A TREATISE OF THE GOUT. Written Originally in the French Tongue, By THEODOR TURQUET, DE MAYERNE, Knight, Baron of Aubonne, Councillor, and chief Physician to the late KING and QUEEN of ENGLAND. Englished for the general Benefit, By Thomas Shirley, M. D. Physician in Ordinary to his present Majesty Charles the II. Whereunto is added, Advice about Hypochondriacal-Fits, by the same Author. London, Printed for D. Newman, at the King's Arms in the Poultry, 1676. THE EPISTLE TO THE READER. Reader, HAving perused this ensuing Treatise of the Gout, (which fell but lately into my hands) I found it not only so Ingenious, but so Solid and Useful a Work, that I thought it much pity, it should remain locked up from the knowledge of those worthy persons of our own Nation, which languish under the affliction of this torturing Disease; and therefore I have taken the pains to present you with it in our Native Language: I was the more encouraged to do this, because both the Principles and Method which this worthy Author makes use of, are not only very rational, but consonant for the most part with those of my own, which I had assumed many years before I had a sight of this Book; the usefulness of which Method and Principles (though not in all particulars the same with my own, especially the Medicines; yet having the same tendency) I can recommend by way of Analogy from my own practice, which hath been employed about the Persons of divers of eminent Worth, Learning, and Dignity in this Kingdom; not only by way of giving ease in, and shortening the Paroxysm, or Fits of the Gout, but by returning the Parts to their Tone, Strength, and Vigour, after the Fits are past, and also by preventing the otherwise too frequent returns and assaults of this Disease: All which I do assert (whatever the opinion of some others may be to the contrary) not only may probably be done, but that I have actually done it to Regular and Judicious Persons, with a constant and laudable success. And all this not (as some erroneously suppose) by hindering Nature from discharging the Gouty humour upon the joints, which indeed was a dangerous way, but by actually and really removing the Diseasie-Product, and carrying on the Offending matter by rationally-composed, safe, and easy Medicines; by this means hindering the Disease from recruiting itself, & getting head; & by this Method, I have preserved some, divers years together, in a Vigorous and healthy state of Body. Wherefore (I say) finding this worthy Author so nearly concurring with my own Sentiments, I thought it would be an Obliging Service to the Sick, if I exposed this Tract to the public view of the English Reader; and that for these Reasons: First, To comfort such as groan under this Distemper, and to remove the prejudice which some men have endeavoured to implant in them; as if there were no remedy in this Disease but Patience, and nothing to be done, but to Groan. Secondly, To satisfy the desires of many, which I know thirst after the Works of this dead Hero in Physic, Sir Theodor Mayerne, (whose Fame nevertheless can never die,) and yet none of them hath hitherto come to light, though, as I have been credibly informed, before his death he had fitted a large Volume for the Press, with which we have not been blessed, by reason of the disagreements and Law-Suits of his Heirs: For the aforesaid reasons I have put out this Treatise, in the doing which, I have had a greater consideration of thy interest, Reader, than my own; for which, if you have a grateful mind, you must acknowledge that I am Your Real Friend, Thomas Shirley. A TREATISE OF THE GOUT. AMongst those Afflictions and Diseases which molest Human bodies, and portend their early dissolution, and Exit, before the fatal and determinate time, the Gout above all others deserves our Compassion; for this cause, that it is reckoned by many men (though very erroneously) amongst those Diseases that are absolutely incurable: So that the Sick person is left with a Prognostic: And the endeavours of Physicians in this Disease, is only employed about the mitigation of pain, by the application of Topical or outward Medicines to the grieved part; they striving rather to please their Patient's desires, than to perform their own office and duty: for most Physicians are more desirous by compliance to gain themselves Credit, than to procure the Health of the Patients, committed to their care, they being only intent upon pacifying their cries; the possibility of restoring their Patients to their perfect Health, doth not so much as once come in their thoughts. And if this Disease be narrowly examined, without doubt it will hardly seem to deserve a slighter censure; for its Cause proceeds with so slow and Tortoise-like a pace, that it gains ground, and is augmented by degrees, not producing its full effect, until it hath first wrought the parts into a depraved 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, or distemperature by means of the included humours, and then by often errors in Diet, and an intemperate Life, it getteth to so vast a height, that the Sick seems to be placed (as it were) upon the brink of a Precipice, where beholding the magnitude of the accumilated matter, and the length of the way which must of necessity be gone back before there can be a return to former health; they are frighted, and cast away all hope, and take up an aversion and loathing to all sorts of Remedies. Add to this, that the Gout seeks out Rich and Great men's Houses, and there it fixeth its chief Fortress, (or Garrison) to whose commands (the Fates so pleasing) all such yield obedience, in so much that you cannot extort an assent from such men, to those precepts which are requisite for the recovery of their healths. But it is not at all true, that God hath Created Nature a Stepmother, and destitute of help, or that there is any disease (whose 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, or Essence, doth not consist in a mere privation) which doth not admit of a Cure: But if the singular Nature of the Disease, or its cause doth withstand a Cure, we may endeavour to give help, even to such (though they refuse to be governed by the Precepts of Physicians,) either by metigating the fierceness of their pain, or by preventing the frequent returns of their Paroxsysms, or Fits; and at last, by taking care lest the parts by omitting their usual Offices, and by long Idleness, grow torped, and become unfit for the employments they are designed for: And that these scopes or intentions may be obtained by Art, in any subject whatsoever, is most certain; if the Patient be yet capable of receiving the benefit of those Medicines which are to be applied, and is not already come to the ut-most and last extremity. That we may with the more clearness, manifest the nature and quality of the Gout, we are not to regard the division of the humours into four parts; for though they appear distinct when they are voided from a human body, we are to look deeper into the thing, and to consider that all the Excrements of the body do admit into themselves, & contain in their Composition, Salt. Especially the Liquid humours, as Urine, and Sweated, whose thinner parts being discussed into Vapours, there will remain a saline Sediment: From hence we may infer that Salt; as long as it continueth within the bounds and