions, and draw downe the matter to the joints. Therefore the Cholericke humor must bee incrassated and refrigerated by taking things inwardly, and applying things outwardly, lest by its tenuity it should fall downe into the grieved parts. To this purpose conduce brothes altered with lettuce, purslaine, sorrell, and the like herbs, and barly creames made with a decocti∣on of the foure cold seeds. Phlegmaticke bodies, by reason that they have not so vi∣gorous * 1.55 heate, doe as it were carry their provant about them, wherefore they must not be fed, neither with many nor with moist meats. All that are troubled with the Goute must shun those things which are hard of digestion, and which are soone cor∣rupted, for they all have a certain remiss feaver which diminisheth the native heat, & makes the meates apt to putrefie. Too plentifull drinking not onely of wine, but al∣so of any other liquor is to be avoided. For by too great a quantity of moisture the meat floats in the stomacke, and the native heat is in some sort extinguished, whence proceed crudities. Some physitians comm••nd the use of white wine, for that it pro∣vokes

urine, which is not altogether to be disallowed if so be that the body bee free from excrements, otherwise by this, as it were a vehicle, especially if the tempera∣ture * 1.56 of the body be somewhat more hot, they shall be carryed down into the joints. Therefore in such a case I should rather advise them to use clarer, which is somewhat * 1.57 weake and astringent, for that it doth not so much offend the head nor joints, and it shuts and strengthens the orifices of the vessels. Yet it will bee more convenient wholly to abstaine therefrom, and in stead thereof to drinke a Hydromel made after this manner. ℞. aquae lb. iiii. mellis opt. q. i. bulliant ad consumptionem lb. i. bene despu∣mando, * 1.58 adde ad finem, salviae p. i. imo si ••ger sit pituitosus, cinamomi aut caryophyllorum momentum. For cholerike persons make a sugred water thus. ℞. aquae fontis lb. iiii. sacchari β. ss. colentur per manicam sine ••bullitione, addendo in fine cinamomi ʒ. ii. For thus the stomacke shall also be strengthened; also he may drinke ptisan, wherein at * 1.59 the end of the decoction shall bee boiled some dryed roses, or else some syrupe of pomegranates added thereto, lest it should offend the stomack; as soone as it comes from off the fire, let it stand and settle, and then straine it through an Hippocras bag, or cleane linnen cloath.

CHAP. XIII. How to strengthen the Joints.

IT is a matter of much consequence for the prevention of this e∣vill, to strengten the joints, whereby they may be able to resist the humors preternaturally falling downe upon them. Wherefore it is good morning and evening to rubbe them with Oleum O••∣phacinum, that is, oile made of olives not come to their perfect ma∣turitie; or with oile of roses mixed with common salt finely pou∣dered. It may also bee mixed with common oile, adding thereto the powder of harts horne, as that which hath an astringent and drying faculty. Also it is good to bath them in this following Lye. ℞. cort. granat. nucum cupres. * 1.60 gallarum, sumach. cortic. querni, an. ℥ ii. salis com. alumin. roch. an. ℥ i. salviae, ••••rismar. lavendul. lauri, ivae arthretic. an. m. i. rosar. rub. m. ss. bulliant omnia in sex lb. vini crassi & astringentis & lixivio parato ex aquae chalibeatae & cinere querno. Then ••o∣ment the part with sponges or cotton clothes; after this fomentation shall be care∣fully wiped & dryed with hot linnen clothes, taking heed of cold. The juice of un∣ripe * 1.61 Hawes tempered with oxycrate is a singular thing for this purpose. But if you desire to strengthen the joints weakened by a cold cause, then, ℞. salviae, r••rism. thy∣mi, lavendul. laur. absinth. an. m. i. caryophyl. zinzib. piperis, conquas••atorum an. ℥ i. in∣fundantur in aquae vitae & vini rubri astringenti••, an. lb. iiii. bulliant leniter in balneo mariae. With this liquor foment the joints morning and evening. Some thinke it good to strengthen the joynts, to tread grapes in vintage time, which if they be not able to doe, then let them wash their feete in the Muste or new pressed Wine. Also bagges may be thus made for the same purpose. ℞. salis com. alum. roch. cort. granat. * 1.62 sumach. berberis, nucum cupressi, an. ℥iiii. fol. salviae, roris••ar. rosar. rub. an. m. ss. Let them be all put in linnen bags and boyled in Lye, and so make a decoction for to foment the joynts.

CHAP. XIIII. Of the Palliative Cure of the Goute and the materiall causes thereof.

HERE also must we consider the causes whence this disease proceeds, the * 1.63 temper of the diseased body, the parts affected, & those from whence it proceeds. For as these are not alwayes alike, so neither can one and the like remedy be usefull in every Goute. For first those which pro∣ceed of a cold cause require other remedies, than those which arise from a hot, and that which proceeds from any one simple humour, than that which ariseth from divers mixed together. For Choler alone causeth cruell paines, but tempered by the admixture of Phlegme, it becomes more gentle. Furthermore some remedies are good in the beginning, some in the encrease, and some at other times. Neither may we use repercussives in the Sciatica, as we may in the Goute of the feet and other joints; unlesse peradventure the part be fearefully enflamed. Taking these things to consideration we must observe that the Palliative cure of that Gout, which * 1.64 cannot absolutely be helped, as that which is hereditary and inveterate, is performed by foure scopes. The first is, by appointing a convenient diet in the sixe things which are termed not naturall. The second by evacuating and diverting the antecedent matter, both by purging and phlebotomy. The third, by applying topicke medi∣cines according to the condition of the morbificke humour and nature of the part. The fourth, by correcting the symptomes, but especially the paine, whereof in these affects there is oft times so great excesse by reason of the unexplicable and in∣vincible malignity of the virulent quality associating the humour, that it alone is oft times sufficient to kill the patient. And because the variety of morbificke causes, brings a variety of remedies, fitted to these foure intentions, therefore it behoves a physitian to be most attentive in the distinction of the causes. For he may be easily deceived and mistake one for another; for arthritick pains proceeding from a cold matter, if they be mitigated by the application of Narcoticke and cold medicines, it * 1.65 may induce us to beleeve that the materiall cause is hot, though really it bee not so; for Narcotickes asswage paine, not for that they are contrary to the cause thereof, but because they take away the sense by inducing a numnesse; on the contrary, the materiall cause may sometimes seeme cold, which notwithstanding is hot, for that it becoms better by application of hot medicines, that is, by taking an argument from that which helps, because contraries are cured by contraries, and the like preserved by the like. But herein consists the error, for that hot medicines profit not by their contrariety, but by the attenuation of the grosse matter, by the rarefaction of the skin and dissipating them into aire. Whence you may gather that an argument drawne from that which helpes and hurts, is very deceitfull: moreover it may happen that a large quantity of cold matter flowing down from the brain, may cause great pain by reason of the virulency, & a small quantity of choler mixed therwith, which serves for a vehicle to carry down the tough and slow phlegme into the joints, whence the patient becomes thirsty and feavourish by reason of the heate and inflammation of these parts, whereby such as are lesse cautelous and heedy will easily be induced to beleeve that some hot matter is the occasion of this Gout. Now when as not some * 1.66 one simple humour, but different by reason of mixture, causeth the Gout, the yel∣lowish colour of the part may deceive one, as, if the evill matter should proceed from choler onely, which by the tenuity of its substance leaving the center, easily possesseth the circumference of the body or part: & notwithstanding much phlegm being as it were enraged by the admixtion of a little choler, may be the chiefe cause of the disease, and may peradventure be discovered by the encrease of paine in the night season. A feaver arising by meanes of paine and watching may encrease the conceived opinion of choler, which attenuating and diffusing the humours, drives * 1.67 them into the joynts, and causeth fiery urines, tinctured with much choller, and a quicke pulse. Yet notwithstanding the Physitian shall be in errour, if deceived with * 1.68 these appearances, he attempt the cure of this Gout, as arising from a hot, and not from a cold cause: yet I am not ignorant that the cure of the proper disease must be

