A DISSERTATION ON THE GOUT, AND ALL CHRONIC DISEASES.  A DISSERTATION ON THE GOUT, AND ALL CHRONIC DISEASES, JOINTLY CONSIDERED, AS PROCEEDING FROM THE SAME CAUSES; WHAT THOSE CAUSES ARE, AND A RATIONAL AND NATURAL METHOD OF CURE PROPOSED. ADDRESSED TO ALL INVALIDS, By WILLIAM CADOGAN, FELLOW OF THE COLLEGE OF PHYSICIANS. QUOD PETIS IN TE EST. LONDON, PRINTED: PROVIDENCE, Re-printed by BENNETT WHEELER, for ENOCH HUNT, l785. CONSCIENCE. Conscience, what art thou? thou tremen- dous power; Who dost inhabit us without our leave; And art within ourselves another self, A master self, that loves to domineer, And treat the monarch frankly as the slave. How dost thou light a torch to distant deeps? Make the past present and the future frown? How, ever and anon, awake the soul, As with a peal of thunder, to strange horrors, In this long restless dream, which ideots hug, Nay wise men flatter with the name of life? Anecdotes.—The celebrated physician, Du- moulin, being surrounded at his last moments by several of the most distinguished doctors of Paris, who vied with each other in ex- pressions of regret at his situation—" Gen- tlemen," said he, suddenly, "do not so much regret me: I leave behind me three great physicians." On their pressing him to name them, each being sure that his own name would be among the number, he added— "Water, exercise, and diet," to the no small discomfiture of his disappointed brethren. A gamester finding luck to go very hard against him, exclaimed, "Ah, fortune! 'tis true you make me lose, but I defy you to make me pay." PREFACE. TO enjoy good health is better than to command the world, says a celebrated practical philoso- pher *, who understood the use and value of life and health better than most men; for in exile, with a small income, and no very good constitution, he cultivated an uncommon length of days into a rational series of pleasures; and what is more, an uninterrupted course of happiness. But, as far as I can find, he was almost the only man that did so. The generality of men seem to me not to bestow a thought upon either, till it be too late to reap the benefit of their conviction; so that health, like time, becomes valuable only when it is lost, and we can no longer think of it but with retrospect and regret. That men in, good health, the young and gay in their career, should be negligent of it, or abuse it, re- fusing to stop and listen to, or take warning from others, is no great wonder; but it is very surprising that man- kind in general should be mistaken and misled forever in the same perpetual round of fruitless attempts to re- pair and establish it; not the ignorant vulgar only, but the sensible, the judicious, men of parts and knowledge in other things, in this case equally blind, should pur- sue, with the same vain hope, after repeated disappoint- ments, the thousand and ten thousand idle arts and tricks of medication and quackery; never once lifting their eyes up to Nature, or consulting her book, open as it lies for the perusal, conviction and benefit of all. Some * St. Evremond. (vi) Some industious men, fancying that whatever is va- luable must lie deep, have, with the greatest alacrity in sinking, plunged into the immense abyss of antient Greek, Roman, and Arabic learning, in hopes to, find good precepts of health, and sure remedy for disease. But after all their pioneering into endless heaps of rub- bish, what have they found at last but this? That in natural philosophy some of the antients were very inge- nious in guessing wrong; for guess was all they did; they never studied Nature at all, they made no experi- ments, and therefore knew nothing of her; but either blindly followed or combated each others opinions: School against school, and sect against sect, waged equal and endless war. In the art of physic it was impossible for them to know much; for before our immortal Harvey's discovery of the circulation, there could be no physiology at all, nor any knowledge either of the in- ternal structure or action of any one part of the body. Before the justly celebrated Asellius and Pequet there could be no idea of nourishment; nor was it known how our food passed into the blood, whether it went there or not, or what became of it. But now, since these lights have shone in upon us, all the antient con- jectures, reasonings, and systems, must vanish like clouds before the fun. Besides all this, there are some of our diseases which the antients had not, nor have we all theirs; some few, and very few useful, discoveries they made in medicine, which have descended to us, and with some late tricks in chemistry, are the chief foundation of modern quackery. Thus have men of deep learning, if the knowledge of antient errors can be called so, sunk far out of sight of truth, which in things of general use and necessity, particularly the health of mankind, lies most commonly upon the surface. It has been of great disservice, as well as discredit, to the art of physic, and every fair practiser of it, that men's expectations have been raised by the ignorant and presuming, or the dishonest and artful, to hope for too much from it, more than it ever did or can do. Re- spite (vii) spite and relief may be had in most chronic cases; re- medy, I fear, but in very few, if it be expected from art alone. But a skilful and honest physician (unless he be sent for too late and dismissed too soon, which is ge- nerally the case) will employ those intervals of relief to introduce the powers of life and nature to act for them- selves, and insensibly withdrawing all his medicines, and watching carefully over his patient's whole con- duct, leave him confirmed, from conviction of their ne- cessity, in such good and salutary habits, as cannot fail to establish his health for life; Possibly, if men were better informed of the real causes of their diseases,they might be left unreasonable in their demands, and learn to be contented with pre- sent relief; submitting with patience to that plan of life which alone can lead them to, and preserve them in, permanent health. With this view of engaging men's attention to their own happiness, and undeceiv- ing them in their vain and groundless hopes of remedy, and diverting them from the delusions of art to the realities of nature, I have ventured to publish the fol- lowing Dissertation; which I must beg the reader to consider as, what it really is, a hasty extract of a much larger work, intended to take in the whole circle of Chronic Diseases, here comprehended only in their representative the Gout. If what I have said may seem to want farther illustration, or more demonstrative proof, he will look upon it as a sketch to furnish hints for his own thoughts and reflections, either to improve mine or reject them entirely, as may seem good unto him. If he thinks, from what I have said here, or in the brochure itself, that I mean to impeach the practice of physic in general; I say, that it is not my intention. I would decry all quacks, from Æsculapius to the present, either as ignorant fools, or self-convicted impostors, advertising daily lies; whether mounted on stages, or riding in chariots. But the art of physic, fairly and honestly practised, I honor as the first of professions, comprehending the most useful, the most extensive and universal (viii) universal knowledge of nature. I think a real physi- cian the most liberal of characters upon earth; by which I do not mean every doctor that goes about taking guineas, but him who will neither flatter the great nor deceive the ignorant, and who would prefer the satis- faction of making one invalid a healthy man, to the wealth of Radcliff or the vogue of Ward. But there is an evil spirit of quackery gone forth, that has pos- sessed all orders of men among us. I would lay it, if I could, together with every demon of superstition, fraud and error, and restore the world to truth and nature. George-Street, Hanover-Square, November 20, 1771. A DISSERTATION ON THE GOUT, &c. HOWEVER common it may be for men that suffer, to complain of the evils of life, as the un- avoidable lot of humanity; would they stop but for a moment to consider them in the light of reason and philosophy, they would find little or no foundation for them in nature; but that every man was the real author of all or most of his own miseries. Whatever doubts may be entertained of moral evils, the natural, for the most part, such as bodily infirmity, sickness, and pain, all that class of complaints which the learned call chro- nic diseases, we most undoubtedly bring upon our- selves by our own indulgencies, excesses, or mistaken habits of life; or by suffering our ill-conducted passions to lead us astray or disturb our peace of mind. What- ever notions men have been taught or have received of other causes, such as accidental colds, or particularities of constitution, this or that thing disagreeable or sur- feiting, &c. these are too trifling to produce diseases that commonly last for life: There must be something more substantial, something more constant and perma- nent in our daily habits to produce such inveterate evils. Though if you read authors or consult practitioners, what do you find, but that you have taken cold, though B you [10] you know not how, or that your complaints are gouty, rheumatic, bilious, nervous, &c.? Words that satisfy, though they give no kind of idea, and seem to have gained credit and assent only by the politeness of phy- sicians, who, while they are taking their patient's money, are too well bred to tell them disagreeable truths, and that it is by their own faults they are ill. To enquire a little further into this matter may be well worth our trouble; the talk seems to have been left for me, and I will perform it most sincerely. I have long had it in my mind to write upon chronic diseases in general, in the hope of giving mankind, what most assuredly they have never yet had, a few ra- tional ideas about them; thinking, that if the true original causes of them were fully and fairly set forth, men could not be so capitally mistaken to impute them, as they do, to false and imaginary causes, and therefore apply false and imaginary remedies; nor think that the general health of mankind were to be overset by every trifle, and the recovery of it lay hid in a few drops or powders of any kind. Did they better understand the nature of chronic diseases in general, and whence they proceed, they could not be so unreasonable as to think they might live as they lift with impunity, ex- pecting repeated remedy from art; or, did they know any thing of the nature of medicine, they would find that though fits of pain have been relieved, or sickness cured by it for a time, the establishment of health is a very different thing, depending upon other powers and principles: The first may be and often is done by me- dicine, the other never. That their opinion of medi- cine is vain and ridiculous must appear, I think, very evidently to anyone who recollects that the art of physic has, now been practised, more or less regularly, above two thousand years; and most assuredly there is not yet discovered any one certain remedy for any disease. Ought not this to make us suspect that there is no such thing? How can it be, when different degrees of the very same disease require various, means and methods, and [11] and the same thing that in one degree would relieve, or perhaps cure, in another might kill? It is by plan, re- gimen, and successive intention, that diseases must be cured, when they are curable; or relieved and palliated when they are not. The skilful in medicine, and learned in nature, know well that health is not to be established by medicine; for its effects are but momentary, and the frequent repetition of it destructive to the strongest frames; that if it is to be restored, it must be by gently