proportions allotted it by Nature, is inoffencive; but when it exceeds that, and abounds, whether it be Liquid, and mixed with its dissolvent, or separated from it, and be coagulate, or become solid, it cannot be accumulated together in the body without hurt. For, as in the Macrocosm, or greater World, there are divers sorts of Salts, of which some are sweet as Sugars; others sower as Vitriolet Salts; some are bitter as the Salt of Soot; others truly Salt, as Sea Salt, and Salt-Gemme; others Volatile, as Sal-Armoniack; others insipid, of which sort are those which are contained in Pebbles, Gravel, and other stones: So likewise in the Microcosm, or body of Man, there are generated Tartarous Salts, which according to their native proprieties, and disposition, produce distempers, which from thence are called Tartarous Diseases, which in respect of their material cause, and peculiar dispositions, are divided into two sorts; the one taking its origin from the solution, the other from the coagulation or concretion of these Tartarous Salts; which disposition is nourished, and furthered much by the distemperature of the parts, upon which the native heat acts according to the degrees of their proper Essence, and essential mixtion; and so either dissolves these Salts, as it doth in the Livers of those which are Hydropical; or it doth cause a Concretion, as it happens in the Kidneys, and Bladder, of those which are Obnoxious to the Stone. The four first Elements, (or the four humours) being dismissed, let us pass over to the Examination of their Succedana's, or those principles constituted in their place, which by the Spagirists or Chemists, (who resolve sublunary bodies into their principles by the help of their fires,) are asserted to be three: They calling whatsoever is watery, and volatile, Mercury; and styling all that is fat and devourable by fire, Sulphur; and giving the name of Salt to all the fixed and dry parts, separated from the impure and dead Earth. This Salt is of the nature of Balsam, which the body being deprived of, it certainly becomes putrid. Wherefore, since there is a constant dissolution, and dissipation of this triple substance, these principles require to be restored and repaired; for we are nourished by the same things of which we are constituted: But the Elementary substances which we receive to sustain ourselves, are various, both in their composition and temperament; and in every sort of aliment, one of the aforesaid principles doth always abound above the rest, wherefore it is a necessary consequence then, that whosoever useth such Meat, in which Salt doth radically abound, he shall experience in himself the increase of the same Principle. And here we may admire Divine Providence that hath ordered the serous humour (an Excrement of the first Concoction) to be Liquid; in which, when the Aliment is dissolved into the form of Chyle, there is made a separation of the (aforesaid) three substances, and the Salt is almost all dissolved by that Ichorous Liquor▪ which being mixed with the blood, it becomes a Vehicule to it; and thus being transmitted with it to the smallest parts of the body, it serves them instead of a Balsam; and the overpluss of it, constituting the Lixiviate body of the Urine, floweth out at the place destinated for its Excression; and if there be any unuseful and superfluous parts of it left behind, after the third Concoction is performed, they are sent off by Sweat; or else seeking an Exit by insensible transpiration at the Pores, it degenerates into thick scurf and foulness, sticking to the skin. And this happens in those bodies which are well constituted, whose faculties are vigorous, and their functions performed without defect; but if by default of the parts, or through ill Diet, Nature be oppressed, and the Secretions and Expulsions of Excrements be slowly performed, then of necessity this Salt will accumulate and gather itself together upon the parts, and abounding in quantity, whereas before it preserved them like a Balsam from Putrefaction: Now on the contrary, wheresoever it is conveyed, and remains, (although it be dissolved, and of a liquid form, like Brine) yet it inflames the parts, and villicates and gnaws them, exciting pain. Moreover, since the natural proportion betwixt the dissolvant, and the thing to be dissolved is such, that the most subtle Liquor, will hardly receive into itself above the fourth part (of any thing) in proportion to its self; if the Salt exceed in the aforesaid watery Latex, or Liquor, then of necessity it will be stopped in its passages and Vessels, in which it will grow together, and be coagulated into different sort of Stones, according to the nature of the predominant Salt. And here we may consider the various Concretions which hap in the bowels of the Earth; as also those which are made by Art: For Allom, when it coagulates, hath one form, Salt-Peter another, Sea-Salt another, and Sal-Armoniack another, different from all these: Nay, he that shall remove his contemplations from the Coagulations of Salts, to those which hap to Stones and Marcasits, (or Minerals), he shall find several of them so elaborately formed according to Geometrical Rules, that he will be forced to acknowledge that Art is outdone by Nature. * Upon this subject, read what the Translator of this Treatise hath writ in his Philosophical Essay of Putrification; Printed Anno, 1672. From what hath been said, we may infer, that Tartarous Diseases are the offspring of a certain Native, (or Seedy) disposition of generating their like; or rather (as I may say) a powerful separating and assimulating of that Salt which we call Tartar from the Aliments, (which is contained in them) or if you will, the vicious and evil disposition of the aforesaid Aliments (indiscreetly taken into the body) overcomeing the Tone of the Faculties, and depraving the Functions, which at length, through the frequent concourse of these Procatartick, or procuring causes, must necessarily be oppressed and overwhelmed: Wherefore these sort of Diseases, are either Hereditary, and transmitted by Parents infected with the same Infirmities, to their Children, or accidentary, and engendered in us by our own default. According to the Philosophical Axiom, received opinion, or Dogma, the definition of the Gout is thus stated. That it is a painful solution of the continuety of the Ligaments and Nervous parts (which are very sensible) encompassing all the joints, introduced upon them by the sharp and biteing quality of a certain Tartarous matter, or Salt, separated from the mass of Blood, and transmitted to those parts (as being most weak and aptest to receive it,) together with its proper Vehicule the serous humour; that being unuseful to nutrition, and unfit to coagulate into flesh. This definition of the Gout acknowledgeth but one cause of it, and shows the division of it into a hot and cold Gout, to be futile or vain. Yet doth not this hinder, but that the Arthretick (or Gout) pains may be mitigated by the application of remedies of a contrary nature: But than it is to be considered, that the Spirits, together with that humour which predominates above the rest, and is generated by the Temperament of the body, doth flow to the part grieved with pain, (in aid thereof.) And so in a Phlegmatic temperament the pained parts are