neglected for the cure of the symptomes. Besides also it may come to passe, that cho∣ler * 1.69 may be the cause of the Gout, and notwithstanding no signes therof may appeare in the skin, and surface of the affected part, because the coldness of the ambient aire, and the force of applyed Narcoticks may have destroyed the colour of the juices ly∣ing therunder, and as it were imprinted a certain blacknesse. It also happens, that the body being overcharged with a great quantity of grosse and viscide humours, the * 1.70 expulsive faculty may discharge some portion thereof unto the joints, but leave the rest impact in the cavity of some entraile, where causing obstruction and putrefacti∣on may presently cause a feaver, and that intermitting, if it be small, & obstruct only the lesser veins, & these of the habit of the body. Wherefore then it is not sufficient that the Physitian employ himselfe in the cure of the Gout, but it behoves him much more to attend the cure of the feaver, which if it bee continuall, it discredites the physitian, and endangers the patient; if it bee intermitting, it easily becomes conti∣nuall, unlesse it be withstood with fit remedies, that is, unlesse you let blood, the bel∣ly being first gently purged, and nature be presently freed by a stronger purge of the troublesome burden of the humours. Now it is convenient the purge be somewhat stronger than ordinary, for if it should bee too weake, it will stir up the humors, but * 1.71 not carry them away, & they thus agitated will fall into the pained and weak joints, and cause the Gout to encrease. By this it appeares how deceitfull that conjecture is, which relyes & is grounded on one signe, as often as we must pronounce judgement of morbificke causes. Wherefore to conclude wee must thinke that opinion most certaine concerning the matter of the disease, which is strengthened with multipli∣city of signes, as those which are drawne from the colour of the part, the heate or * 1.72 coldnesse manifest to the touch, those things that helpe and hurt, the patients fami∣liar and usuall diet, temper, age, region, season of they yeare, propriety of paine, the exacerbation or excess thereof, in what daies, & in what houres of the day, the length of these ••its, the urine and other excrements comming from the patients body. But for that not a few are in that heresie, that they thinke that we must neither purge nor let blood in the Gout, we must here convince that opinion. For seing that Physicke * 1.73 is the addition of that which wants, and the taking away of those things that are su∣perfluous, and the Gout is a disease which hath its essence from the plenty of aboun∣ding humours, certainely without the evacuation of them by purging and bleeding, wee cannot hope to cure, either it, or the paine which accompanies it. Metrius, in his Treatise of the Gout writes, that it must be cured by purging, used not onely in the declination, but also in the height of the disease, which wee have found true by * 1.74 experience; and it is consonant to this saying of Hippocrates; in paines wee must purge by the stoole. Besides also, Galen professeth that in great inflammations, fea∣vers, and paines, he knew no greater nor surer remedy than to let blood, even to the fainting of the patient. If those which are in this case shall not become better by pur∣ging and phlebotomy conveniently prescribed, then it happens by meanes of drun∣kennesse, gluttony, and the like distemper. For hence abundance of crude humors are heaped up, which by their contumacy yeeld themselves lesse obedient to medi∣cines. Therefore such gouty persons as are intemperate and given to gluttony and venery, may hope for no health by use of medicines.

CHAP. XV. Of locall medicines which may be used to a cold Gout.

LIttle doe to picke medicines availe, unlesse the body of the gouty patient shall be purged from excrementitious humours; besides also there is danger lest by the use of repelling medicines, the vi∣rulency * 1.75 of the humours may be driven into the entrailes, which thing hath bin the cause of sodaine death to many. Now in the first place we will speake of locall medicines which are thought meet for a phlegmatick juice, because this is more frequent, than that which is from

a hot cause. At the beginning in every gout, the sciatica excepted, wee must use a∣stringent things which have a faculty to binde or strengthen the joints, and to dry and waste the excrementitious humour. As, ℞. fol. sabinae m. ss. nucum cupressi ℥iii. * 1.76 aluminis roch. ℥i. gum. tragacanthae. ℥iiii. mucaginispsilii & cydon. quantum sufficit, fiat cataplasma. Or, ℞. ••••ercoris bubuli recentis lb. i. mellis ros. ℥iiii. olei ros. & aceti an. ℥ii. bulliant simulparum, fiat cataplasma. Or else, ℞. olei rosar. & myrtill. an. ℥ii. pul∣veris myrrhae & aloes an. ℥i. acaciae ℥liss. incorporentur cum aqua gallarum coctarum, & fiat unguentum. Some boyle sage, camomile and melilote flowers, wormewood and * 1.77 dane-wort, of each a handfull in a sufficient quantity of vinegar, then they put the grieved part into this decoction being warme; & by frequent using this medicine, it hath beene found to repell and consume the noxious humour, not onely cold, but also cholericke, and also to strengthen the part. The fresh faeces of Olives layd to the part, asswage paine: dryed Oranges boiled in vinegar, beaten and applyed doethe same. Or, ℞. medii corticis ulmi lb. ss. caudae equin. stoechad. consolid. majo∣ris, * 1.78 an. m. ss. aluminis roch. thuris an. ʒiii. farin. hordei ʒv. lixivii com. quantum suf∣ficit, fiat cataplasma ad formampultis satis liquidae. Commonly then when as the part swelleth up, the paine is lessened, for that the expulsive faculty driveth the humour from the center into the circumference of the part, that is, from within outwards; for in like sort, such as have the tooth ach have lesse paine when their cheekes be∣gin to swell.

After repercussives, wee must come to those which evacuate the conteyned hu∣mour by evacuating or resolving it. For every defluxion of humours remaining in any part requires evacuation. Neither must we marvaile thereat, if the digested hu∣mour doth not vanish at the first time; for we must have regard to the cold phlegme which is thick and viscide; as also of the part which is ligamentous, membranous and nervous, and consequently more dense than fleshy parts. ℞. rad. Bryon. sigilli * 1.79 beat. Mariae an. ℥iv. bulliant in lixivio, postea terantur, & colentur per setaceum, adden∣do farin. hordei & faburum an. ℥i. olei chamaem. ℥iii. fiat cataplasma. Or, ℞. farin. hor∣dei & lupin. an. ℥iii. sulphuris vivi & salis. com. an. ℥i. mellis com. ℥v. pul. aloës & myrrhae an. ℥ss. aq. vit. ℥i. cum lixivio fiat cataplasma. Or, ℞. succi caulium rub. aceti boni, an. ℥iiii. farin. hordei ℥iss. pul. Hermodactyl. ℥ss. vitellos ovorum nu. iii. olei cha∣maem. ℥iii. croci ℈ii. some burne the roots and stalkes of colworts, and mixe the a∣shes with hogs greace and the powder of Orris, and so make a pultis. Or, ℞. La∣ctis vaccini lb. ii. micae panis albi quantum sufficit, bulliant simul; addendo pulveris subti∣lis * 1.80 florum••homaem. & meliloti an. m. ss. croci ℈i. vitellos ovorum nu. iiii. ol. rosar. ℥iii. butyri recentis ℥i. terebinth. ℥ii. fiat cataplasma ad formam pultis satis liquidae. This Cata∣plasme may be applyed with good successe, not only to phlegmatick & cold, but also to any gout, at any time to mitigate the extremity of the pain in men of any temper, and it must bee changed twice or thrice a day. Also Treacle dissolved in wine, and annoy▪ ted on the part, is sayd to asswage this paine. You may for the same pur∣pose make and apply emplasters, unguents, cerats and liniments: This may bee the forme of an emplaster. ℞. gummi ammoniaci, bdelii, s••yracis, an. ℥ii. cum aceto & * 1.81 aqua vit. dissolve, & adde farin. foenugr. ℥ss. olei chamaem. & anethi, an. ℥ii. cerae quantum sufficit, fiat emplastrum molle. Or, ℞. rad. bryon. sigill. beat. Mariae, an. ℥v. bulliant in lixivio completè, & colentur per setaceum, addendo olei cham. ℥iiii. sevi hirci∣ni ℥iiii. cerae nov. quantum sufficit, fiat emplastrum molle. Or, ℞. gum. ammon. opo∣panacis galbani, an ʒii. dissolvantur in aceto, post••a colentur, adde olei li••iorum, iere∣binth. venet. an ℥i. picis navalis, & cer. nov. quantum sufficit; fiat emplastrum mol∣le. Or else, ℞. succi r••d. enul. camp. & ebuli an. ℥iii. rad. alth. lb. ss. coquantur & co∣lentur per setaceum, addendo storum cham. melil. sambuci, rorismar. & hyperici an. p. ii. nucum cupressi, nu. iiii. ol. cham. aneth. hyper. liliorum, de spica an. ʒii. pi••guedinis ana∣tis, gallin. anseris an. ʒss. ranas virides vivas nu. vi. catellos duos nuper natos, bulliant omnia simul, in lb. ii. ss. vini oderiferi, & unâ aquae vit. ad consumptionem succorum & vini, & ossium catellorum dissolutionem, & fortiter exprimantur; expressioni adde terebinth. ℥iii. cer. quantum sufficit. fiat emplastrum molle. Also, Emp. de vigo. Oxicroce∣um, de mucilaginibus, de meliloto and the like mixed together, and softened with a

little oyle or axungia, are of the like faculty, and good for the same purpose.

