Arthritology: OR, A DISCOURSE OF THE GOUT. Written by JOHN GROENEVELT, M. D. One of the College of Physicians.  
LONDON: Printed for the Author. MDCXCI.   

TO THE READER.  
ALL improvements in arts have ever been alike obnoxious, to the fate of either being slighted by the injudicious, or frowned upon by the censorious; till being crowned with success, their manifest advantages have forced mankind to a liking of, and compliance with the undertaking.  
And though Physic is more than the rest capable of improvement, as it's daily advance doth sufficiently manifest: yet being likewise daily sullied by the vain pretences of the ignorant, 'tis no wonder, if even the judicious themselves look somewhat strangely upon what is beyond the common method of practice.  
But every thing that seems new ought not therefore to be rejected; since, if it be verified by experience, it bears date with time and truth itself: the limits of art and nature not being of so narrow a compass as our present knowledge. And though it be far from me to imagine my skill and judgement to be above that of other Physicians, however my university, and collegiate qualifications, will (I hope) sufficiently exempt me, from being accounted only a pretender to what I profess.  
Yet having (besides the other parts of Physic) chiefly employed my time and studies, in order to the cure of the Stone; wherein what success I have had, both by inward remedies and manual operation, this famous city can sufficiently evidence; and finding the Gout to be equally tormenting, if not as pernicious a disease, and altogether of the same origine, 'tis no wonder if the proximity of the subject bent my endeavours that way.  
Now having by the blessing of GOD attained, to a seldom failing method for the cure of, and preservation from that disease: I submit my endeavours to your candid reception, referring you for your further satisfaction, to the ensuing treatise, and a continued success by experience.   

Arthritology: OR, A DISCOURSE OF THE GOUT.  
THE body of man contains in it blood, phlegm, and a twofold bile, to wit, yellow and black, of which the nature of this body is constituted, upon account whereof also it is sick, and enjoys health, Hipp. de Naturâ Hominis, Text nineteen, & sequ. Yet not these humours alone do affect the body, but the qualities of the humours are in a possibility to affect it; such as, a bitter, a salt, an acid, and other things both within a man, and out of a man; and these qualities indeed through a mixtion, and mutual temperament among themselves, are neither discerned, nor create any man trouble: but when any one of these is divided or separated from the rest, and exists by itself, than it is clear and plainly evident, how great trouble and pain it creates a man.  
The salt in our body, the salt, I say, and acrid, which was diuted with a thin insipid, or water, as soon as ever it is separated, and falls upon the sensible parts about the joints, there it presently excites pain, first of all by twitching and pricking them, and not long after by pressing and distending them with its abundance. As this salt likewise is more or less sharp or vehement, the pains also do much vary, that is, do increase or abate. And this salt is lodged in the serum, which that it is acid, or that an acid adheres to it, cannot be denied.  
There is moreover in the serum of our body a certain thicker matter, which we may call the terrene feculency, of which nodes are chiefly generated. This one thing also we do over and above maintain, that there is something of a thicker salt in the serum itself, which joined by some of the terrene blood out of the rest of the mass, will much alter the nature of the Gout, in respect of pain, heat, and duration, as to degree, or violence, or gentleness. Besides, this salt serum is contained about the extremities of the muscles, tendons, ligaments, periostea, and the other nervous parts of the joints, in which places also nodes and stones are usually bred.  
Moreover, as long as the use of things none natural is moderate, all goes well; but when the body is pampered with more plenty than is needful, the particles of the blood are not so exactly mixed with the rest of the mass, but are blended and confounded as heterogeneous; whereupon, sanguification once vitiated, the blood is usually corrupted by divers humours, and the non-natural heat grows so high, that it is forced to undergo a fermentation, like new beer, and it works so much more than usual, that it seems to boil: than it forces those sharp and foreign juices, together with part of the serum, by what way it finds; what gets into the guts is evacuated by a watery looseness; what into the kidneys, by plenty of urine; what into the habit of the body, by the pores of the skin: but what falls upon the joints, pierceth into the inmost recesses and interstices of the nervous parts, which being beset round with dense and cold parts, use to stop and retain the serum. This Serum at first is very small, but thin and sharp, producing pain only deep within, and a swelling without; yet the violence of the pain continuing, greater store of serum, and very often a flood of other humours with it, supervenes, so that at last the swelling appears, which in a plethoric body by its redness, heat, and throbbing pain resembles an angry boil: and when this humour is spent, that fit of the Gout is at an end.  