whitish, and swell without inflammation; and in the Sanguine and Choleric, their pains are cruel and great, and require sudden relief: But in whatsoever sort of Gout it be, the pains do never cease (I spoke not of the use of Narcotticks, or stupifying Medicines here) until the Salt the Parent and cause of the pain be diluted by some gentle Liquor (a good Diet being instituted, as the forbearing of Wine, and using to drink Water impregnated with the virtue of such things as are usually given in Fits of the Gout) or else a diversion of those humours be made, which impetuously rush upon the parts; and then that Salt, if it be Volatile, will be discussed into the habit of the body, or outward parts; or at length it will be tempered and mitigated by internal Medicines, such as are Sugar of Lead, and Salt of Tartar. I omit the opinion of those, who derive the Original of the Gout from the Liver, or Brain: For in my judgement, the first fountain of its material cause, is in the Stomach; which afterwards is from thence derived, and by all the Genus venosum, (or Veins) poured out upon, (and rendered habitual to,) those parts afflicted. (Either by hereditary right, or ill Diet:) which parts attract the acrimony of the humour, which insinuates itself into them, as being very weak, and therefore prone to receive, and suffer, and lesle apt to resist its power. For every pain of the joints, is not to be called the Gout, but that only which proceeds from the aforesaid Tartarous matter, and brings forth this effect; leaving upon the parts a great debility after the pain is gone. There is a sort of wand'ring Gout, called by the English, Ninning; it is Erratic, and shifteth place, sparing no joint, but invading all of them successively, and oftentimes possessing several of them at once; whose set-time, (the inflammation being finished) is determined by Hypocrates to be forty days. This ariseth from a general Cataclysme, or flood of humours, which happeneth in Plethoric, or full bodies, abounding with such serous watery humours; which falling into the caveties of the Joints, prove afflictive to the adjacent parts, more upon the account of their filling, and stretching them, than from their being accrimonius. This depraved Diathesis falls not under this disquisition here; since it is easily taken away, either by frequent Phlebotomy, (or bleeding) or else by large Evacuations with Hydragogol, or water-purging Medicines; which means make a revultion and subduction of the peccant and offensive humours. But dismissing this Distemper, let us remove our discourse to that trucculent and rebellious Disease, particularly called Podagra, which Hypocrates, according to certain conditions, pronounceth either curable or incurable, lib. 2. Praedict. (says he) De Podagra haec dico, quicunque aut senes sunt, aut circa articulos calculos tophaceos Concretos habent; aut aerumnose viunt, aut siccam habent Alvum, high Omnes sani humana arte fieri non possunt, quantùm ego novi: Sanant quidem hos Optime Dysenteriae si successerint, sed etiam aliae eliquationes valde prosunt, quae ad internos locos repunt: Qui vero juvenis est, & circa articulos nondum tophaceos callos habet, concretos, & accurate vivit, & laboris amans esti & Alvum bonam habet, ad obediendum pro studiorum ratione, hic sani Medicum intelligentiam habentem nactus, sanus fieri poterit. (That is), concerning the Gout, I say, That those which are old, and have soft stones gathered about their Joints, or live Debauchly, or are bound in their Bellies, all these cannot be cured by human Art, as far as I know. But such are best cured by a Bloody Flux; also other sorts of Purgations, which carry the humours inwards, are very advantageous to them: But he that is young, and hath not yet any Stony Concretions about his joints, and liveth a very regular life, and is a lover of labour, and hath a loose Belly, and ready to obey directions; these certainly may be cured by a careful and understanding Physician. I trusting to the Oracle of this great Man, do believe the Gout may be prevented and hindered, even in those which have it Hereditarily, though not in every individual person: But in such, in whom it is in its first beginnings, and before it hath left, and deposited any stony sediment in the Caveties of the Joints; and by its native efficacy, hath hardened the glutinous liquor of those parts into a stone. These I say, I believe are capable of a cure: This seems to be rashly spoken, yet it is most true; if Gouty persons would but observe the first Aphorism of Hypocrates, which teaches that the Physician ought not only to do his duty, but the Patient, and those which are about them, and assist them, should do theirs also. For outward causes must also conspire towards this Cure. As to the prevention of this Disease, Galen handles it perfunctorily, and slightly, supposing it sufficient to use Purging and Blood-letting in the Spring and Fall; adding to these a regular course of Diet: And this he thinks is not only sufficient to prevent it in those who have not yet been seized with it, but also for those who have already been afflicted with it: But we add, that the concurrence of many other things is requisite; of which sort, Diet justly challengeth the first place, for such nourishments ought to be chose which are Euchymick and Eupeptick, that is, of good juice and easy digestion; commanding the Patient to forbear all sorts of Foods that are Glutinous, Tartarous, or impregnated with Salt, and such as are easily Coagulated. The kinds of which are to be learned out of such Books which treat of useful or noxious Diet. Drink is of great moment in this affair, which because it serves to dilute the meat, it therefore affords the principle matter to the Ichorous Excrement, (of which we have discoursed before.) If this participate much of the aforesaid Tartarous matter, without doubt it attracts to itself (from its similitude of substance), the like matter contained in the Aliments, and therefore promotes the increase of the Gout. For Viscous and thick drinks, of which sort are Beer and Ale (which have not worked well) are very apt to coagulate, and do easily produce the Stone: As on the other side, simple drinks, and uncompounded, and such as have little of Salt matter in them, are lesle prone to generate these kind of Diseases: From hence those which drink water, so it be unmixed, are lesle subject to the Gout; chiefly Rich men, who out of curiosity cast clean Flints and Pebbles into the Wells and Fountains, from whence they draw their Waters; for these stones cover themselves with the Musilage and Slime, which the water by running through the Earth, had contracted and brought along with it; and these being removed, they cast in others: or they make use of Rain-water received in Cisterns filled with Gravel. Mead, made with Rain-water, well purified, and throughly wrought, till it become clear, and leave nothing in the bottom, is of excellent use; and this may be made Medicinal by adding of Cephalick, Neurotic, and Arthretick Herbs; (that is) such as are appropriate to the Head, Nerves, and Joints; of which sort are Bettony, Ground Pine, Cowslips, Primroses, and the like. Wine taken in to large quantities, turbid, and not sufficiently freed from its Tartar, is very hurtful; both because from the constant, and too much use of it, the