Let this be the forme of an ointment. ℞. anserem pinguem, & imple catellis duobus, * 1.82 de quibus deme cutem, viscera, caput & pedes; item accipe ranas nu. x. colubros detra∣cta cute in frusta dissectos nu. iv. mithridat. & theriac. an. ℥ss. fol. salviae, rorismar. thy∣mi, rutae, an. m. ss. baccarum lauri, & juniperi conquassat. an. ℥i. pulveris nuc. moschat. zinzib. caryophyl. & piper. an. ʒi. de co quod stillabat fiat unguentum vel linimentum cum cera & terebinth. veneta, pauca aqua vitae addita; this marvelously asswageth the paine of the gout arising from a cold cause. Another, ℞. Gummi pini, & lodani, an. ℥iv gummi elemi & picis naval. an. ℥ss. terebinth. venet. clarae ʒvi. chamaemel. & lilio∣rum an. ℥iv. vini rub. lb. i. ss. aq. vit. & salv. an, ʒvi. dissolvantur omnia simul lento igne, baculo semper agitando, deinde adde pul. ireos, flor. baccarum lauri, & hermodactyl. and ℥iiss. mastiches, myrrhae & olibani an. ℥ii. farinae fabar. ℥iv. incorporentur omnia si∣mul, fiat unguentum molle. Or else, ℞. mucag. seminis foen••gr. in aceto extract. quan∣tum volueris, cui misce mellis quantum sufficit; let them be boyled together untill they acquire the consistence of an oyntment. These things shall be changed, as often as need shall seeme to require. Also anodine and discussing fomentations are good to * 1.83 resolve; as this, ℞. fol. rutae, salv. rorismar. an. m. i. bulliant cum aceto & vino; and so make a decoction for a fomentation, which you may use not only in a cold gout, but also in a hot, because it resolveth and strengtheneth the part by astriction, and freeth it from the defluxion: you must have a care that the medicines which are used * 1.84 to paines of the gout be changed now and then. For in this kinde of disease that re∣medy which did good a little before, and now availeth, will in a short time become hurtfull.

But if the contumacy and excesse of the pain be so great, that it will not yeeld to the described medicines, then it is fit, because the disease is extreme, to use (according to Hypocrates counsell) extreme remedies, such as are those which follow. ℞. axun∣giae * 1.85 gallinae, olei laurini mastic. & ••uphorb. an. ℥i. pulver. euphorb. & pyreth. an. ʒi. fiat li∣tus; herewith let the part bee rubbed every day, for it is a very effectuall medicine. For euphorbium and pellitory by their heat attenuate and resolve, the capons grease and oile of bayes, relaxe, the oyle of mastich strengtheneth the part and hindereth a new defluxion. Also there is made a very anodine ointment of oyle of foxes, where∣in earth-wormes, the roots of elecampane and bryoni•• have beene boiled, with a lit∣tle * 1.86 turpentine and waxe; this softens, attenuates and resolves the cold humour im∣pact in the joints. Or else, ℞. seminis sinapi pulverisati, & aceto acerrimo dissoluti, ℥iii. mellis anacardini ℥ii. aquae vitae ℥i. salis com. ʒii. Let them bee all mixed together, and applyed to the pained part. Or, ℞. picis nigrae, ℥iii. terebinth. venetae ℥ii. sulphuris vivi subtiliter pulverisati ℥iii. olei quant. sufficit, liquefiant simul, fiat emplastrum; Let it bee spread upon leather, and laid upon the part for two or three dayes space, if the pati∣ent perceive any ease thereby; if otherwise, let it be changed as we said before. Some for the same purpose apply nettles thereto, and presently after wash the part in sea or salt water. Others foment the part with vineger wherein pidgeons dung hath beene boiled. A vesicatory made of very sower leaven, cantharides, and a little a∣qua * 1.87 vitae, is very powerfull to evacuate the conjunct matter. For thus the maligne and virulent serum, or whayish humour is let out, whence followes some ease of the pain. Now there are some gouty paines, which cannot bee lessened or asswaged unlesse by remedies more powerfull than the distemper, therefore vesicatories ought not to be rejected, seeing that the Ancients in this affect have also made use of actuall caute∣ries, as we shall shew hereafter. Christopher Andreas in his booke termed Oëcoitarie [that is, Domestick physicke] much commends Oxe dung wrapped in cabbage or vine leaves, and roasted in the embers, and so applyed hot to the grieved part.

CHAP. XVI. Of locall medicines to be applied to a hot or sanguine Gout.

HEre must wee in the beginning make use of repercussives, such as are cold and dry, that they may contend with the morbificke matter by both * 1.88 their qualities; also let them bee astrictive, so to adde strength to the part. But I would have you alwaies to understand that you must first premise generall medicines. ℞. albuminum ovorum nu. iv. succi lactuca & solani an. ℥i. aq. rosar. ℥ii. incorporentur simul, & fiat linimentum saepius renovandum. Others take the meale of barly, lentils, acatia, oile of roses, myrtles, and with a little vineger they make a cataplasme; Or, ℞. sumach, myrtillorum, boli arm. an. ʒss. acatiae, corticum granat. balust. an. ʒi. aq. plantag. & rosar. an. ℥iii. ol. rosati ℥iss. aceti ℥i. farinae hordei & lenti∣um quantum satis erit, fiat cataplasma. This is very excellent and effectuall to stay or hinder phlegmonous and erysipelatous tumours. Also you may make a Cata∣plasme ex mucagine Cydoniorum in aqua rosarum extracta, cassiae fistula, oleo rosato, & aceto. Or, ℞. pampinorum vitis viridum, m. ii. terantur & bulliant in oxycrato ex aqua fabrorum, cui adde sumach. conquassati ℥i. olei rosat. ℥ii. farinae hordei quantum sufficit, fiat cataplasma. Or else, ℞. succi sempervivi, hyoscyami, & portulacae * 1.89 an. ℥iv. corticum mali granati ℥iss. farinae hordei ℥v. vini austeri quantum sufficit, fiat cataplasma; this is much commended, for it hath entring thereinto wine and the pomgranate pill, which both are very great astrictives; and the juices are exceeding cooling, the meale also hinders and thickens the sanguine humours that are ready to flow downe, and make the medicine of a good consistence. Another, ℞. fol. hyos∣cyami & acetosae an. m. i. involvantur papyro, & sub cineribus coquantur, mox cum un∣guento populeon. aut rosat. ℥ii. incorporentur; and then lay this Cataplasme thus made warme unto the part. Another, ℞. florum hyoscyami lb. ii. ponantur in phiala vitrea∣ta, & reconde in fimo equino donec putruerint, accipe ex putredine ℥ii. in quibus dissolve olei de junipero ℥ss. fiat linimentum adusum. Others beat the pulpe of a Gourd or Ci∣trull in a mortar, and so apply it. Another, ℞. mucag. sem. psilii, & cyton. extract. in aquae rosar. & solani an. ℥iiii. olei rosati omphacini, ℥iii. vini granatorum ℥i. vitellos ovorum cum albumine nu. iii. camphorae ʒi. incorporentur simul, fiat linimentum. Or else, ℞. ol. rosat. omphacini ℥iv. album. ovorum cum vitellis nu. vi. succi plantag. & solani, an ℥i. farinae hordei ℥iii. incorporentur simul, fiat cataplasma. Or, ℞. farinae fabarum & hordei an. ℥iii. olei rosati, ℥ii. oxycrati quantum sufficit, coquantur simul, fiat cataplasma. Another, ℞. mucag. sem. psilii ℥iiii. ol. rosati ℥ii. aceti ℥i. vitellos ovorum, nu. iii. croci ℈i. misce. Pliny reporteth that Sextus Pomponius the Governour of the hither Spaine, as hee * 1.90 overlooked the winowing of his corne, was taken by the paine of the gout in his feet, wherefore hee covered himselfe with the Wheat above his knees, and so was eased, his feet being wonderfully dryed; and he afterwards used this kind of remedy. It is note worthy, which often happeneth, that the paine cannot bee altogether eased by such like remedies, by reason of the abundance of bloud impact in the part; * 1.91 wherefore it must bee evacuated: which I have done in many with good successe, opening the veine which was most swelled and nigh to the affected part; for the paine was presently asswaged. Neither must wee too long make use of repercus∣sives; lest the matter become so hardened, that it can scarce bee afterwards resol∣ved, as when it shall bee concrete into knots and plaisterlike stones: resolving medicines are to bee mixed with repercussives conveniently applied, so to dis∣cusse the humour remaining as yet in the part, whereof shall bee spoken in the fol∣lowing Chapter.

