OBSERVATION XCIII. The Gout.
MR. Hamilton, in the Flower of his Age, was miserably tormen∣ted with the Gout, in the Joynt of his Right-shoulder; so that he had not slept in three Days and Nights. After I had prescrib∣ed him a proper Diet, I purged him with Cochia Pills, gave him a Diure∣tic Decoction for some days, and then applied this Plaister to the place affected.
℞. Gum. Galbanum dissolved in Spirit of Wine, Tacamahacca dissolved in Spirit of Turpentine, Emplaster of Oxycroceum, an. ℥s. Mix them and spread them upon Leather
This Plaster stuck on eight days, within which time that immense Pain went off, so that he could freely move his Arm; after that, he return∣ed to the Camp, where he was unfortunately slain.
ANNOTATIONS.
MAny Disputes there are about the Causes of the Gout; but for my part, I believe there are necessarily two. For either those Pains proceed from cold Defluxions, mixed with some Salt and Acrimony, falling from the Head upon the Joynts, refrigerating and cor∣roding the Nerves, Tendons and Liga∣ments, annexed to the Joynts. For how great an Enemy Cold is to the Nerves and membranous Parts, we find in Winter-time, by the Wounds by which those Parts are laid bare. There, says Hippocrates, all cold things are fatal to the Nerves. Besides, that such De∣fluxions cause Weakness and Stiffness of the Nerves, or too much Relaxati∣on; so that being oppressed with weight, they are extended with Pains; but this sort of Gout is not so terrible. For the second Cause of the Gout proceeds from the salt, sharp and tartarous Humors, separated from the Blood, and thrust forward upon the Joynts. Therefore, says Sennertus, I must conclude, that a sharp, salt, subtil Humor, nearest to the Nature of salt Spirits, is the Cause of the Gout. Let any Man call it by what other Name he please, Choler, or Flegm mixed with Choler, Salt or Tartar, so the thing be rightly understood.
In vain therefore Physicians have hi∣therto sought, for the Cause of the Gout in the Heat and Drougth of Cho∣ler, or the Moisture and Cold of Flegm, for they are not the first but the second Qualities which induce those Pains; that is, the Salt and the Acrimony which corrode and gnaw those Parts. Therefore, says Hippocrates, 'tis not hot, cold, moist and dry, that have the act∣ing Power, but bitter and salt, sweet and acid, insipid and sharp, which if rightly tempered together, are no way troublesome, but when alone and separated one from the other, then they give the Vexation and shew themselves, &c.
In the Cure of the first, in regard the Cause proceeds from a depraved Dispo∣sition of the Brain; therefore the Brain is to be evacuated and corroborated, to prevent these Excrements from gather∣ing any more in that place. The Parts affected also are to be corroborated with Topics, warming the Parts, dissipating and drying up the crude Humors.
In the Cure of the hot Gout, the salt Humors are to be evacuated and purged away by inward Medicaments, before they be pushed forward into the Joynts, and that their Generation may be prevented. Topics also must be made use of to temper the Acrimony of the salt Humors, to dissolve, dissi∣pate and evacuate by transpiration, those Humors; the Forms of which, I shall give in another place.