And the nature of this disease is such, that when it has once seized a man (unless by the care and industry of Physicians prevented, especially by such as are well experienced in this affair) scarce any one can look so well to himself, but that at certain seasons and distances of time it will return, when the matter is increased afresh, and gathered to the joints again; which distances in the beginning are longer, and when the mass of blood is vitiated, and the joints weakened, become shorter, so that they confine some people perpetually to their bed, and render the joints stiff and knotty.  
It remains now to inquire, what the causes of the serous matter in the blood are, and then what moves it first, and causes the fit; the first our Schools call Antecedent, the latter, Procatarctick causes. Hypocrates in his Book de prisca Medicina teacheth, how that Salts, Acids, Sweets, and abundance of other such things, which are in us, have divers faculties according to their plenty and power; but do no way molest us, when they are mixed and mutually tempered one with another.  
This mixture and temper is often dissolved in the mass of blood, when the humours are augmented in plenty or power, or in both. Omitting other humours, in the foregoing discourse, we have only mentioned the serum, to which in the further disquisition hereof we will confine ourselves, and do say, that sometimes the evacuation of this serum is hindered, and sometimes too great plenty of serum is bred. The necessary evacuation of the serum is hindered, when some vicious matter is impacted in the very glands, whence it comes to pass, that either the sensible or insensible transpiration of our body is insufficient, as it happens in idleness, melancholy, stopping of sweat, and overcooling the body.  
Moreover the necessary evacaution of this serum is hindered, when people are costive, and make but a little urine and thin, such as contains not in itself enough of salt and sediment.  
For the alimentary and sweet portion of what we eat and drink, cannot be wholly converted into the substance of our body, but even this has some excrements: So that the Succus 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, the imperfect and violent juice, which is the other part of our aliment, (according to Hypocrates) ought not to be wholly mixed with the blood, but the greatest share of it should be purged out by stool and urine (whence it may be drawn by distillation). Now if for the causes aforesaid the evacuation of the sharp serum be checked, as it increases first in plenty, and then in power, it is separated from the other parts; and so it affords matter for the Gout.  
Now we proceed to the second, that is, to the more plentiful generation of serum; here we do not mean the supply of the watery part, but of the acrid and salt, or a certain hereditary inclination to the Gout, (derived from the seed and maternal blood) which seems to consist in a weakness of the joints, and especially in some innate fault of the blood. Then there is an adscititious disposition of the body, induced partly by the frequent invasion of the fit partly by the manner of living, such as is in them, who though they use their utmost diligence, cannot guard themselves from the return of this grief.  
Which indeed happens for divers causes, hereafter to be mentioned, namely, through the weakness of the parts about the joints; through pains, whereby many fibres of the nervous parts are broke; from a frequent influx of humours, whereby the parts are relaxed and softened; through unreasonable heat or cold; from violent motion, as it happens in Venery; and finally, when a vicious sanguification is contracted, whereby the acrid matter is continually bred in the blood.  
Such meats and drink should be taken notice of, as have in them a sharp matter in such plenty and power, as not being to be conquered with the other juices in our body, it can neither be sufficiently separated nor discharged, nor can it be exactly mixed or tempered with the other juices.  
Such as are generous Wines, which have much Tartar in them; for not only that Tartar, but the spirit also breeds the Gout, which consists of an oil, an acid and a volatile salt, from whence the Wine receives all its strength.  
Moreover, gluttony and drunkenness contribute much to the breeding of this humour; all intemperance likewise in dainty meat and drink, over hard study, especially in the night, which in this case is the most dangerous; and afflicting cares; all these hinder sanguification, so that the sharp part in the aliment is either not well mixed, or not well separated; and above all immoderate Venus is the most dangerous and hurtful.  
But if any doubt arise, and the question be, what way it hurts, it may properly be replied, that Hypocrates his assertion is of undoubted truth; there is in us a salt and a sharp: Now I think this is rendered more efficacious by the use of Venery, so that at first it is augmented not so much in plenty as in power; for what is sweet or fat in the blood, is consumed partly with the spirits, partly with the seed, and what remains is more and more exasperated, and so existing more apart, it acquires strength and does harm.  
This matter being augmented and gathered by the foresaid causes, is moved, not always by the proper impulse of nature, but often as it is stimulated by several evident causes; such as are able either to impress an impulse on the blood, or to quicken its internal motion or fermentation, violent passions of the mind, especially anger and fear, sudden cold and heat, retention of accustomed sweat, some seasons of the year, especially Spring and Autumn, and as we said before, gluttony and Venery.  