CHAP. XVII. Of locall medicines for a cholericke gout.

THe repercussives that must first be used in this kinde of gout ought to bee cold and moiste, that so they may resist both the qualities of choler: such * 1.92 are the leaves of night-shade, purslaine, house-leeke, henbane, sorrell, plantaine, poppy, cold water, and the like, whereof may bee made di∣vers compositions. As, ℞. succi hyosciami, sempervivi. lactuc. an. ℥ii. farin. hordei ʒi. olei rosati, ℥ii. agitando simul fiat medicamentum; let it bee applyed and often chan∣ged, for so at length it will asswage the inflammation. Some thinke the braine of a hogge mixed with white starch, or barly meale and oile of roses, an excellent me∣dicine. The leaves of mallowes boyled in water, and beaten with a pestell, and ap∣plyed, asswage pain. ℞. mucag. sem. psilii extract. in aq. solani, vel rosarum ℥ii. farin. hor∣dei ℥i. a••eti q. s. fiat linimentum. Or else, ℞. unguent. rosat. mesuae, & populei. an. ℥iii. succi melonum ℥ii. alb. ovorum, nu. iii. misceantur simul pro litu. Also a spunge dipped in oxy∣crate, and pressed out again and applied thereto doth the same. Or else, ℞. fol. caulium rub. m. ii. coquantur in oxycrato & terantur: adde ovorum vitellos tres, olei rosati ℥iii. farinae hordei quantum sufficit, ••ingatur cataplasma: Also you may take the crude juice of cole-worts, dane-weede, and roses beaten and pressed out, and of these incorporated with oyle of roses and barly meale make a cataplasme. In winter time, when as these things cannot bee had greene, you may use unguentum infrige∣dans Galeni & populeon. Or else, ℞. cerae albae ℥i. croci ℈i. opii ℈iiii. olei rosati quan∣tum * 1.93 sufficit, marcerentur opium & crocus in aceto, deinde terantur & incorporentur cum cera & oleo, fiat ceratum; spread it upon a cloth, & lay it upon the part, and all about it, and let it bee often renewed. Some cut Frogges open and apply them to the grieved part. It is confirmed by sundry mens experience, that the paine of the sciatica, when it would yeeld to no other remedy, to have beene asswaged by annoynting the part affected with the mucous water or gelly of Snailes, being used for the space of seven or eight dayes; the truth whereof was assured mee by the worthy * 1.94 Gentleman the Lord of Longemean, a man of great honesty and credit, who him∣selfe was troubled for sixe moneths space with the sciatica. This water is thus made, Take fifty or sixty red Snailes, put them in a copper pot or kettle, and sprin∣kle them over with common salt, and keep them so for the space of a day; then presse them in a course or haire cloth; in the expressed liquor dip linnen ragges, and apply them so dipped to the part affected, and renew them often. But if there bee great inflammation, the Snailes shall bee boyled in Vineger and Rose-water. They say that Citrons or Oranges boyled in Vineger, and beaten in a mortar, and incorpo∣rated with a little barly or beane flower, are good against these paines. Or else, ℞. pomorum coctorum in lacte lib. i. butyri ℥i. vitellos ovorum, nu. ii. aceti ℥i. fiat cataplas∣ma. There are some who take cheese crud newly made, and mixe it in a mortar with oyle of Roses and barly meale, and so apply it; it represseth the inflam∣mation and asswageth paine. Others mixe Cassia newly extracted forth of the Cane, with the juice of Gourds or Melons. Others apply to the part the leaves of Cole-worts, and Dane-weede or smallage, or all three mixed together and bea∣ten with a little Vineger. Others macerate or steepe an ounce of linseed in Wurt, and make the mucilage extracted therefrom into Cataplasme with some oyle of Roses and barly meale. Some put oyle of poppyes to the pulpe of Citrulls or Gourds being beaten, and so incorporate them together, and apply it.

This following medicine hath its credit from a certain Gascoine of Basas that was * 1.95 throughly cured therwith, when as he had bin vexed long & much with gouty pains, above the common custome of such as are troubled with that disease. Thus it is; Take a great ridge tile thick & strong, and heat it red hot in the fire, then put it into such another tile of the same bignesse, but cold, lest it should burne the bed-clothes, then * 1.96 forthwith fill the hot one with so many Dane-wurt leaves, that the patient may safe∣ly lay the affected part therein; without any danger of burning it. Then let the pati∣ent

endure the heate that comes therefrom, and by sweate receive the fruit there∣of, for the space of an houre, substituting fresh Dane-wurt leaves, if the former be∣come too dry, as also another hot tile, if the former shall grow too cold before the houre bee ended. This being done, let the part bee dryed with warme and dry linnen clothes. Use this particular stove for the space of fifteene dayes, and that in the morning fasting; afterwards annoynt the part with this following oyntment. ℞. succi ebuli lb i. ss. olei com. lb i. misceantur simul, and let them be put into a strait mouthed glasse, and well luted up; then let it boyle in balnco Mariae, being * 1.97 first mixed with some wine, until the halfe thereof bee consumed, for the space of renne or twelve houres, then let it coole, and so keepe it for use, adding there∣to in the time of annoynting, some few drops of aquavitae. It may bee annoynted twice or thrice in a day, long after meate. Moreover the roots and leaves of Dane-wurt boyled in water, beaten and applyed asswage paine; the oyle thereof chi∣mically extracted performes the same.

But if the contumacious paine cannot bee mitigated by the described remedies, and becomming intolerably hot and raging, make the patient almost to swoune, then must wee fly to narcoticks. For although the temper of the part may bee wea∣kened by these, the native heate diminished or rather exstinguished; yet this is a far * 1.98 lesse inconvenience than to let the whole body bee wasted by paine; These things have a powerfull refrigerating and drying faculty, taking away the sense of the paine, and furthermore, incrassate, thin, acride and biting humours, such as chole∣ricke humours are. Wherefore if the matter which causeth the paine be thick, wee must abstaine from narcoticks, or certainely use them with great caution. ℞. micae panis secalini parum cocti in lacte ℥ii. vitellos ovorum, nu. ii opii ʒi. saccorum solani, hy∣osciami, * 1.99 mandragorae, portulacae, sempervivi, an. ℥i. Let them bee mixed together and applyed, and often changed. Or else, ℞. fol. hyosciami cicutae, acetos. an. m. i. bul∣liant in oxycrato & contundantur, cumque vitellis ovorum crudorum nu. ii. & olei ro∣sat. ℥ii. farin•• hordei quod sit satis, incorporentur, fiat cataplasma; with the use thereof I am accustomed to asswage great pains. Or else, ℞. Opii ʒiii. camphor. ʒss. olei nenuph. ℥i. lactis ℥ii. unguent. ros. Galeni ℥iv. incorporentur simul in mortario, applicentur. Moreo∣ver, cold water applyed & dropped upon the part drop by drop, is narcotick and stu∣pefactive, as Hippocrates affirmeth, Aphor. 29. Sect. 5. for a moderate numnesse mitiga∣teth paine; there is also another reason why it may bee profitably used in all paines of the Gout, for that by repelling the humours, it hindereth their defluxion into the part. Mandrage apples boyled in milke, and beaten, doe the samething; also the leaves of henbane, hemlock, lettuce, purslaine, being so boiled, doe the same. If any desire to use these more cold, hee must apply them crude, and not boy∣led.

But the excesse of paine being mitigated, wee must desist from the use of such narcotickes, and they must rather bee strengthened with hot and digerating things; otherwise there will bee danger lest it bee too much weakened, the temper thereof being destroyed, and so afterwards it may bee subject to every kinde of defluxion. * 1.100 Wherefore it shall bee strengthened with the formerly described discussing fo∣mentations, and these ensuing remedies. As, ℞. gum. ammoniaci & bdelii an. ℥i. dissolvantur in aceto, & passentur per setaceum, addendo styracis liquid. & fari••. foenug. * 1.101 an. •…•…ss. pul. ireos ℥iiii. olei ch••maem. ℥ii. pulveris pyrethri ʒii. cum cera fiat emplastrum molle. Or else, ℞. rad. emul••, ebuli altheae an lb. ss. sem. lini, foenugr. an. ʒii. ficu∣um ping. nu. xx. coquantur completè & trajiciantur per setaceum, addendo pul. euphorb. ʒii. olei chamaem. aneth. & rutacei, an. ℥iii. medullae cervi ℥iv. fiat cataplasma. Yet you must use moderation in discussing, lest the subtler part of the impact humour be∣ing * 1.102 discussed, the grosser part may turne into a stony consistence, which also is to bee feared in using repercussives.

