CHAP. IX. The general method of preventing and cureing the Gout.
THose who desire to prevent the Gout, must not glut themselves with meat, must be quick to labor, and abstain from wine and venerie,* 1.1 or certainly must not use them unless for their healths sake, must vomit and purge at certain times. Hippocrates writes, that bodies are not troubled with the Gout before the use of venerie. Yet at this day many Eunuchs are seen to have the Gout, but especially those who abound with idleness and pleasure; yet these we have heretofore mentioned are very effectual, not only for the prevention, but also for the cure of the present disease. Yet we must diligently distinguish the causes, what they be, and whence they may proceed, and oppose thereto remedies contrary in quantity and quality. There are absolute∣ly three distinct causes of the Gout: A tainture from the parents;* 1.2 a corruption of the humors by dyet and air; a native, or adventitious weakness of the joints. Against these there is a twofold in∣dication: the first is the evacuation and alteration of the peccant humors, the other the strengthe∣ning of the weak joints. These two shall be performed by diet conveniently appointed, purging, blood-letting, provocation of the hemorrhoids, courses, vomit, sweat, urine, and fit application of local medicines. Therefore, when the time shall come, wherein the Gout accustometh to re∣turn by course, the patient shall have a care of himself by a diligent manner of diet, he shall lessen the matter of the disease by phlebotomie (if that the Gout shall arise from the blood) from the opposite part, that by the same means revulsion and evacuation may be made;* 1.3 as if the upper parts be inflamed, blood shall be drawn from the lower; if on the contrary the lower, out of the up∣per, alwaies observing the straightness of the fibres. Thus the right arm being troubled with a gouty inflammation, the Sapheia of the right leg shall be opened, and so on the contrary; but if this general blood-letting being premised, the pain shall not cease, it will be requisite to open the vein next to the pain, which I have often performed with happy success.
Yet phlebotomie hath not the like effect in all,* 1.4 for it is not availeable to such as are continual∣ly and uncertainly troubled with gouty pains, or whose bodies are weak and cold, wherein phlegm only is predominant. We may say the same of purging, for though it be oft-times necessarie, yet too frequently re-iterated, it proves hurtful; furthermore, neither of these remedies is usually ve∣ry profitable to such as observe no order in meat & drink, which use venerie too intemperately, who abound with crude and contumacious humors, whose joints by long vexation of the disease, have contracted an hectick distemper and weakness, so that they are departed from their natural constitution, and suffer a great change of their proper substance.* 1.5 Wherefore as often as these greater remedies shall be used, a Physician shall be called, who according to his judgment may de∣termine thereof. For oft-times diet proveth more available then medicines: therefore the patient (if the matter of the Gout be hot) shall either drink no wine at all, or else very much allaied, that is, as much as his custom and the constitution of his stomach can endure. A fit time for purging and bleeding is the Spring and Autumnn, because, according to the opinion of Hippocrates,* 1.6 Gouts reign chiefly in these seasons; in Autum, for that the heat of the precedent Summer debilitateth the digestive faculty, the native heat being dissipated: as also the eating of summer-fruits hath heaped up plenty of crude humors in the body, which easily flow down into the passages of the joints opened and dilated by the Summers heat: add hereunto, that the inequality or variable∣ness of Autumn weakneth all nervous parts, and consequently the joints. But in the Spring, for that the humors forced inward, by the coldness of the Winter, are drawn forth from the centre to the circumference of the body, and being attenuated, fall into the joints upon a very small occasi∣on, therefore there is great both necessitie and opportunity for evacuation, which if it shall not avert the accustomed fit, yet it will make it more gentle and easie.