The causes of this disease being now explained, we lay down this definition of the Gout:  
The Gout is a violent pain of the parts about the joints, caused by a serous and sharp humour, suddenly coming out of the Vessels.  
Sometimes wand'ring pains foretell the Gout to be coming, especially in the joints of the feet or hands: that it is at hand, stretching, yawning, painful weariness, catarrhs, wand'ring pains in the limbs and joints, and sometimes a heaviness in the head do show: a kind of feverish heat, a pricking pain in the joint, with inability to move, and after that a swelling usually red, which are attended by divers other things, as watching, loss of strength, and several other complaints familiar to gouty persons, show it to be present.  
The Gout ends either in the translation of the matter to a more ignoble part, or in the discussion of it, or when, being changed into corruption, it breaks through the skin, or when, tarrying long there, it turns knotty: All which come to pass, sometimes by the assistance of nature, sometimes of art.  
For there is a twofold design in the artificial cure; First, to remove that which aggravates the paroxysm; Secondly, to preserve the patient from the return of it. In the fit three things are urgent, pain, the swelling and inability to move; of all which since an humour is the cause, partly still coming in, partly got in already; so the whole method of cure consists in two things; first in hindering the influx of the humour; secondly in expelling the humour that is got in.  
Which method of cure is often interrupted by some grievous pain or by some other urgent symptom.  
The influx may be checked by repelling the humour from the joint, or by stopping its motion, or by expelling it out of the Body.  
Repulsion, whereby the humour is driven from the part affected, may be made either by strong ligatures, or by application of coolers and astringents.  
The Repulsion of this humour in the beginning is very dangerous, because the repulsed humour may run either into another joint, or into some more noble part, or being impacted into the inner recesses of the parts about the joint, it may increase the pain.  
The motion of the humour, which depends upon a certain inevitable agitation of the heterogenous humours, cannot of itself be stopped; yet it may be abated by evacuating some part of the mass of blood (if nothing hinder) by venaesection; whereupon the quantity of the humours being lessened, the heat of the blood, and the violence of the peccant matter, may both be stopped in some measure.  
The evacuation of the humour, which does offend, (if this humour could altogether be evacuated,) would prove a most effectual remedy against its running into the joints.  
Now this evacuation is made by vomits and sweats. Vomits and purges may either follow blood-letting, or they may serve instead of it, without any previous preparatives or alterations. Diuretics and sudorificks do very often give much relief; the reason is, because nothing in a manner besides are so able to extirpate the very root of the disease, that is, the salt and tartar: for we have known several, who have been recovered by virtue of these, taken either separately or together: such as are antimonial medicines, antimonium diaphoreticum, Cinnabar of Antimony, etc. Volatile Salts, as volatile Salt of hartshorn, greater burdock-root, a decoction of germander, and several things called antipodagricks.  
To remove the humour, when it is fallen upon the joint, there is a necessity for discutients, wherewith sometimes something of a repellent is to be mixed. Fat and oily things are carefully to be avoided, whereby the pores are shut up. Remedies composed of salts, either fixed or volatile, are the safest of all; the reason is, because they vehemently discuss the impacted humours, and corroborate the weakened parts. There are some also, who use to apply spirit of salt, mixed or allayed with some other Liquor.  
In the mean time we must attend with our utmost diligence and caution, to things which either relieve or do prejudice; because the salt humours may be various, and may be mixed with various ichors. If the matter, when the thinner parts are discussed, do congeal, and degenerate into chalky knots, stronger emollients, together with discutients, are convenient; such as gum Ammoniack, and several sorts of gums, to which if the node gives not way, the skin must be broke, and the chalky stones taken out.  
As to the diet, in the fit it must be altogether spare and thin, small wine may be drunk moderately, sharp and salted food must wholly be avoided, the cold air is to be kept off, and sweeting must be indulged.   

A Pindaric ODE On the Discourse of the Gout.  
O GOUT! thou cruel Jailor of Mankind,  
That fetter'st All,  
Both Great and Small,  
Of every kind!  
O thou tormenting Gout, the worst of things,  
Thou sparest no Scholar of the Gown,  
Nor any Artist of the Town,  
Thou tyrannizest over Kings!  
Other Diseases in respect of Thee  
Arc health and rest, thou'rt pain and misery!  
Thou art the King of Terrors in thy strife,  
A living Death, and yet a dying Life.  