I also omitted, that, according to the opinion of the Ancients, bathes of fresh water, wherein cooling herbes have been boiled, used three houres after meat, con∣duce much to the asswaging of pain; for so used, they are more convenient in cho∣lerick natures, and spare bodies, for that they humect the more, and quickly di∣gest * 1.103 the thin and cholerick, and consequently acride vapours, the pores being open∣ed,

and the humours dissipated by the gentle warmenesse of the bath. After the bath, the body must be annoynted with hydraeleum, or oyle and water tempered to∣gether, lest the native heate exhale, and the body become more weake. Meates of more grosse juice are more convenient, as beefe, sheeps-feet, and the like, if so be that * 1.104 the patient can digest them, for these inspissate the cholerick bloud, and make it more unfit for defluxion.

CHAP. XVIII. What remedies must be used in paines of the joynts proceeding of a distemper onely, without matter.

PAines also happen in the joynts by distemper without any matter, which though rare, yet because I happened once to feele them, I have thought * 1.105 good to shew what remedies I used against them. I once earnestly bu∣sied in study, and therefore not sensible of such externall injuries as might befall mee; a little winde comming secretly in by the crannies of my studie, fell upon my left Hippe; at length wearied with study, as soone as I rose up to goe my way, I could not stand upon my feete, I felt such bitter paine without any swelling or humour which might bee discerned. Therefore I was for∣ced to goe to bed, and calling to minde, that cold, which was absolutely hurtfull to the nerves, had bred mee that paine, I attempted to drive it away by the frequent * 1.106 application of very hot clothes; which, though they scorched and blistered the * 1.107 sound parts adjoyning thereto, yet did they scarce make any impression upon the part where the paine was settled, the distemper was so great, and so firmely fixed therein. And I layed thereto bagges filled with fryed oates and millet, and dip∣ped in hot red wine; as also oxe bladders halfe filled with a decoction of hot herbs. And lastly, a woodden dish almost filled with hot ashes, covered over with sage, rosmarie, and rue lightly bruised, and so covered with a cloth, which, sprink∣led over with aqua vitae, sent forth a vapour which asswaged the paine. Also browne bread newly drawne out of the oven, and sprinkled over with Rose-wa∣ter, and applyed, did very much good. And that I might more fully expell this hurtfull cold, I put stone bottles filled with hot water, to the soales of my feete, that the braine might bee heated by the streightnesse and continuity of the nerves. At length, by the helpe of these remedies, I was very well freed from this con∣tumacious distemper, when it had held mee for the space of foure and twentie houres.

There is another kind of gouty pain sometimes caused by a certain excrementiti∣ous matter, but so thin and subtle that it cannot bee discerned by the eyes. It * 1.108 is a certaine fuliginous or sootie vapour, like to that which passeth from bur∣ning candles or lampes, which adhers and concreets to any thing that is opposed thereto; which being infected by the mixture of a virulent serous humour whither∣soever it runneth, causeth extreme paine, somewhiles in these, and otherwhiles in o∣ther joynts, unlesse you make a way therefore, when as it seeketh passage forth, which must be done by hornes, cupping-glasses, vesicatories, cauteries, or other the like art.

CHAP. XIX. What is to be done after the fit of the gout is over.

IT is convenient when the paine is asswaged, that you strengthen the * 1.109 joints. Now, to strengthen them is not onely to binde and dry, but wholly to amend the weakenesse left in the part by the disease, that is, to discusse the humour, if any superfluity thereof remaine; but to humect the part, if the moysture bee exhausted and dryed up. But * 1.110 such as are troubled with the gout, after they are freed from their paine, have not∣withstanding such impotency of their joynts that they cannot goe of a long time after; for that the nerves and tendons which are in great number in the feete, be∣ing moystened with much phlegme, are so relaxed, that they can no more sustaine or beare themselves upon their feete, than paper when it is wet can bee made to stand. Wherefore, that they may recover the use of their feete, the impacted humour must by all meanes be discussed, and spent with fomentations, cataplasmes, drying and astringent emplasters. You may use the formerly described fomen∣tation, encreasing the quantity of alume and salt, and adding thereto a like quan∣tity of sulphur vivum: then the following emplaster shall bee applyed thereto. ℞. mas. emplast. contra rupturam ℥iiii. tereb. ℥ii. pulv. ros. rub. nucum cupress. gal∣larum, gran, myrtil. & fol. ejusdem, thuris, mastich. & caryophyl. an. ʒi. malaxentur ominae simul, manibus inunctis oleo myrtino & mastichino, fiat emplastrum. Let it bee spread upon leather to a just bignesse, and applyed to the top and sole of the foote. Draw over the plaster, and the whole legge a stocking made of a tanned dogges skinne; this emplaster strengtheneth the nerves, draweth forth the humour impact therein, and intercepts the defluxion. But the dogge-skinne stocking preserveth * 1.111 the native heate of the part, and for that it bindeth, hindreth the defluxion into the feete.

CHAP. XX. Of the Tophi, or knots which grow at the joynts of such as are troubled with the Gout.

SOme that are troubled with the gout, have knotty bunches growing in * 1.112 their joynts, which by the Ancients were called Tophi. These are generated by the congestion of grosse, viscide and crude phlegme, with a little admixtion of an acride and cholericke humour. These matters remaine settled in the part, for that it being too weake cannot digest and depresse them; wherefore being there impact, they easily concrete into a certaine plaster-like or chalke-like substance, whilest by the adventitious and burning heate caused by paine, and the gouty malignity, their more subtle part is * 1.113 dispersed, but the grosser subsides. Yet sometimes the unfit application of reper∣cussive or discussive medicines is a cause of the generation of these Tophi. For by the former, the impact matter is incrassated and gathered together; but by the latter, the subtle part being discussed, the remnant that subsides concretes into Tophi. Those medicines which are made to mollifie, ought to have a moderate∣ly * 1.114 heating, and humecting faculty, that they may diffuse, and as it were dissolve the impact matter; such is warme water, the decoction of emollient herbes, the de∣coction of Calves or Sheepes entrailes, heads and feete: after these or the like fomentations, you shall use the following medicine. ℞. axungiae, human. anseris & gallinae, medul, cervin. an. ℥ii. tereb. ven. ℥i. aq. vit. parum, cerae quantum suficit, fiat unguentum molle. Then this which followeth will bee good. ℞. rad. alth. liliorum, bryon. lapath. acuti, an. ℥iiii. coquantur complete & trajiciantur per setace∣um; adde gum. ammon. bd••l. galb. opopanaci•• in aceto dissolutorum ℥i. medul. cervin.

℥ iss. incorporentur simal, & applicentur. Or else, ℞. olei liliorum, amygd. dul. medullae cruris cer. an. ℥ ii ss. mucag. sem. lini, alth. foenugr. an. ℥i. cerae quantum sufficit; fiat ce∣ratum. Or else ℞. empl. de vigo cum mercurio, & cerat. de aesipo humidae descript. Phila∣grii, an. ℥. ii. malaxentur simul cum oleo lilior. fiat massa. Or else, ℞. gum. ammon. o∣popan. galb. bdel. dissolutorum in aceto, an. ℥ ii. panno lineo colatis, adde pulv. sulph. nitr. sinap••, pyrethri, an. ℥ ss. styracis, liq. & axung. hum. an. ℥i. res. pini, terab. ven. an. ℥. ss. cerae quantum sufficit, fiat ceratum molle. This which followes is thought most effectu∣all in the opinion of Galen and Avicen. ℞. pedes porcel. benesalsos, nu. iiii. veterem * 1.115 pernam, cum illis coque: addendo sub finem, radicis bryoniae, lapath. acut. an. ℥iii. axun∣•…•… tauri. & medul. cervin. an. ℥ i. cum caseo putrefacto fiat empl. molle ad usum: This which followes is also most effectuall. ℞. casei acris & putrefacti, ℥ iiii. pul. sulph. vivi cuphorb. & pyreth. an. ʒiii. decoctionis veter is pernae & porcellorum quod sufficit ad incor∣porandum, ducantur in mortario, & fiat empl. adusum. Or else, ℞. spumae nitri, ℥ vi. te∣reb. ℥ ii. olei veteris, ℥viii. lixivii, quo lanae pileorum lavantur, & cerae quantum sufficit, fiat ceratum sat is molle. After the use of emollients, a fumigation shall be made in this manner. Heat a cogle-stone, milstone or bricke, red hot in the fire, take it forth, and * 1.116 cast upon it a sufficient quantity of very sharp vinegar, & aquavitae, the rising vapour shall be diligently received by the affected member, for this hath a faculty to attenu∣ate and cut grosse, viscide, and plaster like matter, yea also, and to break the skin, yet that is broken oft time of its own accord, without the help of either medicine or in∣strument. To conclude, these medicins which are good to mollifie scirrhous tumors, the same are also good to soften the gouty knots and tophi. But wee must note that these knotty bunches are somtimes suppurated, not truly by the impact & plasterlike matter, but by a new defluxion comming on a sodain, & then it is necessary to make way for the conteined matter, which being done, first there commeth forth a humor like milk, then a plaster-like matter, then it leaves behinde it an ulcer to be cured by applying thereto Empl. gratia dei, and others as the Surgeon shall think fit.

