Praxis medicinæ reformata: = or, The practice of physick reformed Being an epitome of the whole art: wherein is briefly shewed, the true causes, signs, prognosticks, and cure, of most diseases. Published for the benefit of all persons. By Robert Johnson, Med. Professor.

CHAP. XVIII. Of the Gout, and Rheumatism.

THE Gout is called in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 ab 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Articulus, quod Articulos infestet; hence it is called in Latin Articularis morbus, it being a Disease of the Joints.

This is a general Name for all Gouts, or when all or most of the Joints are affected.

But when any particular Joint is infested with a Gouty distemper, it doth from thence take its denomination.

For if it invadeth the Jaw-bones, it may be called in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 maxilla, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 soevio, quod maxillarum usum im∣pediat. It being (for the most part) ac∣companied with a fierce and cruel Pain.

And so likewise if it invade any of the rest of the Joints.

If the Vertebroe of the Neck, &c. be affected, it may be termed 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 collum, vel cervix, &c.

That which molests the Shoulders, may be fitly called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 humerus. &c.

If it affects the Collar-bones, you may call it 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 clavis, vel clavicula, &c.

That in the Elbow may be termed 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 cubitus, &c.

The Gout in the Hand is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 manus, &c.

That in the Hip may be called in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ab 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 coxa, &c. quod ab 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 lumbus.

In Latin Coxendicum dolor, quod coxendices proecipue infestat.

If it be in the Knee 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 genu, &c. If in the Foot 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 pes, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 soevio, Quod pedum usum impediat, which may be added to every particular.

This and all other Gouts are most com∣monly accompanied with a fierce, cruel, tor∣menting pain; and thus much, if not too much of the Names of the Gout.

The Causes are either external, or inter∣nal.

The external Causes are Gluttony, Drun∣kenness, immoderate Venery, Idleness, ex∣ternal Cold, and excess or defect of any of the non-naturals.

The internal Cause of all Arthritick pains, is the Juice of the Pancreas too acid and sharp, which raiseth a vitious Effervescency with Choler, &c. whereby a Fermental sharp∣ness is increased; and when it is exorbi∣tant, it is sent forth into the extreme parts, and meeting with that seedy Glue, which is between the Joints, doth not onely affect it with its fermental Acrimony, but is also the grand Cause of the virulent tormenting pain and inflammation in the part affected.

But seeing the pains are different, not one∣ly in divers People sick of this Distemper, but also the Pains of the Gout are divers in the same sick party, we must therefore, as well by reason as experience, search in∣to the true Cause thereof.

Therefore in as much as the present mo∣lesting pains, are not always freed with the same medicines, no not in the same fit; much less all that are Gouty.

We may hence consider that divers hu∣mours, as Choler, Phlegm, &c. are diversly mixt and fermented with the Juice of the Pancreas, which is peccant in a sour Acri∣mony, being the primary Cause of all Gouts.

And here we may note, that this over acid humour doth molest the sick (chiefly in the beginning of the fit) with a corroding pain; but after a while, when Choler (by its ex∣ceeding heat) hath gotten the Predominan∣cy, it causeth a divers burning pain, accor∣ding to the diversity of its faultiness.

But if viscous Phlegm be predominant, the pain is much dull'd, and the motion of the part hinder'd with a phlegmatick Tumour, rather than an acute pain; which ought to be accurately observ'd by every ingenious Artist.

When the Gouty humour hath invaded any joint, there is presently an unusual heat, and more exquisite sense in it, than formerly,

so that the least touch of any hard thing doth hurt the part; and the longer it continues, the more the Pain increaseth, with redness and swelling of the part affected, and most commonly attended with a Symptomatical Fever.

1. The Gout is a Chronical disease, atten∣ded with violent Pain, but is seldom mor∣tal, except in very weak Bodies that are much decay'd by Sickness, or old Age.

2. If it continue long, till the Joints are knotty, it is incurable, according to Ovid,

Tollere nodosam nescit medicina Podagram.