calling forth the powers of the body to act for them- selves, introducing gradually a little more and more activity, chosen diet, and, above all, peace of mind, changing entirely that course of life which first brought on the disease: Medicine co-operating a little. That this is the truth, all who know any thing of nature or art must know; and I may safely take upon me to say, that, though I firmly believe health may be restored in most cases that are not absolutely mortal, I am very sure that no invalid was ever made a healthy man by the mere power of medicine. If this be the case, how must the initiated, according as their humanity is touched, either laugh at or pity the poor foolish world, surrendering at diferetion to the most ignorant of quacks, pretending to infallible remedies which are not in nature. But what is still more ridiculous, the patients themselves are often so ashamed to own they have been deluded, that they favour the cheat, by pretending to relief which they never felt. I have collected a few materials for this work, which I intend to put in order, as soon as I can find time and industry enough to let about it in earnest; and, if I can finish it to my own satisfaction, perhaps I may some time or other trouble the world with it. At present I think myself particularly called upon to say something of the gout, as that disease was to make a considerable part of my plan; and, as I see now so many, and hear of more, who are throwing away, not only their money very foolishly, but, as I very believe, the future health of their lives also, in hopes of a medical cure for it, to shew [12] shew that such hopes are chimerical, and contradictory to every idea of true philosophy and common sense. I shall therefore take a few extracts from this general plan, sufficient to shew the real original causes of all chronic diseases; which, though they have been multi- plied without end, and numberless causes have been assigned them, are certainly not many, and their first causes very few. I think they may very fairly be re- duced to these three: Indolence, intemperance, and vexation. From one or more of these three causes, I have un- dertaken to prove that all or most chronic diseases are produced; for different diseases may have the same ori- ginal cause, the difference proceeding from the various degrees of strength and vigor in bodies; so that what would be gout in one, in another might be rheumatism, stone, cholic, jaundice, palsy, &c. The gout is mani- festly, and I think confessedly, a disease of the best con- stitution, and may therefore fairly stand as a represen- tative of all the rest; as such I shall consider it for the present, and speak of these causes in their order; but it may be necessary to say a word or two of the gout itself before we enquire into its cause. The gout is so common a disease, that there is scarcely a man in the world, whether he has had it or not, but thinks he knows perfectly what it is. So does a cook- maid think she knows what fire is as well as Sir Isaac Newton, It may therefore seem needless at present to trouble ourselves about a definition, to say what it is: But I will venture to say what I am persuaded it is not, though contrary to the general opinion. It is not he- reditary, it is not periodical, and it is not incurable. If it were hereditary, it would be necessarily trans- mitted from father to son, and no man whose father had it could possibly be free from it: but this is not the case, there are many instances to the contrary: It is therefore not necessarily so; but the father's having it in- clines or disposes the son to it. This is the causa proegu- mena or prœdisponent of the learned, which of itself never produced [13] produced any effect at all; there must be joined the causa procatarctica, or active efficient cause, that is our own intemperance or mistaken habit of life, to produce it; and accordingly, as this operates more or less, so will the gout be. Our parents undoubtedly give us constitutions similar to their own, and, if we live in the same manner they did, we shall very probably be troubled with the same diseases; but this by no means proves them to be hereditary; it is what we do our- selves that will either bring them on, or keep us free. If it were hereditary, it would appear in infancy and in women, which in general it does not. I may be told of some women who have had it. I believe never young, nor till they had contributed to it themselves; for women, as well as men, may abuse a good consti- tution. I have heard likewise of a boy or two out of a million that had it, or something like it; but these boys had been suffered to sip wine very early, and had been fed and indulged every way most unwholesomely. Those, who insist that the gout is hereditary, because they think they see it so sometimes, must argue very in- conclusively; for if we compute the number of children who have it not, and women who have it not, together with all those active and temperate men who are free from it, though born of gouty parents, the proportion will be found at least a hundred to one against that opi- nion. And surely I have a greater right, from all these instances, to say, that it is not hereditary, than they have from a few to contend that it is. What is all this, but to pronounce a disease hereditary, and prove it by saying that it is sometimes so, but oftener not so? Can there be a greater absurdity? Some men observing, in the circle of their acquain- tance, the children of gouty parents assisted with the gout, and often very early in life, though they are what they call temperate, conclude, not unnaturally, that the disease must be parental, and unavoidably transfused into their constitutions. If this were the case, it must be for ever incurable, and the sins of the father visited upon [14] upon the children not only of three or four, but endless generations to come. Diseases really hereditary, I fear, are never cured by any art or method whatever, as is but too true in the cases of scrophula and madness, and diseases of taint or infection, and maleformation. But here lies the error, their idea of intemperance is by no means just *: For some men require a greater degree, a stricter mode of it than others, to be kept in good health, I make no doubt but if the lives these gouty desendants lead were closely inquired into by real physicians, they would be found to commit many errors, and to sin often against nature's law of temperance, or to want that constant peace of mind or regular activity of body, which are as necessary as temperance, not only to keep off the gout, but to preserve health in general; and thus it will appear at last, that they have contributed to it more than their parents. If the gout be a disease of indigestion, and therefore of our own acquiring, we must reason very ill, or rather not reason at all, when we say it is hereditary; for surely no man will say that indigestion is hereditary, any more than intemperance. There are whole nations of active people knowing no luxury, who for ages have been free from it, but have it now since the Europeans have brought them wine and spirits. If the gout be thought hereditary, because it is incu- rable by medicine, the same may be said of every chronic disease, none of which ever are cured by it; I mean so as not to return again. When was there a man who, having had one fit of the rheumatism, stone, cholic, &c. however happily relieved by art for a time, had it, not again and again, or some thing worse in the place of it, till he became a confirmed invalid, and died long before his time, unless some very remarkable alteration took place in the course of his life to confirm his health? So it is in the gout; a man gets a fit of it, and by absti- nence, patience, time and nature, the crude acrimony producing it is subdued and exhausted, and he is re- lieved * See chapter of Intemperance. [15] lieved for that time; he might be so much sooner, and very safely too, by the assistance of art judiciously em- ployed: He recovers however, and in a few months is taken again. Why? Not from any thing inherent in his constitution, but because he returned to his former habit of life that produced it at first, and will for ever produce it, while the strength of his body lasts. The truth is, we breed it at first, we renew it again and again, and bring it on ourselves, by our own mis- takes or faults, which we would fain excuse, by throwing them back upon our parents, that our complaints may be more justly founded. And as bankrupts, undone by idleness and extravagance, for ever plead losses and misfortunes, so do we inheritance, to exculpate our- selves. It is natural enough for those who believe the gout hereditary, to think it also periodical, as if some thing innate and inherent in our constitutions produced it at certain times: But this is a great mistake; for, if it were periodical, it must be regularly so. The only pe- riodical disease I know, is the intermittent fever, which, till it be disturbed by the bark, or any other febrifuge, is as regular as a good clock. The returns of the gout are always very uncertain, according to the quantity or quality of accumulated indigestion within, and the strength of our bodies. I come now to mew that the gout is not incurable. If by the cure of it be meant the administering a pill or powder, or medicine of any kind to do it, I fear it is and ever will be incurable. It has been long and often at- tempted in vain, from the origin of physic to this day, from the first quack to the present. Indeed there is a most glaring absurdity at first sight, that must stop any man of common sense, who has the least insight into na- ture, or knowledge of the human frame: For, if the gout be the necessary effect of intemperance, as I hope to shew very evidently that it is, a medicine to cure it must be some thing that will enable a man to bear the daily in- temperance of his future life unhurt by the gout or any others [16] other disease; that is, some thing given now that will take away the effect of a future cause. As well might a medicine be given now to prevent a man's breaking his leg or his neck seven years hence. One would think the utmost that any rational man could expect from medicine was, that it should have power to relieve and remove present disorders, leaving the body quite free, without pretending to insure it from future injuries. Here lies the error: Men think the gout to be some thing latent in the body now, which, once well eradicated, would never return; not suspecting it to be no more than each day's indigestion accumulated to a certain pitch, that, as long as the vigor of life lasts, always brings on every fit, which once well over, the man has no more gout, nor seeds of gout in him, than he who never had it; and, if he did not breed it again, most certainly would never have it again. A proof of this is, that the gout has been often cured by a milk diet, which, as long as it lasted, has generally kept the patient free. But this method of cure I cannot approve, be- cause it relaxes and enervates the man, and does not sufficiently support the health and vigor of his body. Though I think the gout incurable by medicine, it is so far from being incurable in its nature, that I am firmly persuaded it may be more easily and more per- fectly cured than almost any other chronic disease; and this is another strong argument that proves it not here- ditary. My reason is, that it is confessedly a disease of the strongest and best constitutions, relieving itself by throwing off harsh and bad humours from the vitals, and out of the blood upon the extremities, where they do the least harm to the powers and principles of life and health; and as these humours can be nothing more than the daily accumulations of indigestion, if a man can