Pandora's Box no Fable is, but true;  
For why, 'tis plainly verified in you.  
From these great Evils when thou sets us free,  
Greenfield, thou shalt our Guardian-Angel be.  
Sic Cecinit, F. F. T.   

A Copy of a Letter.  
Huntingdon, Octob. 5. 1960. Honoured Doctor, SIR,  
AFter I had made use of your directions, I thought fit to give you an account thereof: I bless God, I am well rid of my pain, so that I am able to do any thing about the House, to the admiration of all my Neighbours. I could not have made a bed within this three months, if I might have had the wait of it in gold, to have done it, my pains were so great, and my strength so little in my joints, etc. which is all from your Servant, who shall ever own you for my Doctor and Restorer of my health under God.  
Catherine Ashton.   

Another.  
Bellow near Alford, March 20. 1690/ 1. Worthy SIR,  
YOur medicines, though not so timely brought by the Carrier, yet came to my hands at last. I consulted Dr. Gibbons, my Friend at Oxford, who is against violent precipitating medicines, for fear they should wake, as be calls it, the sleeping Lion.  
(Now the case of this Gentleman who writes this Letter to the Author of this Treatise, was the Gout and Stone in the Kidneys, the Doctor's speech relates to the latter).  
I like your medicines well, because they prevent the Gout, and increase Urine gently, etc.  
Your affectionate Friend and Servant, John Morrel.   
FINIS.  

Postscript.  
SEveral Persons having applied themselves to the Author, since this Treatise was made public, enquiring about the Success of the Author's Method, he has thought it not amiss for their convenience and ease to himself, to publish the Names and places of Abode of some of those he hath cured of the Gout, that so any that are inquisitive, may receive a further satisfaction, and doth not doubt but they will be convinced, that what he has asserted, is not merely rational, but verified by Practice.  
Frances Stracy, at the Corner House of Cole-Stairs in Shadwel, who keeps a Slopshop, says, That some Years ago she herself was violently seized with the Gout over all her Limbs so that she could not stir herself without Crutches, was raised and perfectly cured by Dr. Greenfield, and that she hath not had ever since the least sign of any relapse.  
Mrs. Law (in Petty-Coat-Lane, in Cobb's Yard) says, That she herself was in all her Limbs full of the Gout, insomuch that her Husband expected no Cure, but that she should have been always lame, and gone on Crutches, that she could not help herself, and was perfectly cured by Dr. Greenfield about a Year ago, taking now and then something still from the Doctor, to prevent a relapse.  
Captain Webber in Foxes-Lane in Shadwel: The Wife and Daughter relate, That last May was a Twelvemonth, the Captain had the Gout in great extremity, and was cured by Dr. Greenfield, even to a Miracle, and under God cannot deny to give the Doctor the Honour of it, for since he hath not perceived the least Relapse.  
Mrs. De Vlieger says, That her Husband (in St martin's Le Grand, in the new Rents against the Coffeehouse) was last Winter very much afflicted with the Gout, and that under God he was raised by Dr. Greenfield, and has kept well ever since: That the Doctor still followed him with Medicines, to prevent a Relapse.  
Sir John Matthew in Winchester-street, and Sir Robert Holmes, Men of great Note and Eminency, having made use of the Author's Prescriptions and Medicaments, have found them very effectual, giving much ease and benefit in a little time, their Fits being quite removed, their Lamenesses much abated in respect of what they used to be, and went about with more strength, whereas they used to be long laid up, and not able to stir.  
Mr. John Mulder, in Goldstone Square in White-Chappel.  
Mrs. Webb, in St. Olaves-street, against Barnaby-street, were also lately both cured of the Gout by the Author, and continue well.  
Mr. How, a Confectioner in Red-Cross-street, at the Rose and Crown; and  
Mr. Sturt, a Mercer in West-Smithfield, the corner of Cloth-Fair, both give an Honourable Account of what they have received by the Author of this Treatise.  
The Author has made a beginning with Captain Edward Bartelet, who has lost sixty Ounces of Blood in one day, and is now very lame, having a Fit of the Gout upon him: The Reader may inquire about the Author's Proceedings and Success: He lives on Stepney-Causey. He began his Course the 18th. of August, 1691.  
Thus Mrs. Harrison has also begun, being the Wife of Ralph Harrison (being under the same Circumstances) Living in Sheeles near Newcastle.  
From my House in Throgmorton-street, the next Door but one to Broad-street.  
FINIS.