native heat is dissipated, the Concoction of the Stomach impeded, (chiefly of flesh-meats, which in this liquor grow hard;) as also the Liver is offended, and accride, and serous blood generated, the Brain rendered weak, and the strength of the Nerves impaired, Cathars and Defluxions provoked, whose matter being condenced in that Region, falls perpendicularly upon those parts of the body that are under it, and destroys all that it meets with, chiefly those parts which are weak. Amongst Wines, some are of that nature, that, although they seem watery, yet they prick the Tongue and palate; such abound with a Vitriolin Tartor, sharp, pontic, and pricking: Others are of a more generous kind, and abound with more plenty of spirits, whose strength is quickly abated by mixing them with water; and these chiefly infest the Brain, as the other do the joints: But there is an Artificial way found out, to take away the hurtful vapours of such Wine, and this is performed by transcolating or straining it by a double glassinstrument, called by the French Montevin; and with this Engine, it is deprived of its superfluous Tartar, pouring into it any liquor endowed with a precipitating faculty; of which sort is Oil of Tartar, (by the help of which, Wine inclining to be sour, is sweetened) also the solution of Litharige, or Sugar of Lead, made with Vinegar: The solution of Crystals, made by often repeated reverberations, and extinctions in Nettle-water, and dissolved with the Accid Spirit of Turpentine, according to Art. But it is hard, and tedious, to use medicated meats and drinks at our Meals: Those therefore which cannot refrain from Wine, let them elect those which are lesle hurtful and Oligophorick; diluting them well with water, not taking more than is needful, and abstaining also from too plentiful feeding. Let this be the first, or prime rule of health, not to satiate themselves with Food, nor overburthen the strength of the Stomach with a superfluous 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, or fullness, by which means the native heat will act upon the subjects committed to its charge without trouble, and this is healthful. Nor ought there more new Food to be taken in, till the former be concocted: Also let their Diet be simple, and the chief Sauce to it, hunger; exciting an Appetite, if it be wanting, by moderate exercise at convenient hours (that is, before, not after meat,) by which the drowsy heat will be excited, even as fire covered with ashes, is, by stirring it up. But since we have mentioned Exercise, whose Essence consists in motion, we may bring in under this head, Frixtions, or Rubbing, as well of the whole Body, as of the joints: These open the Pores, draw out the superfluous matter which (is suppressed,) and call back the natural heat to the parts; which is the chief instrument and Master workman of the Faculties: Wherefore, because there is no nourishment which doth not contain some impurities in it, which turns to Excrement, we must take care that these superfluities be Evacuated by the natural passages, (or Emunctiorys) in convenient quantities, and at fitting times; which if Nature perform not, Art must supply that defect, carefully regarding that the Belly be kept loose. And that the Stomach never abound with impurities or filth: So that the first concoctions may not be as it were a Ferment to the rest, which would give a Salt accrimony to the succeeding Aliementary juice. To perform these intentions, certain familiar Medicines conduce much; such as are Pilulae Mastichinae, Macri, Aloes impregnated with divers juices; also Stomachical, Epatick, and other gentle Medicines, which we call Eccoprotick: 'Tis of great concern to examine well, if the Urine answer in proportion to the Drink that is drank; for if it do not, 'tis very requisite to take Potions, and other forms of Diuretic Medicines, at convenient times; that is, betwixt Meals. Of which sort is the Vinous Liquor, which is made with fully ripe juniper Berry's bruised and boiled in water, adding a little Yeast or Mustard to it, to promote the Fermentation. Or there may be taken a little of the red liquor made according to Art, by digesting Spirit of Wine upon Salt of Tartar. To provoke Sweat is also wonderful beneficial; whether it be procured by exercise, or by going once or twice in a month into a Hothouse; some times also taking Glisters when the Stomach is empty. Let them avoid all extremities of the Wether, chiefly cold and moist Air, carefully defending their joints from it. Let both their Sleep and Watchings be moderate; for the excess of either is hurtful. The same judgement is to be given of Venery, which is extremely offensive to Gouty People; for experience doth testify, that the Salt and Nitrious humours, with which those which have the Gout do abound, are often stirred up by these kind of conflicts: Concerning which, a certain person being asked which was the most convenient time to perform them in; he presently answered, Whensoever any man desires to make himself weak. Lastly, if a moderation be to be observed in all those things which concern the Body, much more ought it to be so in those things which relate to the Mind; for the assaults of it will destroy the Organs of the Body, unless they be governed by the motions of reason. Behold a short 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, or description, of the principle Cannons of Diet, to be observed by those which have the Gout; as also of such things which ought to be avoided by the Gouty. By way of prevention from this evil, we will subjoin some remedies, (chiefly such as are Purgative) by which this evil, happily whilst it is in its first beginnings, (and as they say, in the Herb) may be taken away, or avoided, by drawing off its cause before it break out into act, and fall upon those parts, in which, it useth to exercise its Tyranny and Butchery. Vomits are the most precious Prophylacticks, or preventer of the Gout which may be largely provoked by the help of Emetticks, where the joints are yet lax and limber, and the Disease is at the door, and ready to fall upon them. And this may be done both to those Gouty persons, which have had former fits, and to those which have not yet sustained any; and govern themselves; not submitting to the advice of Physicians, but indulge their own genius, (most commonly) to the destruction of their health. Amongst the Classes of Vomits, this is the most tried, and never given without success, viz. The infusion of Crocus Mettalorum, made into a fine Powder, well washed, and steeped in two, or three Ounces of White-wine, for the space of 24. hours, giving the straining of it, with an ounce of simple Oxymel; in a morning, upon an empty Stomach, taking a little fat broth after every provocation to Vomit. But this kind of Medicine performs its Operations with some violence, and therefore is not equally convenient for all Constitutions, but only for such as are fitted by nature for it: But it takes away the Disease by the Roots, neither is it ever given in vain; and although it be accompanied with some trouble, and molestation, yet is it innocent and harmless, so it be administered in a seasonable, and convenient time. Clean white Vitriol given to the quantity of a dram, dissolved in Barleywater, or else given in any Conserve; and drinking upon it, a great draught of the same water, in which a large quantity of Liquorish hath been boiled, doth wash, and also strengthen the Stomach, in tender and easy bodies: And in such cases, in which the humours are not to be drawn from the farthest, or remote parts of the body. The Emultion also of 25. or thirty grains of Cataputia, or Spurge (the greater sort) being made with the Broth of a Chicken strained, or else with Barleywater, sweetened with Sugar, adding two or three Almonds, is very good in this case. There is another sort of Vomits; very useful, and lesle difficult: And that you may apprehend the reason of this the better, we are to remember what was said before, That the primitive matter of the Gout, is generated in the Stomach. 