live without breeding constantly this indigested acrimony, he must undoubtedly live free, not only from the gout but every other chronic disease also. And that he may live so, not in a perpetual state of mortifi- cation and self-denial, but with great ease and comfort to [17] to himself, in the truest, most philosophic luxury, I shall endeavour to prove, I hope to the satisfaction of all thinking, reasonable men. I have said, that Indolence, Intemperance, and Vexation, are the original causes of all or most of our chronic diseases; perhaps a few accidents must be ex- cepted, to which the strongest and healthiest are most liable; and the effects of fevers not happily ended; and which I except, to obviate all cavil and dispute with the men of art. I believe, to every considerate man, whose eyes have been opened so as to give the least insight into nature, the truth of this proposition will be so self-evident, that he must instantly perceive it; and every invalid that will be candid enough to do it, may fairly trace all his complaints up to one or other of these causes. But it may require some explanation to the generality of men, who are so short-sighted as never to look back or forward far beyond the ken of their nose, and therefore never see either distant causes or effects; and when they are sick seldom enquire more than for some cold or surfeit of yesterday, and to some such trifling cause impute diseases that last for life. An accidental cold, or even debauch, that happens but seldom can have no such effect; and men otherwise healthy, living in good habits, soon get rid of both. It is the constant course of life we lead, what we do, or neglect to do, habitually every day, that if right esta- blishes our health, if wrong, makes us invalids for life. Men ignorant of the ways of nature in the produc- tion and sopport of animals, not knowing what she re- quires to preserve them in health and vigour to their utmost period, have conceived very strange, and most assuredly very false ideas of diseases in general, and seem to think every disease a distinct kind of being or thing, and that there are medicines opposed to each, that will certainly remove and cure it. This makes them so solicitous to know the name of their complaint, which once ascertained, they think the remedy not far off. Poor men! Is not the gout sufficiently dis- C tinguished? [18] tinguished? But where is the remedy? Certainly not in the precarious skill of prescribing doctors, or the secret of ignorant and enterprizing quacks. They fancy too that there is great variety of constitution, with dis- eases unavoidably peculiar to each: That certain times of life must produce many, and that it is impossible to grow old without sickness of some kind or other. There is certainly no foundation in nature for any of these opinions, nor is there any real essential difference of constitution, but of strong or weak, and this is produced more by habit than nature. The strong by bad habits are made weaker, and by good the weak stronger. But the most delicate frames may be as healthy as the strongest, for the same reason that a squirrel may be as healthy as an elephant. There is no disease necessarily peculiar to any time of life, however the changes into the different stages of it may effect the valetudinary. And it is possible for men to live to great age without any disease at all, for many have lived to upwards of an hundred with uninterrupted health. Not from the natural defects of our constitutions therefore, but the abuse of them, proceed all our chror- nic diseases. That is, from Indolence, Intemperance, or Vexation. Let us now proceed to enquire what must be the necessary effect of one or more of these causes acting daily upon the body; whether in the strongest and most vigorous frames it must not be the gout; in weaker, rheumatism, cholic, stone, palsy, &c. or any, or all of the nervous and hysterical class. First, of Indolence, by which I do not mean insensi- bility, but an inactive habit of life, taking the word in the general common sense it is now used. OF INDOLENCE. IT seems to have been the design of Providence that all men should labour, every one for himself. That some are rich enough to purchase the strength and acti- vity of others is a mere accident with regard to indi- viduals, [l9] viduals, in which the care of Providence appears to be no otherwise concerned, than having unequally distri- buted those powers and abilities by which active and fiery spirits rise uppermost to preserve the harmony of subordination, without which society could never exist. The rich and great have so far forgot this first principle of nature, that they renounce all bodily labour, as un- worthy their condition, and are either too lazy or too inattentive to substitute exercise instead of it: Thus sacrificing health to indulgence and dignity, they do not enjoy those advantages their superior stations and fortunes give them; but in happiness fall often below the labouring hind. I remember to have seen a little book upon the origin of evil, in which labour is consi- dered as a great evil. The author must surely mean when it is excessive, and urged on to the wearing and wasting the body: for in general it is the first principle of good to mankind, and to none more than the labo- rious themselves. Does he mean that it would be bet- ter for us all, did the earth spontaneousty bring forth her fruits in such abundance, that we should no more la- bour or contend for them than we do for the air, and have nothing to do but bask in ease and riot in enjoy- ment? If so, I can by no means agree with him; for soon, very soon, in such a state of things, there would not be one healthy man upon the earth, and the whole race must quickly perish. Indeed I am afraid, not- withstanding all our unreasonable and unphilosophical complainings, the utmost wit of man cannot remove the least evil out of nature, without taking with it all the good. But begging pardon for this little digression, and to come back to my own purpose, I think he had been nearer the truth, had he put indolence in its stead, which is a source of great evil. Nothing undermines the foundation of all our happiness, the health and vigor of the body like it, or lays such a train of diseases to come. But I must endeavour to shew in what manner. It is upon the minutest and almost invisible parts of the body our best health, strength, and spirits depend: These [20] These fine parts, commonly called capillaries, are little pipes or tubes, the extended continuations of the larger blood vessels, through which the finest parts of the blood must constantly pass, not only to keep these very small channels always free and open, but also that the particles of the blood may in their passage be attenu- ated, broken, and rubbed into globules perfectly smooth and round, and easily divisible in still less and less, till they escape the sight assisted even by the microscope; which gives occular demonstration of this most amaz- ingly minute circulation. I have observed myself, and any curious patient man may see with a good micro- scope, in the pellucid membrane of any living animal, this surprizing minuteness. He may select and observe one single vessel, the smallest of those that convey red blood, many of which would not equal the smallest hair in size, through which the blood may be seen passing, not like a fluid, but a number of little red solid balls pushing one another on till they come to the extremity or ramification of the vessel, where it divides into two still less. There the first globule, stopping a little, and re- coiling, is pushed on again till it divides into two, and, losing its red colour, passes on in the smaller pipes fitted only to receive the serum, which undergoes the same circulation till it be refined into lymph, and this into still finer fluids; which, being thus prepared, escape into a subtility beyond all possible observation. Now the strength of the heart and arteries alone, in a seden- tary course of life, is by no means sufficient to keep up and perpetuate this motion through these capillaries, but requires the assistance and joint force of all the muscles of the body to act by intervals, compress the veins, propel and accelerate the circulation of the whole mass of blood, in order to force and clear these pipes, arid to triturate, cribrate, and purify the fluid passing through, forming every particle of it into a perfect globule, which is the form all the atoms of matter must take from much agitation. Without this extraordinary occasional aid, the little vessels would, by their natural elasticity, [21] elasticity, close up into fibres, or be obstructed by rough angular particles sticking in them, and stopping all passage. Numberless evils of the chronic kind, es- pecially all nervous diseases, owe their origin to this cause alone. Accordingly we see most of those who have lived for any time in a state of indolence, grow emaciated and pale by the drying up of these fine vessels; or, if they happen to be of a lax habit, having a good appetite, and nothing to vex them, they may be loaded with fat; but they grow pale withal, many of those fine pipes being nevertheless closed up; so that they appear bloated, and their fat unwholesome, having much less blood in their veins than thinner people. Hence we may learn why these languid pale persons upon the least motion become faint and breathless, the blood hurrying through the larger vessels yet free, and, like a crowd, obstructing its own passage, causing a dan- gerous suffocation. Or, if they have not been long in this state, nor the capillaries quite closed, they glow, especially young women, with a momentary red, the fine vessels being for that time expanded. Thus in- activity first forms obstructions in these exquisitely fine parts, upon which the health and vigor both of body and mind depend entirely, and lays the foundation of many diseases to come; which with other concomitant circumstances, such as a violent cold, excess of any kind, infection from without, or a particular disposition of the body within, prove often fatal to many in this habit of life, and which the industrious and active never feel. Now I would ask any reasonable person, capable of considering this operation of nature with the least glim- mering of philosophy, or even the attention of common sense, and most assuredly it concerns every man to con- sider it well, whether he can conceive it possible to sub- stitute any medicine to be swallowed, that shall act upon the blood and vessels like the joint force of all the muscles of the body, acting and re-acting occasionally in a regular course of moderate daily labour or exercise. Unless [22] Unless this can be done, I will venture to pronounce, that there is no such thing as a lasting cure, either for the gout or any other chronic disease. Yes, Sir, says a common practitioner, cordials, volatiles, bracers, strengtheners, will do this, will keep up an increased circulation. Possibly they may for a few hours, by doing mischief for many days; but their action soon subsides, and the stimulus ceases; they must therefore be repeated and repeated for life. Woe be to him that takes them, and to him that leaves them off, unless it be done with great judgment. While they act, they coagulate the juices, and corrupt the whole mass of blood; and when omitted, the patient must feel all the languor and horrors of a crapulary fever, after repeated debauch; and must have recourse to them again and again, like a dram-drinker, who cannot bear his ex- istence but in a state of intoxication. No, art can ever come up to nature, in this most salutary of all her operations. But these obstrustions from crude particles of the blood, and this inanition of the capillaries, are not all the evils' produced by indolence. That