CHAP. XXI. Of flatulencies conteined in the joints, and counter feiting true Gouts, and of the remedies to be used thereto.

OF••-times there is small quantity of humour, which moves the paine of the gout; but much flatulencie mixed therwith, especially in great * 1.117 joints, as in the huckle or hippe-bone, and the knees; they sometimes cause so great distention, that they drive the heads of the bones forth of their places. You may partly understand it is so, if a tensive paine afflict the patient with any sense of heavinesse; if when you presse the tumour with your fingers, the place retaine no marke or impression thereof, as happens in an oe∣dema, but on the contrary, a flatulent spirit lifts it up as it were by renitency, as if one should thrust a pair of bellows which are filled with wind, hence the part cannot per∣forme its duty, for that the spaces of the joints are possessed with aboundance of fla∣tulencies, so that the liberty of motion is intercepted, and the member is kept as it were bound up. Many no very skillfull Surgeons putting their fingers to these kind * 1.118 of tumours, so that lifting up the one they presse down the other, when as they per∣ceive the flatulency, as it were, rising betweene their fingers, supposing it to bee the motion of pus, or matter already generated and flowing up and downe, as is usual in impostumes, they have opened it by incision; but when as nothing flowed forth it ap∣peared how much they were deceived, yet in the interim, by this their rashnesse they have caused many dangerous symptomes, as encrease of pain, defluxion of humours, by force whereof the bones have beene dislocated, and brought to the patient an un∣curable lamenesse. But these flatulent gouts are seldome without some phlegmatick matter, which is neither too crude, nor viscide. Such like flatulencies are not easi∣ly * 1.119 discussed, nor at the first endeavour, by reason of a cold distemper which they bring to the part, and the density of the membranes and ligaments by which the ar∣ticulation

is knit and fastened, so that scarce any part of that which is there shut up can breath forth of such strait passages. Therefore the cure must be undertaken with resolving, discussing, and drying fomentations, as for example, with a decoction of fennell, aniseeds, rue, chamornill, melilote, sage, rosemary, origanum, calamints, horehound, and the like, boyled in wine with a little Lye, rose vinegar, and com∣mon salt. This following ointment shall bee used after the fomentation. ℞. olei chamoem. aneth. rut. ••auri, an. ℥ ii. cum cera alba, fiat linimentum addendo aq. vitae pa∣rum. After you have anointed it, apply thereto this following cataplasme. ℞. flor. cham. melil. aneth. ros. rub. pulv. an. m i. fol. malv. & absinth. an. m ss. furfur, m i. bul∣liant omnia simul cum lixivio, & vinorubre, deinde pistentur cum medulla panis, & fari∣na fabarum, quantum sufficit, fiat cataplasma, addendo ol. rosar. & myrtin. an. ℥ ii. Some highly approve of this following medicine for the wasting of flatulencies. ℞. axun. suil. ℥ iv. calcis vivae, ℥ i ss. terantur diligenter in mortario, & incorporata applicentur. Or else, ℞. stercor. caprar. cocti cum vino & aceto, an. lb. ss. tereb. venet. & mell. com. an. ℥ ii. aq. vitae, ℥ ss. pul. rad. lreos florent. & sabin. an. ℥ iii. olei rut. & aneth. an. ℥ i. farin. fabarum quantum sufficit. Make a cataplasme to the forme of a pultis. Also stoupes dipped in oxycrate, and wrung out, shall be applyed: in this oxycrate shall be boyled wormewood, origanum, chamomill, melilote, rue, common salt, adding thereto some aqua vitae. Then the part shall be bound up as strait as the patient can endure it; in conclusion, that the native strenght may by little and little bee restored to the part, it shall be fomented with Lye made of the ashes of Oake-wood and the cuttings of vines, wherein shall be boyled, salt, sulphur, choise alome, and wetting linnen cloaths, or stoups therein, and applying them, it shall be straitly swa∣thed up. Yet if great pain shall more cruelly vexe the part, then neglecting for a time the proper cure of the disease, you shall withstand the symptome by rubbing the part, and anointing it with some discussing oile, laying thereon some moist wooll & other anodyne things.

CHAP. XXII. Of the Ischias, Hip-gout, or Sciatica.

FOR that the hip-gout in the greatnesse of the causes, bitternesse of pain, and vehemency of other symptomes, easily exceeds the other kindes of Gout, therefore I have thought good to treate thereof in particular. * 1.120 The pain of the Sciatica is therefore the most bitter, and the symptomes most violent, for that the dearticulation of the huckle bone, with the head of the Thigh bone, is more deepe than the rest; because also the phlegmaticke humour which causeth it, is commonly more plenteous, cold, grosse, and viscid, that flowes down into this joint, and lastly because the Sciatica commonly succeeds some other chronicall disease, by reason of the translation and falling down thither of the mat∣ter, become maligne and corrupt by the long continuance of the former disease. But the paine not onely troubles the hippe, but entering deepe, is extended to the mus∣cles * 1.121 of the buttockes, the groines, knees, and very ends of the toes, yea often times it vexeth the patient with a sense of paine in the very vertebrae of the loines, so that it makes the patients, and also oft times the very Physitians and Surgeons to thinke it the wind or stone Collicke. The cause of such wandering and dispersed paine is to bee referred to the manifold distribution of the nerves which come to that joint from the loines and holy-bone, for they are sent into the muscles of the buttockes, and so dispersed over the whole legge to the very ends of the toes, as it is shewed in our Anatomy. Therefore the paine is largely extended, that is, to what part soever a nerve runs which comes from the affected Hippe. Often times there is no swelling, no rednesse, nor distemper manifest to the eye, by reason that the veines are very few which rise into the surface and skinne of this part, and the humour lyes, as it were, sunke in; which is the cause that divers times the excrementitious humours mixed with statulencie, runne so violently into the cavity of this joint, that relaxing the li∣gaments,

as well proper as common, the head of the thigh-bone is easily driven out from hence, so that it may never be restored again, if it remain so for any space of * 1.122 time; for that in this time the humor falling down into this cavity, by delay concretes as it were into a stony body, and the head of the Thigh-bone weares it selfe another cavity in the neighbouring bone, but the lips of the true cavity, which are gristly, be∣come more streit and deprest, and lastly all the ligamentous bodies moistened with this excrementitious humour become more loose and weake, whence succeed many and most grievous symptoms, as lamenesse, & the decay not only of the thigh & leg, but at length of the whole body, and lastly a slow and hectick feaver, which in con∣tinuance of time will consume the patient for the causes formerly mentioned. Ther∣fore let Physitians and Surgeons have a care that they resist it at the first, and with such powerfull remedies as are mentioned in the following chapter, hinder the springing up and growth of the formerly mentioned symptomes.

CHAP. XXIII. The cure of the Sciatica.