But if there be no Knots in the Joints, and the Patient is laborious, and the Body is (for the most part) soluble, and there be swelling of the Veins called Varices, then it may be happily cured.

3. If it becomes habitual to the sick, the morbifick Idea is implanted in the vital Spi∣rit, and transfer'd through the seed, which makes it Hereditary.

The Cure of the Gout will consist,

• 1. First in defending the afflicted Joints, as well against future Pain, as freeing them from that which doth molest at present.
• 2. In the universal amendment of the juice of the Pancreas.
• ...

• 3. In the correcting and evacuation of the vitious Choler.
• 4. In the altering and diminishing of Phlegm any way peccant.

To asswage the present Pain I commend the following Medicaments, which will conduce much to mitigate the sharpness of the acrimonious humours in all Gouty peo∣ple, and ease the part affected.

When there is excessive heat, you may bathe the Gouty part with this Fomentation very hot, with wollen Stuphs, which must be often renewed.

Take the Waters of the Spawn of Frogs, Fumitory, Elder, of each one quart; Vine∣gar of Mary-golds one pint; Opium, Cam∣phire, of each half an ounce; mix it accor∣ding to Art.

But when the Pain is more corroding than burning, I commend the following to be used as the former.

Take of Treacle-water half a pint; the Waters of the Spawn of Frogs, Parsley, of each one quart; Opium, Camphire, of each half an ounce; mix it.

After Bathing with either of these; apply this Cataplasm.

Take Powders of the Roots of Marsh∣mallows, Flax-seed, Barley-meal, of each four ounces; new Milk three pints; boil it to the Consistence of a Pultess, and add Oils

of Flax-seed, Earthworms, the Ointment Martiatum, of each three ounces: Camphire half an ounce; mix it according to Art.

Where exceeding heat doth concur, and the Body abounds with sharp Choler; instead of sweet Milk, you may substitute Butter∣milk.

Also a Pultess made of the Crums of White-bread, new Goats or Cows milk and Saffron, with Oil of Lin-seed, and Earth-worms, may be deservedly commended, to asswage any Pain.

If the sick be very phlegmatick, and im∣potency of motion doth afflict, more than pain; then Opiats may be omitted, and things more Aromatical may be used in all external Applications.

The following Pultess, or one like it, may serve for Example.

Take the Powders of Orris-roots; the Flowers of Chamomel, and Elder, Cum∣min-seeds, Barley-meal, of each four ounces; the Tops of Wormwood, Mints, of each four handfulls; boil them in two quarts of water of the Spawn of Frogs, to the Consistence of a Pultess; when it is almost cold, add Treacle-water, Oils of Chamomel, Earth-worms, of each three ounces; mix it.

Also the Root of Briony, and Cuckow∣pintle bruised, and made into a Pultess with Cow-dung is excellent.

If you add Volatile Salts of Animals, or Vegetables to your Medicines, whether Fomentations, Cataplasms, or Ointments, they will be the more effectual.

You may prepare an excellent Volatile Salt of Earth-worms (of great Virtue) for the Gout, which may be resolved into Li∣quour by fermentation, and putrefaction.

If the Gouty Patient do abound with Phlegm, or the Juice of the Pancreas exceed in an acid Acrimony causing a corroding Pain; it may happily be mitigated and re∣mov'd with Balsam of Sulphur made with Oil of Amber, with which let the grieved part be embrocated, and it will forthwith raise a very hot Effervescency, which will presently cease again, and remove the great Pain in a moment, even to admiration.

After the pain is over, you may apply one of the former Cataplasms, or some Anodyne Ointment, to comfort, and (by degrees) restore again the membranous parts.

The following Linament may serve for Example.

Take Oils of Earth-worms, Scurvigrass, Saint John's-wort, of each one ounce; Chy∣mical Oils of Rosemary, Rue, of each twenty drops; mix it.

Afterwards, you may apply a Plaster of De minio cum sapona.

In the mean time, inward means (to take away the Cause, and ease the pain) must not be neglected.