sprightly vigor and alacrity of health which we feel and enjoy in an active course of life, that zest in appetite, and refresh- ment after eating, which sated luxury seeks in vain from art, is owing wholly to new blood made every day from fresh food prepared and distributed by the joint action of all the parts of the body. No man can have these delightful sensations who lives two days with the same blood, but must be languid and spiritless. To introduce new juices, the old must be first thrown off, or there will be no room; there will be too great a ple- thora or fulness, the first cause of disease in many cases. In a state of inactivity, the old humours pass off so slowly, the insensible perspiration is so inconsiderable, that there is no void to be filled; consequently by degrees the ap- petite, which is the last thing that decays, that is the desire of supply, must daily diminish, and at last be to- tally lost. Here art can do wonders; it can procure evacuations; [23] evacuations; we can bleed, purge, and vomit; but then, to do any good by these, the case must be recent, before the humours are vitiated by too long a stay in the body, which will be the case very soon; for they are all in a perishable state, which makes their daily re- newal so essentially necessary to health; but then these artificial evacuations discharge all alike; the new, the middle, and the old juices; that is, the chyle, the blood, the serum, and lymph; and by this indiscriminate ac- tion make strange confusion in those that remain; whereas in nature's course there is a constant, regular transmutation and succession from one state to ano- ther; that is, from chyle into blood, and blood into serum, serum into lymph, and so on, till they are all in their turn, having done their office in various shapes, elaborated and ground to such a minute sub- tility and fineness, that, like wave impelling wave, they successively pass off in the vapor of insensible perspira- tion. In a state of indolence, they do not pass off either so soon or so regularly as they ought, because there, is not motion, nor consequently heat enough to throw off the vapor; they lodge in the body too long, grow putrid, acrimonious, and hurtful many ways, like the matter formed in an ulcer, which, while it is yet sweet, is more healing than any balsam the surgeon can apply; but, when confined, it soon becomes corrosive, and like a caustic eats its way all round in fistulas, to find vent. This shews the virulent acrimony of these confined and stagnating humours; hence the breath, and perspiration, what there is of it occasionally, of in- dolent people is never sweet; and hence in gaols, where these noxious vapours are collected and condensed from crowded wretches languishing in indolence, very ma- lignant and pestilential fevers arise. Perpetual blisters have been often thought, and some- times found, to be serviceable in draining off some of the superfluous juices before they are much corrupted, and making, by a faint resemblance of nature's action, a little more room for new; and it is for this reason they do [24] do any good at all, by increasing the general circula- tion, and forcing off a few of those humours that had circulated too long in the body, and were becoming acrid; for the quantity they discharge is so trifling that there could be no physiology, nor even common sense, in supposing the evacuation to be the benefit procured. By a vomit or a purge, the discharge is a hundred fold more, but the good obtained not always so great, be- cause by these the humours are indiscriminately thrown off, and much more of the new than the old. Many have used frequent bleeding to renew their blood, and I have known it answer very well to some, especially old people, who had been long accustomed to it, whom it preserved to great age; but then it must be begun in time, before the whole mass of humours be vitiated, and continued for life. Is it not strange that men should seek and prefer these violent artificial methods to the simple, easy, pleasant and constant action of nature, and chuse rather to take a vomit or a purge than a walk, and wear a perpetual blister, than make the least use of their limbs? Thus indolence must inevitably lay the foundation of general disease, and according to the constitution and a few concomitant circumstances, will be the kind of the disease; in the very best it may be the gout or rheuma- tism; in the weaker habits, cholic, jaundice, palsy, stone, &c. with all of the hysterical and hypochondri- acal class. In vain have ingenious men of reading and study, mental labour, and sedentary life, who are more subject to disease in general than the gay and thought- less, endeavoured to obviate the evil by abstinence, an excellent means of remedy in many cases, and which few practise but true philosophers, who are not the most likely to want it. But yet even they do not find it answer, and for the reasons which I have just given; that we cannot live two days in health and spirits with the same blood; there must be a new daily supply of that ethe- real part of our food called up to the brain to support its own, as well as the labour of the whole body. By [25] By this I mean the most elaborated, refined parts of all our juices, which constantly repairs and nourishes the smallest vessels and fibres; whether I may be allowed to call it animal spirits or not, is not so material. When- ever this æther fails, we must necessarily feel languor and lassitude both of body and mind; with this dif- ference, that in weariness of the limbs from, much action, the lees and coarser parts are thrown off also, and the first meal and first sleep soon supplies the defect. In mental labour the feculence remains to obstruct all appetite; there is no room, and therefore no call for supply; the whole man suffers and sinks. OF INTEMPERANCE. I COME now to speak of Intemperance; for Indo- lence, blunting all our sensations, naturally leads us to Intemperance: We want the whip and spur of luxury to excite our jaded appetites. There is no enduring the perpetual moping languor of indolence: We fly to the stimulating sensualities of the table and the bottle, friend provokes friend to exceed, and accumulate one evil upon another; a joyous momentary relief is ob- tained, to be paid for severely soon after; the next morning our horrors increase, and in this course there is no remedy but repetition. Thus, whoever is indolent, is intemperate also, and partly from necessity; and the evils necessarily following both these causes often make the rich and great more wretched than the poor, and the balance of happiness is held more equally between them; for however other things may be distributed, happiness, like water, always finds its level among men. I wish this observation might cure these of their envy, and teach the others how to enjoy their wealth. Before I return to my subject, I fear I must make an apology for what I am going to say, and hope no one will be offended, when I venture to say, that nine in ten of all the chronic diseases in the world, particularly D the [26] the gout, owe their first rise to intemperance. Many a good man, who piques himself upon being the most so- ber regular creature alive, and never eats but of one or two plain dishes, as he calls them, nor exceeds his pint of wine at any meal; keeps good hours, and never sleeps above eight or nine, may be surprised, if not affronted, to have his desease imputed to intemperance; which he considers as a great crime. And yet he is often ill, sick in his stomach, troubled with indigestion, and crippled by the gout. The case is, we judge of temperance and intemperance from our own habits, without any just idea of either. What we are used to do, and see others do, we think right, and never go up to nature for our knowledge. The bell way to explain what I mean by intemperance, may be to enquire what is nature's law of temperance, and to deviate from that must be consi- dered as intemperance. And here I must beg leave to observe, that temperance is a thing of which no English- man has or can have the least idea, if he judges from his own or his neighbours habits. To form some notion of it he must have seen other countries, particularly Spain, Portugal, or Italy, and observed how men live there. What they call temperance, or even tolerable living, with us would be thought downright starving, In this view temperance is local and comparative; but what I mean is natural temperance, not depending up- on place or custom (for I do not mean failing or absti- nence, which can never be salutary but after repletion) and we must not judge of it from countries where a piece of bad bread and an onion, with a draught of water, is thought a tolerable meal; nor from our own, where beggars live better than the nobles of some countries, and where we riot in the choice of plenty, na- tive and exotic, every day. To come then to my idea of it; I think there is an absolute, determined temperance, to be measured by every man's natural unprovoked appetite, digestion and consumption, while he continues in a good state of health, and right habit of life. As long as a man eats and [27] and drinks no more than his stomach calls for, and will bear without the least pain, distention, eructation, or uneasiness of any kind; nor than his body consumes and throws off to the last grain; he may be said to live in a very prudent, well-regulated state of tempe- rance, that will probably preserve him in health and spirits to great old age. This is nature's law; and the reverse of it, or indeed any great deviation from it, must be intemperance. When we eat without appetite, or urged beyond mo- derate satiety, provoked by incentives of any kind; when we drink without thirst, for the sake of the liquor. Indeed I cannot allow him to be strictly temperate, who drinks any wine or strong liquor at all, unless it be medicinally, or now and then for the sake of society and good humour, but by no means every day. Now let us compare this simple idea of temperance with the common course of most men's lives, and ob- serve their progress from health to sickness; for I fear we shall find but very few who have any pretentions to real temperance. In early youth we are insensibly led into intemperance by the indulgence and mistaken fondness of parents and friends, wishing to make us happy by anticipation. Having thus exhausted the first degrees of luxury before we come to the dominion of ourselves, we should find no pleasure in our liberty, did we not advance in new sensations, nor feel ourselves free, but as we abuse it. Thus we go on till some friendly pain or disease bids, or rather forces, us to stop. But in youth, all the parts of our bodies are strong and flexible, and bear the first loads of excess with less hurt, and throw them off soon by their own natural vigor and action, or with verv little assistance from artificial eva- cuations. As we grow older, either by nature in due time, or repeated excesses before our time, the body is less able to free itself, and wants more aid from art. The man however goes on, taking daily more than he wants,or can possibly get rid of; he feels himself re- plete and oppressed, and, his appetite failing, his spints sink [28] sink for want of fresh supply. He has recourse to dain- ties, sauces, pickles, provocatives of all sorts. These soon lose their power; and though he washes down each mouthful with a glass of wine, he can relish no- thing. What is to be done? Send for a physician. Doctor, I have lost my stomach; pray give me, says he, with great innocence and ignorance, something to give me an appetite; as if want of appetite was a dis- ease to be cured by art. In vain would the physician, moved by particular friendship to the man, or that in- tegrity he owes to all men, give him the