THough the Sciatica bee commonly occasioned by tough phlegme, yet if the patient be strong and abound with blood, and all things else consent, * 1.123 it shall bee good to draw blood by opening a veine; for phlebotomy e∣qually evacuates all humors; therefore the falling downe of the humors into the part affected, is thereby hindered, or retarded. Verily I have knowne no speedier remedy to asswage the paine of inflammation, than blood-letting, being first made on the Basilica of the grieved side for revulsions sake; and then for evacuati∣on of the conjunct matter on the vena ischiadica, which is at the outside of the ankle, if the paine of the Sciatica be more on the outside; or else on the Sapheia, which is on * 1.124 the inside of the ankle, if the inner parts bee more pained. The quantity of blood which is to be drawne must be left to the judgement of the physitian, without whose advise I would attempt nothing in this case. Also acride glysters are good, if there be nothing which may hinder, as ulcers of the guts, or haemorrhoids. ℞. rad. acor. ℥ ii. centaur. rut. salv. rorism. calam. origan. puleg. an. m ss. staechad. arabic. flo. cham. melil. aneth. an. p i. sem. anis. & foenic. an. ℥ ss. fiat decoctio ad lb. i. in colatura dissolve hierae & diaphen. an. ℥ ss. mellis anthos. sacch. rub. an. ℥ i. olei liliorum ℥ iii. fiat clyster. Strong purgations are also here usefull, as of pillul. foetid. arthritic. Assai••reth. de Hermodactilis, and others used in phlegmaticke causes. Electuarium Diacar••hami * 1.125 purgeth choller and phlegme. Often vomitings doe not onely evacuate the hu∣mors, but also make revulsion, as wee have formerly delivered. Bathes and sweates profit no otherwise than a decoction of guajacum or sarsaparilla. If heat molest the part, then foment it with oile of roses and vinegar, especially if the paine be deepe in, for vinegar by its tenuity pierceth to the bottome, and makes way for the oile, which of its owne nature is anodyne. After the use of generall medicines you shall apply attractive and resolving things: emplasters of pitch and sulphur, or of Ammo∣niacum, euphorbium, Terebinthina, Propolis, Galbanum, Bdelium, Opopanax, draw the humour from within to the surface or skinne. As in like sort also the chymicall oile of sage, rosemary, pellitory of Spaine, and such other like doe the same, which by reason of the tenuity of their substance, and their separation from earthy impuri∣ty, have farre more powerfull and expedite faculties to penetrate and discusse. Yet must you use none of all these without very good judgment and deliberation, other-wise there will be danger of inflammation.

There may also be made somentations of discussing and resolving herbes, as the rootes and leaves of dane-weeds, orris, Bay and Juniper berries, the seeds of faenu∣greeke, anise, fennell, the leaves of sage, rosemary, chamomile, melilote, elder, and the like, boyled in wine and oyle: the following plaster is much commended by the antients to digest, or resolve and asswage the paine, with this which drawes forth thornes, splinters, and rotten bones. ℞. sem. 〈◊〉〈◊〉. mundat. spumaborac▪ salis •…•…∣moniaci,

rad. aristoloch. rotund. colocynth. terebinth. venet. an. ʒ x. foenug. piperis longi, xylobalsam. thur. myrrhae, adipis cap. gum. pini, an. ʒ v. cerae, lb. ss. lactis ficus sylv. ℥ ss. ex omnibus secundum artem praeparatis cum olei liliorum, & vini generosi quantitat. suf∣f••ciente, fiat emplastrum. Let it be applyed to the Hippe. Or, ℞. sinapi acerrimo aceto dissoluti, ℥ ii. fermenti acris, ℥ ss. pul. hermodact. ʒ ii. mellis com. ℥ iii. tereb. ℥ iv. olei laur. & de spicâ, an. ℥ ii. far. foenug. ℥ i ss. terrae formicarum cum ovis, lb i. fol. laur. salv. rut. rorismarin. an. m. ss. vermium terrest. praepar. lb ss. The earth with the egges and wormes shall be boyled apart with the white wine, and herbes cut in pieces, and these being strained out, the rest of the things shall bee added according to art, and then it shall be applyed to the Hippe. Or else, ℞. rad. enul. camp. sigil. salom. bryon. bismal. an. ℥ ii. coquantur complete & terantur, trajiciantur per setaceum, addendo farin. foenug. & hordei, an. ℥ i. olei liliorum, & chamaem. an. ℥ iii. tereb. ℥ iv. cerae quantum sufficit, fi∣at cataplasma. It resolves, asswageth pain, and calleth forth the humours to the skin. Or else, ℞. rad. sigil. beatae Mariae, ℥ vi. empl. diachyl. albi, ʒ iv. croci in aqua vitae dissoluti, ʒ ii. terebinth. ℥ i. ol. de spica nardi quantum sufficit, fiat empl. Let it be spread upon leather and applyed warme. I have oftentimes suddenly asswaged the paine of the sciatica by putting to the pained Hip the root of black Bryony cut into slices, * 1.126 and applyed, when the matter was cold. Or else, ℞. cerae citrin. & tereb. abiet. an. ℥ ii. liquefiant simul in vase duplici, & ubi refrixerint, adde pulv. Hermodact. ℥ ss. flor. cha∣maem. irid. flor. an. ʒ iii. spicae nardi, flor. thymi, an. ʒ ii. interioris cinamomi elect. & semin. nasturt. an. ʒ ii. croci, ℈ iv. malaxantur simul manibus axungia porciveterenon salita unctis, & fiat massa empl. But if the paine be not by this meanes asswaged, then must we come to more powerfull medicines, as to use great Cupping Glasses apply∣ed with much flame, and to vesicatories. As, ℞. cantharid. quibus detractae sunt alae, ʒ ii. * 1.127 staphisagr. ʒ iii. sinapi, ʒ i ss fermenti acerrimi ℥ ss. incorporentur simul, & fiat vesicato∣rium. Also blisters may be raised by applying the inner rinde of Travailers joy to * 1.128 the wait of some two drammes, a little beneath the grieved part: you must have a care that the ulcers that remaine after the skinne of the blisters is taken off, doe run, & be kept open for some time after, that so more of the humor conteined in the part may bee drawne away. But if wee cannot availe by these means, we must according to Hippocrates his counsaile, come to the last and extremest temedy. Such (saith he) * 1.129 as troubled with a long paine of the sciatica, have their Hippe fall out of joint, their leg consumes, & they become lame unlesse they be burnt: we have also read the same approved by Celsus. It is the last (saith he) and most effectuall medicine in longer dis∣eases, to cauterize with hot irons the skinne of the Hippe in three or foure places; * 1.130 and then not to heale up these ulcers or fontenels as soone as may be, but to keepe them open by putting thereinto bullets of gold, or silver, or pills of Gentian, or waxe melted and wrought up with the powder of vitrioll, mercurie, and the like ca∣thaeretickes untill the affect against which we use this remedy be helped, for by this meanes many have bin helped. Therefore three or foure actuall cauteries, or hot i∣rons shall be so thrust in about the joint of the Hip, that they may enter into the flesh some fingers breadth, yet so that you shun the nerves. Cauteryes here doe good, for * 1.131 that by heating the part, they heate and dissolve the cold humours, they cut, attenu∣ate, and draw forth the grosse and viscide, so that they flow out by the ulcers, to∣gether with the quitture. Over and besides, the ligaments are strengthened by their cicatrization, and their loosenesse helped; & by this meanes the whole part is nota∣bly corroberated.

CHAP. XXIIII. Of the flatulent convulsion, or convulsive contraction, which is common∣ly called by the French, Goute Grampe, and by the English, the Crampe.

THat which the French call Goute grampe, wee heare intend to treat of, in∣duced thereto rather by the affinity of the name, than of the thing, * 1.132 for if one speake truly, it is a certaine kinde of convulsion generated by a flatulent matter, by the violence of whose running downe or motion, oft-times the necke, armes, and legs are either extended, or contracted into themselves with great paine, but that for a short time. The cause thereof is a grosse and tough vapor, insinuating it selfe into the branches of the nerves, and the * 1.133 membranes of the muscles. It takes one on the night, rather than on the day, for that then the heat and spirits usually retire themselves into the entrailes and center of the body; whence it is that flatulencies may bee generated, which will fill up, distend and pull the part whereinto they runne, just as wee see lute-strings are ex∣tended. This affect often takes such as swimme in cold water, & causeth many to be drowned, though excellent swimmers, their members by this means being so strait∣ly * 1.134 contracted, that they cannot by any meanes be extended. For the skin by the cold∣nesse of the water is contracted and condensed, and the pores therof shut, so that the engendered flatulencies have no passage forth. Such as give themselves to drunken∣nesse and gluttony, or sloth and idlenesse, are usually more frequently troubled with this disease, by reason of their heaping up of crudities. Therefore it is cured by mo∣derate diet, and ordering of the body, and exercise of each part therof, for thus they * 1.135 gather strength, and the generation of the flatulent matter is hindered. In the very time when it takes one, the patient shall bee cured by long rubbing with warme clothes, and aqua vitae, wherein the leaves of sage, rosemary, time, savory, lavander, cloves, ginger, and the like discussing and resolving things, have beene infused. The extension and flexion of the members or joints, and walking, are also good.

The End of the Eighteenth Booke.