If the Patient have a plethorick Body, after a Stool hath been procured, by a Car∣minative Clyster, with Electuar. Caryocosti∣num, &c. Let a Vein be opened.

Bloud drawn from the Vena poplitis, or sciatica Vein, hath been succesfull in the sciatica.

But Leeches applied to the Hemorrhoidal veins, are effectual in all Gouts.

Two or three days after bleeding, you may administer the following Pills.

Take of Pills Hermodactils, faetidae, ex duobus, Mercur. dulcis, of each one scruple; mix it for two doses, and give them in the Morning fasting.

Or you may give half a drachm or two scruples of pul. Arthriticus in any convenient Vehicle.

But if the sick be inclining to vomit, ad∣minister an Antimonial Emetick.

You may purge and bleed so often as you see occasion.

Issues near the part affected, and also to raise Blisters upon the part, have been found by experience to be very effectual.

Also bathing and sweating in nitrous or sulphurous Baths, either natural or artifici∣al, are much approv'd of.

That which is prescrib'd in the Chapter of the Belly-ach, is very effectual, which may be used, as is there directed.

I might fill a Volume with receipts against the Gout, but I shall onely commend the following water or spirit to be often taken inwardly in any fit Vehicle, the quantity of half a spoonfull at a time.

Take the Roots of Orris, Angelica, Saffa∣phras, of each two ounces; the Tops of Ground-pine, Penny-royal, Sage, Mother of Time; the Flowers of Saint Johns-wort, Chamomel, Prim-roses, Rosemary, Laven∣der, of each three handfulls; the Berries of Bays and Juniper, of each one ounce; Castor two drachms; let them be all cleansed, brui∣sed and infused in six quarts of Spirit of Earth-worms compound for the space of twenty four hours, then distill it in an Alem∣bick according to Art.

The Rheumatism is called in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 fluo; it being a distillation of Rheumatick humours, not onely affecting the Joints, but the adjacent parts, yea some∣times the whole Body; especially the Mus∣cles, Membranes, and Periostium of the Thighs, Legs, and Hip-bones.

The humour is of a very malign Nature, and soon causeth a Cariosity of the Bones, if it be not prevented.

The Cause is the same with the Gout, but sharper.

'Tis seldom mortal, but may be of long continuance, with great Pain, so that the Sick cannot endure to be touched.

In the Cure of this Distemper, Phleboto∣my must be often repeated, and carmina∣tive Clysters often administred.

Foment the pained parts with stale Urine (made very hot) wherein Castle-sope is dissolved; after which anoint with this fol∣lowing.

Take Spirit of Salt Armoniack, Oils of Guiacum, Bricks, of each two ounces; in which dissolve Opium one ounce; Spanish Sope four ounces; then add Oil of Roses six ounces, and make it a Linament according to Art.

If you would have it for a Plaster, you may add so much Empl. de minio to it, as will give it a sufficient Consistency.

The Medicines and Directions prescrib'd in the Cure of the Gout, are also proper here.

From these few observations, it will not be very difficult to select other choice Me∣dicines out of the writings of Practitioners, to cure both the Gout and Rheumatism.

To prevent a Relapse, purge and bleed Spring and Fall, and keep a good Diet, and use moderation in all things.

I have now finisht this little Tract, or Ma∣nual of Physick, which I have written for the common good; not onely to serve young Beginners of the Art of Physick, but also for the sake of the sick themselves.

GOD grant that it may prove succesfull, and tend to the good of them both.

Now unto the onely wise God and our Saviour Jesus Christ with the Holy Ghost our Comfor∣ter; three Persons, and one God, be ascribed, and given all Laud, Honour, Glory and Domi∣nion, from this time forth, and for evermore.

Notes

• Arthritis.
• Causes.
• Observa∣tio.
• Signs.
• Progn.
• Cure.
• Fomenta∣tion.
• Pultess.
• Cata∣plasm.
• Linament.
• Purging Pills.
• Water a∣gainst the Gout.
• Rheuma∣tismus.
• Cause.
• Progn.
• Cure.
• Linament.