best advice in two words, quœre sudando, seek it by labour. He would be thought a man void of all knowledge and skill in his profession, if he did not immediately, or after a few evacuations, prescribe stomachics, bitter spicy infusions in wine or brandy, vitriolic elixirs, bark, steel, &c. By the use of these things the stomach, roused to a little extraordinary action, frees itself, by discharging its crude, austere, coagulated contents into the bowels, to be thence forwarded into the blood. The man is freed for a time, finds he can eat again, and thinks all well. But this is a short-liv'd delusion. If he is robust, the acrimo- ny floating in the blood will be thrown out, and a fit, of gout succeeds; if less so, rheumatism, or cholic, &c. as I have already said. But let us suppose it to be the gout, which if he bears patiently, and lives moderately, drinking no Madeira or brandy to keep it out of his stomach, nature will relieve him in a certain time, and the gouty acrimony concocted and exhausted by the symptomatic fever that always attends, he will recover into health; if assisted by judicious, mild, and soft medicines, his pains might be greatly assuaged and mi- tigated, and he would recover sooner. But however he recovers, it is but for a short time; for he returns to his former habits, and quickly brings on. the same round of complaints again and again, all aggravated by each return, and he less able to bear them, till he becomes a confirmed invalid and cripple for life, which with a great deal of useless medication, and a few jour- nies [29] nies to Bath, he drags on, till, inspite of all the doctors he has consulted, and the infallible quack medicines he has taken, lamenting that none have been lucky enough to hit his case, he sinks below opium and brandy, and dies long before his time. This is the course I have lived to see many take, and believe it to be the case of more whom I have never heard of, and which any one may observe in the circle of his acquaintance; all this chain of evils is brought on and accumulated by indo- lence and intemperance, or mistaken choice of diet. How easily might they have been remedied, had the real cause been known and attended to in time. I believe I must here explain a little more fully what I mean by provoking the appetite, which I take to be the general mode of intemperance among men; for custom has made all kinds of incentives to excess so common, that those of daily use, far from being consi- dered in the class of intemperance, are by most people thought to be not only salutary, but necessary; and they never suspect the least evil from the common de- coraments of the table, salt, pepper, mustard, vinegar and yet, however extraordinary it may seem, I will ven- ture to pronounce, that excess in any of these must be doubly prejudicial to health; hurtful in themselves by their acrimony, they provoke the appetite beyond na- tural satiety to receive an oppressive load, which the stomach itself would soon feel, were it not artificially stimulated to discharge it into the blood by wine and strong liquors immediately after. Thus one error brings on another, and when men have eaten too much, they drink too much also, by a kind of necessity. He will certainly be a healthier man, who is very moderate in the use of these things, than he who exceeds; they may be sometimes useful as medicines, but can never add to the wholsomeness of our daily food. To give some weight to what I say, there are whole nations in the world that have never known any of them, and are healthy, strong and vigorous. I do not mean by this to proscribe them entirely, especially salt and vinegar; but only to recommend great moderation. If [30] If this be true of the common provocatives at every poor man's board, who is there that exceeds not nature's law? Who is truly temperate? What shall we say of that studied, laboured, refined extravagance, at the tables of the rich, where the culinary arts are pushed to that excess, that luxury is become false to itself, and things are valued, not as they are good and agreeable to the natural and undebauched appetite; but high, inflammatory, rare, out of season, and costly; where, though variety is aimed at, every thing has the same taste, and nothing its own. I am sorry, and ashamed, that men professing luxury should understand it so lit- tle, as to think it lies in the dish, or the sauce, or the multitude of either; or that urging beyond natural sa- tiety can afford any real enjoyment. But this they do by all the researches of culinary and medical art, in- troducing all the foreign aids to luxury, every stimulat- ing provocative that can be found in acids, salts, fiery spices, and essences of all kinds, to rouse their nerves to a little feeling; not knowing the more they are chafed and irritated, the more callous they still grow; and the same things must now be more frequently repeated, in- creased in quantity, and exalted in quality, till they know not where to stop, and every meal they make serves only to overload and oppress the stomach, to foul and inflame the blood, obstruct and choak all the ca- pillary channels, bring on a hectic fever of irritation, that though it raises the spirits for the evening, leaves behind it all the horrid sensations of inanition and cra- pula the next morning; and but that nature is so kind as to stop them in their career, with a painful fit of the gout or some other illness, in which she gets a little re- spite, they would soon be at the end of their course. Men bring all these evils upon themselves, either not knowing or not attending to two things: The one, that pleasure is a coy coquet, and to be enjoyed, must hot always be pursued; we must sometimes fit still, that she may come and court us in her turn; the other, that pleasure and happiness are as distinct things as riot [31] riot and enjoyment: Besides, pleasure is not infinite, and our sensations are limited: We can bear but a cer- tain measure, and all urging beyond it, infallibly brings pain in its stead. Let the men of high experience bear me testimony, that this is true of all the luxuries of the table, wine, music, women, and every sensuality. These men may tell me, perhaps that I have made a fine declamation against luxury and intemperance: but what is this to the purpose? They desire not to be told of their faults, nor to hear disagreeable truths which they know already. Have I no art or skill to reconcile health and luxury, no remedy, no rare secret to repair and restore sensation, and vigour worn to rags? No Medea's kettle to boil anew? If not, do not describe to us a life of moderation, temperance, and exercise: It is not worth having upon these terms. I am aware of the unreasonable expectations of many, that their de- mands would rise high, some of them to the impossible. At present I am only setting forth the causes; when I come to talk of remedy, I will endeavour to convince them that the artificial helps they expect are not in na- ture, but that there are in nature ways and means by which many gouty, broken constitutions, that have been despaired of, might be repaired and restored to a very desirable degree of health and enjoyment. But I must first say a word or two to the intemperate or mis- taken in the middle class of life. In England all degrees of men are furnished with the means of intemperance, and therefore it is no wonder that most men are intemperate. If they are less so in other countries, it is not that they have more virtue, but they want the means: their oppressive governments, the precarious state of property, and their superstitious religion keep them so poor, that luxury is not in their power. They have, however, this advantage from their poverty, that they are much less afflicted with chro- nic diseases than we are. I verily believe there are more gouts in England, than in all the rest of Europe: a proof that good living is more universal. But not to the [32] the advocates for this good living do I wish to address myself; I fear they will be as incorrigible as their su- periors in higher and more refined luxury. But there are some not intemperate from choice but example, habit, custom, or mistake, not knowing their daily diet to be unwholesome, and productive of their dis- eases. To these it may be of some use to have the un- wholesome pointed out, and their choice directed to better things. Men of laborious occupations, who work in the open air, can and do bear great excesses, and much unwholsome diet without much hurt: I never knew a sick or gouty gardner that was not a remarkable sot. But men of sedentary trades and business, shop- keepers of all kinds, feel much sooner and more heavily the ill effects of intemperance or mistaken choice in their meat and drink. Their first care therefore ought to be, not to add the diseases of intemperance to those of inactivity, but proportion what they take, as well in quantity, as in quality, to their consumption. But let us see how well they do this. They all say they live upon plain things, and never indulge in made dishes; but they will eat heartily of a goose or duck, with a large quantity of sage, onion, pepper and salt, a pig with similar preparations, and a hare with higher and more compounded seasoning. Do they ever eat veal without stuffing, or even a leg of mutton without caper- sauce? If ever they eat a steak or a chop, if it is some- times without pepper, I believe it is never without pickles, the worst of all poisons. They are surprised that such meals should rise on their stomachs with flatu- lence, sour and bitter hiccups, and eructations, which, if they did not keep them down with a sufficient quan- tity of wine, or sometimes a dram, they would be troubled with all the time of digestion. If this method succeeds so far as to quiet their stomachs for the pre- sent, they go on with it, regardless or ignorant of fu- ture and distant consequences. Thus are these sharp, harsh, hot and inflammatory things forced out of the stomach into the blood, before it has had time to dilute and [33] and subdue, or reject them, and the superfluous load they bring along with them. And thus is laid the foun- dation of every disease, that appears when these acrid and fiery particles are accumulated in the blood to a certain degree. There are others, whose pretensions to plain diet may seem better founded, but who nevertheless eat, and are fond of, things unwholesome, and very unfit for men of sedentary lives; such as salted and smoaked flesh and fish of all kinds, hams, tongues, heavy flour puddings, toasted cheese, &c. all which are of such hard and in- dissoluble texture, that they never dissolve well in the stomach of a ploughman: The same salt, seasoning, and smoke, which harden and preserve them from pu- trefaction before they are eaten, keep them from disso- lution afterwards, so that they are never digested at all; nor is it possible any good nourishment should ever come from them: The salts they contain are indeed melted in the intestinal juices, and get into the blood, producing, in the best constitutions, those tettery, itchy, or scaly eruptions, commonly, but very errone- ously, called the scurvy, which is quite another kind of disease. To this kind of food is owing the bad health of country people, and their children's rickety heads and limbs, and big and hard bellies. Another capital mistake many people fall into, who, in other respests, are very moderate in their diet, is, that the flesh meat they eat is always over-done; if boil- ed too much, the juices are lost; if over-roasted, fried, or broiled, the action of the fire continued too long, changes the mild animal flesh into something of another quality; the fat is made bitter and rancid, which fire will always do by the sweetest oil; and the scorched outside of the lean, dry and acrimonious: The less, therefore, all flesh-meat undergoes the power of fire, the milder and wholesomer it is. I do not mean by this to recommend the customs of cannibals and Tartars, who eat raw flesh, or beasts of prey, that devour animals alive; but it may be observed, that the first are free E from [34] from our diseases, and the others amazingly strong and vigorous. We may learn this from them at least, that our meat cannot be the wholesomer for being, as some call it, thoroughly done; arid that we should learn to like it with some of its red juices, unspoiled by the fire. Upon this principle the English cookery is to be preferred to the French, who stew and roast to rags; and of all English cookery broiling must be the best. This leads me to another observation, which perhaps none but physicians, or those who have studied well the nature of man and his ailments, are able to make. It is this: That men being born to devour most of the fruits and animals of the earth and water, there ought to be a certain proportion of animal and vegetable sub- stances in his food; the animal tending spontaneously to putrefaction, the vegetable correcting that tendency from going too far; thus from the due mixture of both qualities results that neutral property, equally distant from acid as alkali, that is essentially necessary to pro- duce good blood. This is so manifest, that whoever will observe attentively may see, whenever either of these prevails in the body, there is so strong a desire and longing for things of the other sort, as well as pleasing sensation in the palate and stomach when they are taken, as plainly indicate the natural want. Let a man have lived long upon flesh-meat wholly, he will have a most eager appetite for fruit and vegetables; and if kept too long without them, as is the case with those who have lived some time at sea, will grow sick of the real scurvy; but if before they are too far gone they reach the land, they will eat the first common grass they can come at, with more avidity than a horse or ox, and be perfectly cured by it. In like manner, they who have lived long upon vegetables (which regimen is often prescribed to invalids, especially in the gout) will have great craving for flesh-meat. We ought to learn from all this to at- tend diligently to the calls of nature, and balance the mixture with due proportion, not only that our vitals may have the less labour in preparing and making our juices [35] juices fit for nourishment, but to prevent the diseases that are peculiar to the predominancy of either. And here I may observe, that the error of most men's diet in every class of life is, that the acid, erude and austere, almost always abound; not that they do not eat flesh- meat enough, but they spoil it in the preparation and cookery, changing its animal nature into something worse than vegetable, taking off entirely all its tendency to dissolution and putrefaction, by salting, smoaking, pickling, potting, and preserving things that in their own simple nature would soon corrupt and dissolve; but by these preparations are hardened and embalmed to keep for years like mummies. The same may be said of every kind of made dishes; the salts, spices, hot herbs and acids, with which they are seasoned and com- pounded, preserve and harden them to keep for ever; the sauces and gravies they swim in have the same effect as so much pickle. The things we feed upon ought all to be in a perishable state, or they will never furnish the materials of good blood; and whatever is hardened or seasoned so as to keep long before it be eaten, ought not to be eaten at all, for it will never dis- solve in the stomach. The nature of most chronic diseases, and their first symptom, heart-burn, as it is commonly called, plainly shew the original cause to be acid crudity prevailing in the juices, producing coagulations, concretions and ob- structions of various kinds; all which are very manifest in the gout, rheumatism, stone, and most nervous cases; The remedies also, that sometimes relieve and palliate, confirm this; such as the volatile alkalies, hartshorn, salt ammoniac, testaceous powders, soap, &c. Many may be surprised at this, and say, it cannot be; for, though they have these diseases, they take little or no acids; but there are many things they take that are acescent, that is liable to become acid, especially by the heat of the stomach. This they are not aware of; but they are in their nature much more prejudicial than things already sour: For, besides that people take not these [36] these in any quantity, the acescent never becomes sour but by the act of fermentation, which, being raised in the stomach, where it ought never to happen, produces strange tumults, wind, vapour, gas, that is, the fume arising from fermenting liquors of any kind, which has been known sometimes to kill at a stroke. It may here be necessary to enumerate some of those things called acescent: These are sweets of every kind, puddings, cakes, paltry, creams, confections, &c. and every thing made of flour, especially fermented; bread in particular, so far from being, the wholesome thing many imagine, is not only unwholesome, by its acescency, but, by the strong ferment it contains, whenever it predo- minates, it forces into fermentation every thing capable of it, that it meets with in the stomach *: The bread of London I fear is particularly so; partly by being robbed of its bran, which in some degree would soften and correct it, but chiefly by having in it, besides its usual ferment, a great quantity of sour allum, most ab- surdly added to make it unnaturally white,† Many eat bread from principle, and like it by habit; take a slice between meals, and with their fruit, as a corrector; and think a bit of bread and glass of wine a most abste- mious excellent supper, I think, they are mistaken in all this, and that bread ought to be eaten but sparingly, and for want of other and better vegetables. In this light we must also consider most sorts of seasonings, stuffing, force-meats, and compounded sauces. But the greatest acescent, or rather bane of all, high. and low, rich or otherwise, whoever they are that take it constantly, is wine; wine alone produces more diseases than all the other * Whoever requires proof of this, may have it by the following experiment: Put a common toast into half a pint of water, and let it stand six or eight hours near the fire, so as to be kept in the heat of the human stomach, and it will be sour as vinegar. † To be convinced of this, boil a pound of common London bread in a sufficient quantity of water to make it thick as gruel. Let it stand to subside; pour off the clear, and boil away all the water; the allum will be found at the bottom, mixed with a little common salt. [37] other causes put together. All men allow that wine taken to excess is hurtful; they see the immediate evils that follow; but distant effects, that require more de- ducive observation, very few see of believe; and judg- ing from present and agreeable feelings, they say that a little wine is wholesome, and good for every one, and accordingly take it every day, give it their children, and teach them to like it, by debauching their natural taste in the earliest infancy; thus they come to relish it by habit, and to be uneasy without it, like snuff-takers without their tobacco: The want is equally habitual and unnatural in both cases; for the stomach wants wine no more than the nose does snuff; the immediate sensation of both, after a little use, is pleasant; but the remote effect of wine taken constantly, is infinitely more pernicious than of the snuff. This hurts the nose only; the other, accumulating a little indigestion every day, corrupts all the juices of the body most essentially. And though it be often taken with a view to promote digestion, and assist the operations of the stomach, it manifestly does harm to both. Instead of digesting and dissolving, it hardens, and prevents dis- solution, and curdles and corrupts the milky chyle and first juices produced from our food. It warms indeed and stimulates the stomach to greater exertion than is natural or necessary, and thereby enables it to discharge its contents the sooner; whence that agreeable feel of warmth and comfort from its immediate action. But by this extraordinary action it forces our food out of the stomach too soon, before it is softened, dissolved, and properly prepared, and sends it into the bowels crude, hard, and austere, in that state to be carried into the blood, there to produce every kind of disease. Whatever therefore the advocates for a little wine every day may think, or argue in favour of it, they are most undoubtedly in a very great error, and it were certainly much better and safer to drink a bottle and get a little merry once a week, drinking water only or small-beer at all other times; in which interval nature might to- tally [38] tally subdue it, and recover entirely. Water is the only liquor nature knows of or has provided for all ani- mals; and whatever nature gives us, we may depend upon it, is safest and best for us. Accordingly we see, that when we have committed any excesses or mistakes of any kind, and suffer from them, it is water that re- lieves. Hence the chief good of Bath, Spa, and many other medical waters, especially to hard drinkers. It is the element that dilutes and carries off crudities and indigestions, &c. the mineral virtues they contain may make them tolerable to the stomach in their passage, but do, as I believe, little more in the body; it is the water that cures. Wine, if it be not of our own inven- tion, was given us as a cordial in sickness, weariness, sorrow, and old age, and a most salutary charm it would be for most of these evils, did we not exhaust its power by daily use, and instead of taking it as such, drink it up as common draught in youth and health to make us mad. I know this is a very tender topic to touch up- on, and too favourite a pleasure to argue against, with any reasonable hope of convincing; most men having so indulged themselves in this bewitching habit, that they think they cannot live without a little wine every day, and their very existence depends upon it; their stomachs require it, nature calls for it, St. Paul ad- vises it, it must be good. Thus men catch at every shadow of an argument that favours their inclinations, St. Paul advises it as a medicine sometimes, but cer- tainly not every day. There is no medicine I know of, that, taken every day, will not either cease to act entirely, or by acting too much, do harm. It will be said, that many drink wine every day without gout, stone, or any disease at all in consequence of it. I be- lieve not many, or I should know some of them. If any are so strong as to bear it to old age unhurt, they must be very active as well as strong to subdue it. But I have nothing to say to these; my business is with in- valids who complain, and certainly ought not to mea- sure constitutions with those above their match. The same [39] same arguments will hold equally in favour of every other bad habit. Your nose will want its snuff, your palate its spices: and when the fashion was for women to be small waisted, their galled sides grown callous by the long compression of the stays wanted their support. Nature, like a true female, cries out at the first violence, but submits in time, is reconciled, and grows fond of the ravisher. But it is the business of philosophers to distinguish carefully between the real wants of nature and the artificial calls of habit; and when we find these begin to hurt us, we ought to make the utmost perse- vering efforts to break the enchantment of bad customs; and though it cost us some uneasy sensations at first, we must bear them patiently; they will not kill, and a very little time will reconcile us to better