Notes

• * 1.1

  What it is.
• * 1.2

  Particular gouts.
• * 1.3

  Lib. 12. Cap. 12.
• * 1.4

  The resem∣blance of the Goat to the Epilepsie.
• * 1.5

  The strange variety of the Gout.
• * 1.6

  Lib. 3. sect. 22. tract. 2. cap. 3.
• * 1.7

  Lib. de ther. ad Pisonem c. 15.
• * 1.8

  The matter of the gout par∣takes of occult malignity.
• * 1.9

  A historie.
• * 1.10

  A terrible fit.
• * 1.11

  How an Epilep∣tick fit differs from the gout.
• * 1.12

  The first primi∣tive cause of the gout.
• * 1.13

  Lib. de aëre, loc. & aqua. Lib. 1. cap. 17.
• * 1.14

  Li. 3. feu. 22. tract. 2. cap. 5. Another primi∣tive cause of the gout.
• * 1.15

  Aph. 29. Sect. 6.
• * 1.16

  The antecedent cause of the gout.
• * 1.17

  The conjunct.
• * 1.18

  Five causes of the paine of the gout.
• * 1.19

  What and how the matter of the gout comes downe from the braine.
• * 1.20

  Gout by con∣gestion.
• * 1.21

  When the gout which proceeds from the de∣fault of the li∣ver, assimulates the nature of an oedema.
• * 1.22

  Why the gout seldome pro∣ceeds from me∣lancholy.
• * 1.23

  The gout fre∣quent in the Spring & Fall. What gout un∣curable.
• * 1.24

  Gal••und aphor. 49. Sect. 〈◊〉〈◊〉.
• * 1.25

  Why the Scia∣tica causeth lamenesse.
• * 1.26

  Three causes of the lamenesse or decay of the limoes.
• * 1.27

  How the gout turnes into the palsie.
• * 1.28

  Why the gout takes one in winter and the midst of sum∣mer.
• * 1.29

  Why such as have the gout upon them, doe oft-times desire Venery.
• * 1.30

  Venery hurtfull in the gout.
• * 1.31

  Aph. 30. Sect. 6.
• * 1.32

  Two generall scopes of cuting the gout.
• * 1.33

  Whence bloud must be let in the gout.
• * 1.34

  What gouty persons find no benefit by phle∣botomy.
• * 1.35

  In what gout di∣et proves more effectuall than medicin••s.
• * 1.36

  Aphor. 55. Sect. 6.
• * 1.37

  To what gout vomiting is to be used.
• * 1.38

  What time the ••ittest therefore.
• * 1.39

  A history.
• * 1.40

  How to make one vomit easily.
• * 1.41

  Lib. de••rat. victis.
• * 1.42

  How Diure∣ticks are good for the gout.
• * 1.43

  Issues or ••on∣••anels.
• * 1.44

  Where to be made.
• * 1.45

  An actuall cautery.
• * 1.46

  Pills.
• * 1.47

  Common pills with the addi∣tion of scamo∣ny.
• * 1.48

  Treacle, how usefull in the gout.
• * 1.49

  Cephalick fu∣migation.
• * 1.50

  Cephalicke bagges
• * 1.51

  A masticatory.
• * 1.52

  The fault of the first con∣coction, is not amended in the alter.
• * 1.53

  Capons subject to the Gout.
• * 1.54

  Cholericke per∣son cannot a∣way with long fasting.
• * 1.55

  Phlegmaticke bodies infasting feed upon themselves.
• * 1.56

  White wine not good for the gout.
• * 1.57

  Claret may be the safelier drunke.
• * 1.58

  Hydrom•• most safely.
• * 1.59

  A 〈◊〉〈◊〉∣〈◊〉〈◊〉.
• * 1.60

  A•…•… ••tation to strengthen the joints.
• * 1.61

  The juice of hawes with oxy∣crate.
• * 1.62

  Bagges.
• * 1.63

  The scopes of curing
• * 1.64

  Repercussives not to be used in the scīatica. The palliative cure performed by foure scopes.
• * 1.65

  An argument taken from that which helpeth, or gi∣veth ease, is not alwaies, certaine. How cold dis∣eases may be helped by cold, and hot by hot medi∣cines. The first thing that may de∣ceive a Physi∣cian.
• * 1.66

  The second.
• * 1.67

  The third.
• * 1.68

  The fourth.
• * 1.69

  The third.
• * 1.70

  The six••.
• * 1.71

  Why strong purges must bee given to such as have the gout.
• * 1.72

  That judge∣ment most cer∣tain which rests upon multipli∣city of signes.
• * 1.73

  Why we must use purging and bleeding in the gout.
• * 1.74

  Lib. de affect. ubi de Arthri••. loqui∣tur. Ad••ph. 23. sect. 1. Lib. decur. per 〈◊〉〈◊〉. missionem.
• * 1.75

  It is not safe to use repercus∣sives in the gout before purging.
• * 1.76

  An astringent Cataplasme.
• * 1.77

  A discussing fo∣mentation.
• * 1.78

  One partly a∣stringent and partly discus∣sing.
• * 1.79

  Why the gouty humour doth not presently vanish upon the use of reper∣cussiv••s. Greater dis∣cussers.
• * 1.80

  A Cataplasune good for any gout at any time.
• * 1.81

  Discussing em∣plasters.
• * 1.82

  Ointments.
• * 1.83

  Discussing fo∣mentations.
• * 1.84

  Remedies must be often chan∣ged in the gout.
• * 1.85

  A great dis∣cusser.
• * 1.86

  An anodine.
• * 1.87

  A vesicatory a∣gainst the con∣tumacy of the conjunct mat∣ter.
• * 1.88

  What repercus∣sives are here required.
• * 1.89

  An excellent astringent ca∣taplasme.
• * 1.90

  Lib. 22. cap. 25.
• * 1.91

  Phlebotomy to evacuate the conjunct mat∣ter, and asswage paine.
• * 1.92

  What repercus∣sives are here required.
• * 1.93

  A cerate with opium.
• * 1.94

  ••he water of Snailes.
• * 1.95

  A histori••.
• * 1.96

  A particular s••ove.
• * 1.97

  An ointment of the juice of Dane-wurt.
• * 1.98

  When to use narcoticks.
• * 1.99

  A cataplasme with opium.
• * 1.100

  How to amend the harm done by narcoticks.
• * 1.101

  Dicussers.
• * 1.102

  A meane to be used in discus∣sing.
• * 1.103

  Bathes asswage the paine of the gout.
• * 1.104

  How meats of grosse juice are profitable.
• * 1.105

  A historie.
• * 1.106

  〈…〉〈…〉 p••••p. 10. sect. 5.
• * 1.107

  Divers r••••e∣dies or paine arising from a cold distemper without matter.
• * 1.108

  A fuliginous vapour some∣times the cause of the gout.
• * 1.109

  How to streng∣then the joints.
• * 1.110

  Remedies for the weaknesse left in the joints after the paine is gone.
• * 1.111

  The benefit of a dog-skinne stocking.
• * 1.112

  Whence the to∣phi are gene∣rated.
• * 1.113

  The unfit appli∣cation of discus∣sive & re percus∣sive medicines cause the tophi.
• * 1.114

  Mollifying medicines.
• * 1.115

  Lib. 10. simp. c. 7 sc. 22. lib. 3. tract. 2. cap. 21.
• * 1.116

  An effectuall ••umigation.
• * 1.117

  In what joints flatulencies are chiesly genera∣ted. Signes of flatu∣lencies.
• * 1.118

  How flatulen∣cies may make you beleeve there is p••s or matter.
• * 1.119

  Why hard to cure.
• * 1.120

  Why it hath the most grie∣vous symp∣tomes.
• * 1.121

  The cause of the large sprea∣ding of the paine.
• * 1.122

  The thighbone often dislocated by the Sciatica.
• * 1.123

  Why we must open a veine in the Sciatica.
• * 1.124

  When the vena ischiadica and sapheia must be opened in the sciatica.
• * 1.125

  Strong purgati∣ons in the sci∣a••ica.
• * 1.126

  Blacke bryony discusseth.
• * 1.127

  A strong vesica∣tory.
• * 1.128

  The inner rinde of Travellers∣joy a vesicato∣ry.
• * 1.129

  Aph. ult. sect. 6.
• * 1.130

  Lib. 4. cap. 22.
• * 1.131

  The use of cauteries in the sciatica.
• * 1.132

  What the Cr••mp is.
• * 1.133

  The cause thereof.
• * 1.134

  Who subject thereto.
• * 1.135

  The cure.