'Tis the Opinion of the Arabians, that it is convenient to be Drunk once in a month: And this would not be so much amiss, if it left us the use of Reason, and did not turn us into the nature of Swine. But this advice will agree well enough with Debauchees, and Glutonous persons, who devour all things without distinction: Let these once, or twice in a month, stuff their Stomaches above measure, with variety of Meats, chiefly such as is fat; drinking upon it more than ordinary of what sort of Liquor they please; so loaded, let them remain quiet for one hour; after which, let them walk half an hour gently: at last, putting their Fingers into their Throats, let them provoke themselves to Vomit, and to throw up, not only the meat they have eaten, but also the formerly collected Slime sticking to the sides of the Stomach, and which (after eating almost to Vomiting) doth mix itself with the Aliment, and is diluted by the Liquors, and drink which is drank: For Nature endeavours every single concoction, to collect what she finds in the hollow of the Stomach, that she may convert it into the form and substance of Chyle, and afterwards change it into Blood: In some there is required a longer time to perform this in, (almost two hours) according as the Stomach doth more slowly obey the act of Chylification. As to the Motion which was required as necessary before the act of Vomiting, that is sufficiently made out by Navigation; which as Hypocrates notes, (and common experience confirms) doth help to provoke these kind of Evacuations. Besides Vomiting, 'tis necessary to Purge the body, having premised before a preparation of it, with brisk and spirituous Medicines, which 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, and with power, act upon such sort of Tartars; of which kind are the sour Spirit of Vitriol, of Sulphur, and of Salt, which may be exhibited in any so●t of Liquor, or Conserve, or otherwise: Also the Cream, Salt, and Spirit of Tartar, prepare the matter for Expulsion. Purges which are peculiar for the Gouty humours, are truly Hydragogol, or purgers of water, of which there are a vast number. Syrup de Rhamno, that is, Syrup of Bucks-horn, is esteemed a Specific against this Disease, and is to be taken immediately before Meat; the Dose of it is two or three Ounces. Cream of Tartar is a most useful Medicine; if you add to it 10, 12, or 15, grains of the Extract, or Rosin of Scamony (precipitated in Rose-water,) dissolving them together in White wine, or taking them in Broth, with a drop of the distilled Oil of Cinnamon; also Cydonium Laxativum, or the purging Quinces of Lions is of the same effect. Also jallop root taken to the quantity of a dram; or four scruples in White-wine, is a pleasant and useful remedy: nor of lesle virtue are the Berries of Dwarfe-Elder, and the Oil made of them by boiling and pressing. Electuarium Caryocostinum is singularly commended: But the most powerful of all remedies is Mercurius-dulcis, which may be happily given to the quantity of a scruple, adding by way of Stimulation, and that it may not make too long a stay in the body, 23. or 25. grains of Pilulae Cochiarum Minorum, faithfully made up; adding for correction, a few leaves of Gold, and a few drops of the distilled Oil of Rosemary, Anniseeds, or Cinnamon. Let not very generous Medicines be used too often, but only in the beginning of the Spring and Fall: But Vomits only ought to be frequently used, as was said before; and also the Pills called Pilulae Usualium. Niter, or Salt Peter, doth belong to the Classis of Evacuators, for it sends forth the Tartarous substance by the way of the Kidneys and Bladder, which matter doth easily Coagulate into Stones, in such as are inclined to the Gout. Let it be taken in the wain of the Moon, to the quantity of a dram, or two, in sugared Barleywater: Also Antimonium Diaphoreticum fixum, prepared Crollius his way, is good to provoke Sweat, when given with Rob, or the thickened juice of Elderberries, once or twice in a month, according as the party is full-bodyed, or irregular in his Diet, going into a Hothouse, or being in Bed when it is taken. As to the rest do as it is in the Adage, Take care to keep your Head and Feet warm; & in other things, live as the Bruits do; (that is) eat at convenient hours, and avoid plenitude or fullness. He that observeth the aforesaid rules, though he be naturally inclined to the Gout, shall hardly be seized with it, so that these things be performed carefully, and in order. Now it is time to afford help to those which are actually afflicted with the Gout: And that these may receive manifest relief and help, I have found, (and am confirmed in it,) by often repeated experiments; either by prohibiting the fits, or hindering their often, or frequent returns, cutting off the length of them, or mitigating the fierceness of the pain, or by sooner restoring strength to the joints and other parts, made weak by the length of the disease. To the defence of such, besides those general and necessary Indications: 1. Of Evacuating the Tartarom matter, drawing it away from its original Fountain, the Stomach, at the beginning. 2dly. Preparing the same by all temperate means. And 3dly. Excluding the matter so prepared, by Purgation. And 4thly. Of drawing off the greatest part of it, by the way, and Vessels designed for the Excresion of Urine. But 5thly. Moreover, the superfluous matter is to be dissipated by Exiccating and Obsorbiant things. 6thly. By procuring (by the way of interception,) a Consumption of that part of the matter which hath escaped the power of other Medicines. 7. Blunting the accrimony of the Salt in the parts offended. 8thly. Dissolving it into vapours, whilst it yet remaineth under a liquid form. 9thly. If necessity require it, to fix and condence the same in the place from whence it flows. 