modes of life. There is another capital mistake many labour under in the choice of their wine, preferring the strong, hot, and coarse sorts, Madeira, Port, Mountain, &c. to the milder, more elegant, and certainly less unwholesome French and Italian wines, accounting them better for the stomach, and good against wind, &c. My obser- vation has been, that they who use these strong stomach wines to cure wind are never free from it, and all the gouty disorders of indigestion. Indeed, it cannot well be otherwise; for there is nothing so repugnant to na- tural digestion as the use of these strong liquors, which, instead of dissolving, harden every thing; and thus for ever, when the first warmth is gone off, leave a crapu- lary, crude, sour load of yesterday, to ferment, fret, and irritate the stomach and bowels every day. Thus have I endeavoured to point out two of the true, primary, capital causes of the gout, and most other chronic diseases; and most sincerely with that what I have said may engage those whom it mostly concerns, the gouty, the infirm, and valetudinary of every class, to observe, reflect, and think for themselves, upon the hints I have thrown out; in which light what I have said, must be considered, rather than as logical or demonstrative proof. I know the reasoning and arguments [40] arguments may be much improved and carried farther, and if I had more leisure I might have attempted it; but I am well aware of the unsurmountable difficulty of convincing men against their will by any arguments at all. I choose therefore at present to invite them to self-conviction, from their own observations and expe- rience. I flatter myself they will find it well worth their pains, to reason a little more than they do with and for themselves; and it will be a great point gained for them, if it turn their milled opinions from all that imaginary power of restoring health in any of that mul- titude of ridiculous and most truly contemptible medi- cines, that are daily obtruded upon the public, with end- less lies to recommend them, by a set of the poorest, most ignorant, and paltry rogues in the nation; and engage their attention to their true remedy, a right in- stitution of life. In judging of which, if they find themselves unequal to the task, they may be assisted by men of humanity, skill, and honesty. OF VEXATION. I COME now to the last general cause of chronic diseases, Vexation. A very fruitful parent of many bodily evils, producing generally diseases of inanition, much more difficult, not only to be cured, but relieved, than those we suffer either from Indolence or Intempe- rance. But as it is not so common a cause of the gout as the other two, it may not be necessary to consider it very minutely at present. I shall not therefore enter deeply into the regions of metaphysical conjecture, nor run wild after my own conceits, or theirs who have gone astray before me, in guessing at the incomprehen- sible union of soul and body, and their mutual powers of acting upon each other, I shall content myself with observing only, what may be of some use, that every great degree of vexation, whether in the shape of anger, envy, resentment, discontent, or sorrow, has most destructive [45] destructive and deleterious effects upon the vitals of the body, whether sudden and violent, or slow and lasting. The first immediate effect of violent grief or vexation is to take off the action of the stomach entirely. Let us soppose a man, in the best health, the highest good hu- mour and spirits, as well as good stomach, sitting down to dinner with his friends, receives suddenly some very afflicting news. Instantly his appetite is gone, and he can neither eat nor swallow a morsel. Let the same thing happen after he has made a hearty, chearful meal, as suddenly the action of his stomach, the whole power of digestion, is cut off totally, as if it were become pa- ralytic, and what he has eaten lies a most oppressive load. Perhaps, as the excess of weakness is often con- vulsion, it may be rejected by a violent vomit, or do greater mischief. For which reason such strokes of distress are less hurtful received upon an empty than a full stomach. But why is this? What connection is there between a piece of bad news and a man's stomach, full or empty? Whatever the cause be, the effect is certain and invariable. Is it because the animal spirits, or the action of the nerves, whatever be the secret cause of their power, is called off to supply and support the tumultuous agitation of the brain, and the stomach, with all its appendages, and their secretions, is left powerless and paralytic, and must therefore either act convulsively, or not at all. Besides this pernicious effect of perverting the natural action of the stomach and intestines, the whole circula- tion of the blood is disturbed. The contraction and dilatation of the heart, that is, the alternate action by which it opens to receive the blood from the veins, and closes again to force it out through the arteries, Which operations ought to be as true and certain as the vibrations of a pendulum, are broken and uneven; the heart flutters, palpitates, now is overloaded with blood, and in danger of suffocation, now receives none at all; consequently all the secretions must be as irregular, F some [42] some of the glands receiving too abundant a supply, that either hurries through, or oppresses and overpowers them, others none at all. Hence that hasty gushing of pale limpid urine in amazing quantities, those sudden bursts of unmeaning tears; sometimes great dryness and choaking thirst, sometimes the overflowing of the mouth with water instead of saliva, and many other nervous and hysterical affections, fits, syncope, epilepsy, &c. all which indicate the greatest tumults and per- turbations in the inmost recesses of the nervous and vi- tal frame. Many kinds of disease have sprung from this fountain, of such unaccountably horrid and terrify- ing appearances, that formerly they could no otherwise account for them, but by the malefice of sorcery, and the immediate possession of devils. In flower, more silent, but longer continued grief, the effects are similar, but not so violent. Many little strokes repeated will do the same thing in time that a great blow does at once. The function of the stomach will be more gently disturbed and perverted, its juices vitiated, and all its contents will forever turn sour, bit- ter, or rancid; so that no mild milky chyle, or wholesome material of nourishment, can ever come into the blood. The patient must languish with cachectic inanition, uni- versal bad habit of body, or pine and waste with atro- phy, the want of nourishing supply, whence arise com- plications of various diseases succeeding each other, always from bad to worse; and unless he can subdue his anxiety, and restore peace of mind, he must in time sink under it, and die, as it is said, of a broken heart. Whoever is vexed long, must certainly want nourish- ment; for, besides the disturbed state of the stomach, its broken appetite and bad digestion, from whence what, supply there is must come not only ill prepared, but vi- tiated into the blood; there can be no sleep in this state of mind; the perturbed spirit cannot rest; and it is in sleep that all nourishment is performed, and the finer parts of the body chased and worn with the fatigue of the day, are repaired and restored to their natural vigor. While [43] While we are awake this cannot so well be done; be- cause the incessant action of the body or mind, being always partial and irregular, prevents that equal distri- bution of the blood to all parts alike, from which each fibre and filament receives that share or portion that suits it best. In sleep, when it is quiet and natural, all the muscles of the body, that is, all its active powers that are subject to our will, are lulled to rest, composed and relaxed into a genial, temporary kind of palsy, that leaves not the least obstruction or hindrance of the pas- sage of the blood to every atom. Accordingly the pulse is always flower and more equal, the respiration deeper and more regular, and the same degree of vital warmth diffused alike through every part, so that the extremities are equally warm with the heart. Vexation operating in this manner upon the organs of digestion and concoction, and disturbing and ob- structing the natural progress of nutrition, must often produce diseases similar to those of long-continued in- temperance; its first effect being indigestion, with all its symptoms, wind, eructation, heart-burn, hiccup, &c. It is no wonder therefore it should sometimes bring on a fit of the gout (which, as I have said, is manifestly a disease of crudity and indigestion) and often the gout in the stomach and bowels. Indeed most cold crude cholics are of this kind. Schirrous concretions will also be formed in the spleen, liver, glands of the mesen- tery, and throughout the whole system of the belly. Many of these indurated tumours will appear out- wardly, so as to be felt by the hand; these in time will degenerate into cancers and cancerous ulcerations, and many fatal evils, not the least of which, in my opinion, is, that the patient will suffer a long time before he dies. All the passions, when they are inordinate, may have injurious effects upon the vital frame; excessive joy has sometimes given a fatal blow, and sudden bursts of laughter done great mischiefs, especially to delicate or weakly people, who have often been thrown into spasms, cramps, convulsions, hysteric fits, and hæmorrhages, by them. [44] them. But as I think the word Vexation comprehends the chief of those passions that hurt us most, and mean not to make a metaphysical enquiry about them, it is needless to be particular upon each. It may suffice to have shewn the immediate and remote influence of vex- ation upon the human body. Whatever men may think of their diseases, their strange symptoms and appearances, and their unac- countable causes, these are the three original great sources of most of the chronic diseases of mankind; which I have endeavoured to set forth and explain in so familiar a manner, that I hope I have been perfectly intelligible to every one who will venture to think and judge for himself. To such rational people only I ad- dress myself; and to enable them to do this the better, I have furnished these hints and observations, which maybe extended, improved and applied to particular cases. I want not, nor wish to obtrude my ideas upon any man, however warranted I may think myself from the observation and experience of my whole life; my principal aim has been only to make men stop a little in, their career, and consider with themselves whether it may not be possible for them to be mistaken, even in, that course of diet and those habits of life which they never suspected. If they are ill, and for any time, there must be a more substantial cause for it, than, they are in general willing to allow. It is not always catching cold, for we do not catch cold so often as we think we do; and when a healthy robust person takes cold, which can happen but rarely, if this be the whole of the disease, it cannot last long. But the truth is, when the crudity, superfluity and acrimony of an indo- lent, intemperate life have accumulated to such a de- gree as to make us sick, then we say we have taken cold, or complain of a bad constitution, when we have, spoiled perhaps a very good one; or with Sydenham, that the epidemic constitution of the air has infected us, or that this or that trifle has disagreed. I am fully and firmly persuaded, that whoever will reflect with some degree [45] degree of intelligence and sanity, be just to himself, and candid with his physician, will in general be able to trace his complaints and diseases up to one or other of these three causes. And