10thly. Pain sharply urging to it, to lay it asleep by Narcottick Medicines, which perhaps may seem a Paradox to some men. 11thly. By strengthening the joints betwixt the fits, by which they will not be so subject to Defluxions for the future; and this is to be performed by applying of strong Roboraters betwixt the fits. 12thly, and lastly, (if it may be done) dissolving the aforesaid Matter and Salt, before it be throughly hardened in the Joints; and if possible, let this be performed at the beginning of its Concretion. For to Cure the knotted Gout, there are no lesle remedies requisite than the Philosophers-Stone, or Medea's Bath, in which jason put off his old Age, and became young. But Vomits ought to precede all these things, as being the most necessary of them all; of which we have discoursed before: but whether they are to be made use of seldom or often, necessity, and the orderly, or erregular manner of Diet will teach. But this Eradicating Vomit of Crocus Metellorum, or of Salt of Vitriol, is conveninent of itself, and may be used at any time. When the other forementioned things are only to prevent this Disease in those which have never yet been afflicted with it. It is also convenient oftentimes to provoke Vomiting after Supper, the Stomach being filled with Meat; the trouble of which is recompensed to the Sick, and amended by the Rest of the following Night. Let this kind of Evacuation be made use of, at lest once in a month, as being a most efficacious help, chiefly in the Spring and Fall; or if necessity require it, at the beginning of every Season. This is worthy our Remark, That the Salts commonly called Alkalys (which are made of Vegetables by Calcination) do dulcify the most Corrosive and pungent Spirits; amongst which sort of Salts, or Alkallies, Salt of Tartar is the most powerful. The same thing doth happen in our Bodies, in which the Salts are acuated by their spirituous substances: but if their points be broke and blunted by Alkalys, than they become weak and inoffensive. Neither can the use of Salt of Tartar be hurtful to any body, taken in Broth, or else in some Conserve of Bettony, of Ground-Pine, or of Cichory: for let it be taken under what form soever, it is highly beneficial to those which have the Gout; not only because it tempers the salt matter, but because, it also brings forth the Salt and Tartarous Matter, (the cause of this distemper) by Urine. The Salt of Ground-Pine, Bettony, Wormwood, Dwarf-Elder, etc. produce the same effect. Sugar of Lead may be safely taken inwardly, with appropriate Conserves, and it doth actually mitigate and sweeten (the humours) as its taste doth witness: but it taketh off, and abateth Venerial desires (perhaps much to the advantage of the Gouty Patient.) These sort of Medicines ought to be exhibited in the Wain of the Moon, having before made use of the gentler kind of Eccoprotick, or easy purging Medicines. We have discoursed above of the Purging Medicines that are most convenient in the Gout; to which we will add this Specific; to wit, our Arthretick Powder, which ought to be used once in a month, from the quantity of a dram to four Scruples, about the full of the Moon, when the humours most abound, and are turgent; and this according to the Magnitude of the Disease, having a respect to the strength of the Patient. Those which are Plethoric, or full bodied, and greatly afflicted with the Gout, such may use to take it at suspicious times, (when they expect a fit) one, or two days before the New of the Moon; taking it either in the fat Broth of a Capon, Cream of Barley, White-wine, or Whey; to drink a draught of which, after the taking of the Medicine, is Convenient. ℞. The raseping of a human Skull unburied, and the roots of Turbith, Hermodactyls, jallop, Sena-leaves, Cream of Tartar, Diagrydium, (i e.) prepared Scamony. Cloves, Ana. ℥. i. Mix them and rub them in a Mortar to a fine Powder. Bairus, an Italian Physician, doth highly extol Caryocostinum, whose Ingredients, since they are very hot, and its Operation a little too vehement, I think it scarce safe for dry bodies, but only for very cold and moist ones; so that my before described Powder, may supply the place of this, and all other Purges, excepting Mercury, whose energy and power exceeds all others: We have spoken before of the manner of exhibiting it, that it ought to be joined with such things as will cause it to work quickly, such as are Pilulae Cochiae Minores, and the like Purgers, which have Colocynthidy, Scamony, and black Ellebor in them; out of which, if you please, you may prepare an extract of the consistence of Pills to be mixed with Mercury. If any one be already seized with a fit of the Gout, then is it very desirable that he be delivered from it, or at least that he be lesle (or mildlier) afflicted with it. Such after universal purging of the three Regions of the Body, and having used a Sudorific Diet, let such (I say) use for the space of a years time together, the following Pills; which although they cause no sensible Evacuation, yet by the long and uninterrupted use of them, they send forth the Tartarous matter by Urine, (of the usefulness, or conveniency of which hath been treated before) by a faculty altogether Specific; upon which thing the Physician ought always to be intent, let his method be what it will: It also strengthens the joints. ℞. Powder of Ground-Pine, ℥. ss. Spanish Liquors, ʒ. ij. Bettony, ʒ. 1. ss. The Stones of Medlars, ʒ. iij. all being beaten into a subtle powder, with a sufficient quantity of Venis-Turpentine, make a Mass for Pills, which are to be taken every day, from a ʒ. i. to a ʒ. i. ss. or two Dragmes, three hours before eating, walking, or using gentle exercise after them. The Basis, or foundation of this remedy, is the Chamapytis, or Ground-Pine, which many mix alone with Turpentine; others add Bettony, the use is as before. The year being expired, use this Remedy every Spring and Fall, for the space of thirty or forty days together; observing this, that if the Belly be loose, then leave Nature to her own work, with whom the Medicine will conspire. But if it be otherwise, then provoke it with the usual Pills: or at the same time taking stronger Purgers (if it be requisite) as is before said; in the mean time, shunning an ill Diet, and having a care that what one hand hath built up, the other doth not pull down. Obsorbients are endowed with a manifest quality, and power of drying; to which, if Specificks be added, their effects will be more brisk, lasting, and noble: This faculty is in all sorts of Bones, whether they are Calcined or not, but human bones of the same kind with those parts which are afflicted, are more efficatious, by reason of their similitude. ℞. Of the aforesaid Bones, ʒ. iij. Crude Hartshorn, Calcined Hartshorn, of each two parts; Crabs-eyes finely powdered, one part; of the powder or mealy Pith, of Sarsaparilla, four parts; rub them all into a Powder, to which, if you please, you may add the Seeds of anise, Fennel, Coriander, Cinnamon, Amber, Mosk, but in small quantities, and only to procure a pleasant smell or taste: take Morning and Evening a whole spoonful of this (at a good space from eating) after the Gouty person doth desist from the use of the aforesaid Pills of Ground-Pine, or in the intermediate times when he doth not take them. Issues made (by burning) in the Arms or Legs, do intercept those humours which flow to the joints, and bring them forth another way, and are a great comfort and relief, both as to the preservation from, and Cure of the Gout, especially if the sick party do not observe a good Diet; in which case they must of necessity admit of them. Now follows those Remedies which respect urgent pain. To the enquiring after which, the Physician's industry is forced, by reason of the impatience of the Sick, and the vehemency of their pain. Let there be called to mind then what was formerly said, viz. That Agile, movable, and Acid, or sour particles of saline matter, being mixed amongst themselves, do mutually temper each other; and by doing so, they take off the pains of the Gout. The Lixiviums, or Leys made with the Ashes of Coleworts, Vine-branches, Pot-ashes, Tartar, and the like Alkallisate Salts, do all of them agree in the faculty of mitigating of pain; chiefly if they be mixed with Vitriolin substances, in which is hid an Anadine Sulphur, and a Salt endowed with a powerful discussive virtue. White Vitriol dissolved in distilled water of Coleworts; also Led (by its native sweetness) take off the Mordacety and biting of the Gouty Salt, being outwardly applied with the beforementioned Colewort-water: as also doth Fern, in whose Ashes lurks a Salt of excellent virtue: The Phlegm of White Vitriol, and the water of Frogs Spawn, and the like Liquors, (to which oftentimes Narcotticks are added) are useful upon a double account, both because they take off the sense of pain (of which beneath you shall hear farther) and also by means of their sulphurous Nature, with which they temper the humours. The greatest part of those which endeavour to give help in the Gout, do very improperly make use of Medicines in the form of Cataplasms, or Poultices; from whence there is more hurt than advantage received; because they shut up the Pores, which ought rather to be opened: and this we should labour to do, that so the Lixivium may draw forth the matter whilst it is yet in a liquid form. To the obtaining of which end, Apoplectical waters are to be applied, (which are so much commended by Authors) and are composed of the forementioned Salts and Vitriols. Oxoronia Swingeri; also the water of Urine, and Vitriol, long macerated, putrified, and digested together, these are highly beneficial. Camphor is also of excellent use in easing of pain, for it opens, penetrates, attinuates, digests, and promotes insensible transpiration, upon the account of its subtle Particles; it is usefully applied with the aforesaid waters, and that in the most intence and extreme pain. I have seen some dissolve Opium, digest, and afterwards distil it, and apply these sort of mixtures with much advantage to the joints, even in the extremest height of pain; the efficacy of this is advanced by the addition of Camphor: In this particular these recited helps are sufficient, although others no lesle generous may be produced and prescribed. Sleep puts a stop to all Evacuations but Sweat: And therefore where the Defluxion is vehement, and the pain intence, there is nothing more grateful and beneficial than to procure it: Nor can any thing come in competition with Laudanum, of which there may be exhibited two, three, or four grains at the hour of sleep, nay many nights successively; for by rest and quiet, the humours will be concocted, Nature recovers her strength, and ariseth to overcome her Enemies. There are other somniforous Remedies Succedanous to Laudanum, but that excels them all. The greatest part of Physicians rise up against, and oppose the use of Narcotticks, and stupifying Medicines; pretending there are other helps more safe to take off the vehemence of pain; and in their Opinion, it is better not to abate the pains at all, or to stop the Complaints, and Cries of the Sick, then to render them weak and feeble, by these sort of Medicines: This is certainly a very pleasant thing, and aught to be taken for a plausible excuse, as if by the use of these Medicines, so great an imbecility and weakness could be brought upon the Sick person and his joints. 'Tis true, Narcotticks taken inwardly, if they be not aptly and carefully used, are not without danger; because unseasonably given, they do (as I may say) cause a kind of Congelation in the Brain, and introduce upon the Spirits, an 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, or steadfastness, not by reason of refrigiration, but by a fixing quality, which is the issue of the Luxurient Sulphur contained in these Medicines; from whence there is induced an immobility upon the animal Spirits, hindering their influx; and from thence, Death by suffocation follows; but where there is extreme pain, nothing of this need to be feared: For 'tis certain, that one day of extreme pain doth inflict more weakness upon the Nerves, than the application of Topical Medicines, (though they be Narcotticks) can procure in six days time. But let us suppose that by these means some sort of stupor, or numbness, doth remain upon the parts, there are thousands of Remedies, able and powerful enough to remove, and wash off that fault; as Baths, Fomentations, Plasters, Hot houses, and others, which perform this in a short time; add to this that Narcotticks outwardly applied, being joined with their Antidotes, and Correctors, are harmless and inoffencive. Almost all Authors make use of Henbain in vehement pains of the Gout: And some assend to the use of Opium: If the Spleen be grown very hard, we apply Hemlock to it, without the least danger; which is also very usefully laid upon the Eyes, although they are so near the Brain: I for my part do not fear (happy success having always approved of it) to make use of both these Plants, in the form of a Poultis, joining to them Cassia, Camphor, Saffron, Sperma-Celi, and human Fat, which is a most excellent Anadine in this case. The pain being pacified, we are to come to the use of Roborating and strengthening means; amongst which, Wine is the best, which as outwardly applied, it is very beneficial and friendly to the Nervous parts; so inwardly taken, it is highly injurious and offensive to all the propagations of the Brain; as the Membrains, Merves, Marrow, etc. Those that would be enabled to resist the Assaults of the Gout, must of necessity make use of such Medicines as have a faculty to, dry, and strengthen the Nervous parts, whose Tone and native Temper, require to be preserved by their like. Paulus Aegineta, an Ancient and Learned Physician, adviseth to rub the joints of Gouty people, with a linement made of Salt and Oil, which Medicine is very useful, the pains being first abated; but its chief excellency consists in preventing the Gout. This Oil is prepared with yellow Violets, (they usually call it Cherinum) by the repeated infusion of fresh Flowers in it, by which it becomes most excellent, especially if there be added to it the Flowers of Mullin. ℞. of the said Oil, lb. i. decrepetated, (that is Calcined) Sea Salt, ground upon a Pouphiry to a most subtle powder, of white-Venis-Sope, of each four Ounces; mix them, and make an Ointment, like Nutritum: With this, in the Evening anoint all the joints, chiefly the hands and feet, which are more Obnoxtious to these pains than the other parts: Then afterwards, going to bed, put on Socks and Gloves. I knew a certain Learned Physician, who had been afflicted with the Gout thirty years, (this was Monsieur Quartier, Physician to the Duke of Bollion:) he lived as many years more, and the residue of his life, (for he was above a hundred years old when he died) by the benefit of the above-described Linement: And ten years before his Death, he was seen to walk as firmly, as if he had never been afflicted with this Disease of the Gout. Perhaps many will think the method of Cure by a strict Diet, a tedious way, because thus their pains and care are never at an end. And it is superfluous (say they) to prescribe such a course to Country people that use much exercise, and live soberly. And for the Rich, they hate to take pains, and trouble themselves, and have all things done for them by the help of their Servants, and debauch when they please, yet will not regard these Rules, or endure any method that is tedious. The Fit being over, 'tis comcom to use Emplastrum Diachalciteos, which truly is innocent, but of little advantage. There are better Medicines commonly to be had, as the Plaster of Hermodoctyls, the Majesterial Plaster of Red-lead, (called Emplastrum Sandicis.) Gum Caranna, dissolved with Spirit of Wine; and Tacamahacca are of singular use and virtue: Emplastrum of Bettony, with Mastic, Storax, and Benzoin, dissolved with Spirit of Wine are very good: Balsam of Dwarf-Elder made with Earthworms, Sucking-puppies, and a little Salt, is most excellent. Baths and Fomentations made with Neurotick herbs, (that is such as strengthen the Nerves and Brain) boiled in a lay of Steel'd-water & Red-Wine, with Salt, Sulphur, and Allom, do wonderfully Corroborated: Milk of Allom is singularly good, and is thus prepared. ℞ Aqua Vitae, (or Brandy) lb. i. The Whites of six new-layed Eggs, shake them alongtime together, with three or four big lumps of Alom, in a well-glazed Earthen-Pot; (it is sufficient to agitate and stir it about:) The Medicine will be more Efficatious if there be first infused Nervous herbs in the Brandy, such as Marjarom, Sage, Rosemary; but if this be warmed with the White of the Eggs in it, they will grow hard, and it will separate into Curds; it is therefore better to warm them single, both that, and the red Wine, (that is the best Aligant, if you can procure it;) and the Vessels being took off from the fire, to add a double or treble proportion of the other, though Allom Milk; and to dip Linnen-cleaths in this, and apply them warm to the parts; but what need any more, since the aforesaid things are sufficient. They do but make themselves ridiculous, who undertake to dissolve the knots of the Gout; for if they be once throughly hardened, to attempt this, is to wash the Blackamoor: But whilst the matter is yet Viscous and Slimy, I think the thing not altogether impossible, if we can attain a remedy that will enter into it, and doth agree with the matter in similitude of substance; and such an one is Sal-Armoniack, both that which is Natural, and that which is Arteficial, and compounded of Soot and Urine; but the volatile Salt of Urine, made pure by often subliming, exceeds it in efficacy. The Pores of the parts being sufficiently opened, by the help of a Bath, a Hot house, or a Lixivium, or Ley made with the Scoria or yellow dross of the Regulur of Antimony; (whose Sulphur is a powerful attractor, and hath a great dissolving faculty.) Let there be taken Salt of Urine, mixing it with the best Spirit of Wine, and foment the joints with this mixture. Oil of Arsenic doth digest this slimy matter, and draw it to the superficies of the skin; neither is there any Medicine can equal it upon this account, if a little of it be mixed with May Butter, or some other Fat, and the joints be lightly anointed with this, it sometimes dissipates these Tumours, and causeth a certain viscous matter to sweated forth at the Pores, which looks like Fat; and many times there will arise Pustels, which pour out drops of water, not unlike Eggs exposed to the fire. But the main point about the use of this remedy, consists in this, That you make not too much haste: For to effect this, there is most commonly required the space of twelve or fifteen days time. Some as Dariolus attempt the opening the parts about the joints with a Cautory. And before the matter is hardened, they usefully apply Blistering-Plaisters: But I am of opinion, that the former advice is unnecessary, and that such as oppose the antecedent cause of the Disease with inward remedies, may well forbear the use of outward ones; or at least may abstain from these painful ones, for it is cruel to add affliction to affliction. Before I conclude, I will say somewhat to Blood-letting, which ought to be performed by way of prevention in full Bodies, and such as live highly and plentifully: Open a vein in the Arm, of such in the Spring and Fall. In Melancholy Constitutions, open the Haemorrhod Veins; and in Women, procure their Courses if they be stopped. Galen undauntedly affirms, that it is a present remedy in the highest Pains, most violent Defluxions, and great Inflammations: These three many times meet together in the first assaults of the Gout. And in such a case, according to the urgent necessity, who will deny but that it is often to be ordered? And since this remedy is of that high usefulness, I beseech you, what can there be of more hope, of greater certainty, and of lesle hazard? But whether this, or Purging, is to be preferred in urgent pains, is a question? although Barius asserteth of himself, that being extremely afflicted with the Gout, by taking in the height of his pains, of his Electuary Caryocostinum, he always was restored to the liberty of his feet, in so much, that of himself, without any body to support him, he was able to go from his Close stool. I faithfully give Credit to what he says; for he was a Learned, Ancient, and Experienced Physician: But yet it certainly appeareth that Gouty persons either should not be purged in the height of of their pains; or that this should be done 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉, by carrying the mass, and heap of humours, that increase this Disease another way. This danger may be prevented, if the same day the Purge is given, there be exhibited at Night a Dose of Laudanum, as hath been said before; by which the Orgasmus, or oppressive swelling of the humours is stayed, the Spirits fixed, and at length the cause being diminished, the Disease doth abate, and Nature is restored to her former liberty. These Rules being laid down, it will not be difficult to bring into use, more particular Remedies, besides the aforesaid Specificks; but the great number of them would frighten the Sick, and cause Confusion, both in the mind of the Physician, and those that assist the Sick: And though I have mentioned a great many Medicines, yet it is none of my intention that all of them should be used to the same party: (or upon the same Subject,) for it is the part of the Physician to Elect those which he judgeth most convenient for him that is Sick: For Medicinal Advices ought to be directed by the Masters of that Art, who will give advice for the right and most opportune use of them; and from this the usefulness (and advantage of the Sick) ariseth; otherwise a Medicine is as a Sword in the hand of a Mad man; and if any one, who is ignorant of this Art, intent to employ and make use of them, they will find themselves deceived by their ill managing of them: Let such learn to know, that the whole quality of the Cure is chiefly profited in the Election of a fitting time, which is a thing not obvious to every body, but only to those which have acquired gray-hairs in the Operations of this Art; and this knowledge is not gained in a day, nor a year. Before I conclude, I think fit to give you notice, that this Tract was Extorted from me by a Friend, and was written by me in favour and respect to him, to satisfy his Curiosity rather than necessity. Artem Experientia fecit, Exemplo Monstrate viam. Art from Experience doth flow; Example, us the way doth show. FINIS