whoever does this, must in- fallibly see how vain and idle all his hopes and expec- tations of lasting remedy and established health must be from any kind of quack medicines, or indeed the common and too general practice of physic, when the whole is rested upon something given to swallow; how inadequate the means are to the end proposed and hoped for; how ill vomiting and purging can supply the place of temperance; bleeding, blistering, and all artificial evacuation, of activity; cordials and opium, of peace of mind. Is not this to fill the body with harsh and un- wholesome juices, and then tear it to pieces to get them out again? To make artificial holes and sores in the skin, to renew the blood and discharge superfluities, instead of employing muscular motion to rub off and grind down all the acrimony of angular aculeated par- ticles, and make them smooth and round, and easily divisible; and to employ intoxication and stupefaction to take off the sense of pain, and leave the cause where it was, or fix it faster? Can any reasonable person hope for health or long life by any of these unnatural methods, when these only are employed? Let him look round among his neighbours and acquaintance, and tell me whether, not only all the gouty, but rheumatic, cho- licky, jaundiced? paralytic, dropsical, hysterical people he has ever seen, are not either always so, or by fits so; and whether those returning paroxysms or fits of these disorders do not always grow worse and worse, in spite of all their medication and quackery, till a complica- tion or apoplexy comes on, that at last, though long before their time, puts an end to their miserable lives. These evils are considered as the inheritance of human nature, unavoidable and incurable, and submitted to in absolute despair, though there has not one rational at- tempt, that I know of, ever yet been made to remedy them in earnest. All the methods hitherto employed have [46] have only been to relieve, and those often so perni- ciously, that the future health has been sacrificed to ob- tain present relief or ease. This must forever be the case, when in chronic cases it is obtained by art, and nature has no share, or where the physician does all, and the patient nothing for himself. Of the Cure of the Gout, and all other chronic Diseases, and the Repair of a broken Constitution. HAVING set forth the real causes of the Gout, and all its congenial diseases, I come now to the most essential part, to administer all possible com- fort to those whom great pain and long suffering may have made attentive and docile, and willing to take health upon the terms it is possible to have it. To the young and voluptuous, who are yet in their career, and declare for a short life and a merry one, I have nothing to say but this, that a short life is very seldom a merry one; on the contrary, is generally made up of a few years of riotous pleasure without happiness, to be se- verely paid for by as many more of pain, sickness, re- gret and despair. Having shewn that the gout is not hereditary, nor in- herent in our constitutions, but produced by the daily accumulations of indigested, unsubdued acrimony and superfluity, which, when they abound to a certain de- gree, must end either in a fit of the gout or some other disease, according to the constitution, as long as any vigor is left in the body; for nature will forever free, or endeavour to free itself, and purge the blood of its impurities by gout, by fever, by pain of one kind or other, that takes off the appetite, and for a time gives respite, and prevents the pouring in of more and more enemies to disturb its operation, and make it ineffec- tual. Thus young people, after a fit of gout is happily and [47] and well gone off, are as free from it as if they had never had it; and if they would take warning and be careful not to breed it again, most certainly would forever re- main free. How absurd therefore, how ridicuously ignorant must be every attempt to cure the gout in futuro by medicine, before it be yet formed, before it has any existence! Can such a medicine give super- natural strength, and enable an old man living in in- dolence to digest and consume, or discharge the super- fluities of his daily intemperance? That is, to give him more vigorous powers than nature gave him at one-and-twenty, or when the gout came first upon him. The Duke of Portland's powder promised to do some- thing like this, and most certainly kept off the gout for two or three years. But what was it? And what did it really do? It was a strong spicy bitter, taken in substance, in a large quantity, for a long time; its effect was to keep up a constant fever as long as it was taken; this kept the gouty matter always afloat, and prevented its fixing any where. But there was no living long with a constant fever; accordingly many of those who took it died very soon. I myself observed between fifty and sixty of its advocates, some my patients, some my acquaintance or neighbours, who were apparently cured by it for a little while; but in less than six years time, omnes ad internecionem cæsi, they all died to a man. Many similar attempts have been made with other medicines to cure not only the gout, but most other chronic diseases, and with the same fatal effects, An- timony and mercury, elaborated into poisons by che- mistry, have been administered, particularly the solu- tion of sublimate, has torn many a stomach to rags, so that it could never bear common food afterwards. The deadly night-shade, and hemlock, and many such dreadful poisons, have been given as alteratives to re- store health. The intention here seems to be, kill or cure, to raise a violent agitation or fever in the body, in hopes it may prove strong enough to throw off the disease and medicine together. The effect has ever been, [48] been, notwithstanding a little apparent and deceitful relief may have been perceived from the first efforts, that it has sunk under both loads, and, exhausted by repeated straining, much sooner than by the disease alone. Can any one in his senses suppose that diseases a man has been his whole life contracting, and to which he is adding every day by perseverance in unwholesome diet, and bad habits, are to be thus removed by a coup de main ou de baguette. Or that they will not return, be they cured or conjured away ever so often, whilst he continues the same mode of life that brought them on at first? What then is to be done? How and in what manner are chronic diseases and cachexies to be cured, and health restored and established? I have already shewn that the causes of these evils are Indolence, Intemperance, and Vexation; and if there be any truth or weight in what I have said, the remedies are obvious: Activity, Tempe- rance, and Peace of Mind. It will be said the reme- dies are obvious, but impracticable. Would you bid the feeble cripple, who cannot stand, take up his bed and walk? The man who has lost all appetite, abstain? And the sleepless wretch racked with pain, enjoy peace of mind? No certainly; I am not so absurd. These must be assisted by medicine; and if they have not ex- hausted all its power already, a little respite, a favour- able interval may be obtained, that, with other artifi- cial aids co-operating, may be greatly improved to their advantage, and if rightly employed, they may get on from strength to strength, till they recover into per- fect health. But it is not my design at present to ex- patiate upon that particular kind of medical relief which every chronic case may require; it would lead me into too wide a field, and too far from my present purpose, which is to shew that the gout, in most of its stages and degrees, may be cured, a present paroxysm or fit re- lieved, its return forever safely prevented, and the pa- tient established in perfect health. Let [49] Let us suppose the case of a man from forty to fifty years of age, who has had at least twenty fits of gout, by which most of his joints have been so clogged and obstructed, as to make walking or any kind of motion very uneasy to him; let him have had it sometimes in his stomach, a little in his head, and often all over him, so as to make him universally sick and low-spirited, espe- cially before a regular fit has come to relieve him. This I apprehend to be as bad a case as we need pro- pose, and that it will not be expested that every old cripple, whose joints are burnt to chalk, and his bones grown together and united by anchylosis, who must be carried from his bed to his table and back again, should be proposed as an objest of medication and cure; and yet even he might perhaps receive some relief and pal- liation in pain, if he has any great degree of it, which is not very common in this case. Let us therefore sup- pose the first example. If the point be to assuage the violent raging of a present paroxysm; this may be safely done, by giving some soft and slowly-operating laxative, neither hot nor Cold, but warm, either in small doses repeated, so as to move the patient once or twice in twenty-four hours, or by a larger dole oftener in less time, according to the strength and exigency. This may be followed by a few lenient absorbent correctors of acrimony, or even gentle anodynes; proper cataplasms may also be safely applied to the raging part, which often assuage pain surprizingly; with as much mild and spontaneously dis- solving nourishment as may keep the spirits from sinking too low; but I would wish them to sink a little, and exhort the patient to bear that lowness with patience and resignation, till nature, assisted by soft and succu- lent food, can have time to relieve him. This easy method of treating a fit of the gout would answer in any age; and if the patient was young and vigorous, and the pain violent, there could be no danger in taking away a little blood. Thus in two or three days time I have often seen a severe fit mitigated and made toler- G able. [50] able; and this is a better way of treating it, with regard to future consequences, than bearing it with patience and suffering it to take its course: For the sooner the joints are relieved from distension and pain, the less danger there is of obstructions fixing in them, or their being calcined and utterly destroyed. But instead of this, the general practice is quite the reverse. Oh! keep up your spirits, they cry; keep it out of your sto- mach at all events; where, whenever it rages in a dis- tant part, it is not at all inclined to come. As you can- not eat, you must drink the more freely. So they take cordials, strong wines, and rich spoon-meats. By urg- ing in this manner, a great fever is raised, the pain en- raged and prolonged; and a fit, that would have ended spontaneously in less than a week, protracted to a month or six weeks, and, when it goes it off at last, leaves such obstruction and weakness in the parts, as cripple the man ever after. All this I hope will be fairly and candidly understood; for there is doubtless a great va- riety of gouty cases, but no case that will not admit of medical assistance judiciously administered. But the most capital point of all, and what is mostly desired by all, is to prevent its return, or changing into any other disease, and to establish health. Most men would be very well pleased and happy could this be done by any medical trick or nostrum, with full liberty of living as they lift, and indulging every appetite and passion without controul. Some poor silly creatures, ignorant of all philosophy, and the nature of causes and effects, have been led into experiments of this kind by a few artful rogues, very much to the prejudice of their future health, and danger of their lives also, expecting from medicine, what it never did or can perform alone, the cure of chronic diseases. I think it needless here to take any pains to shew the inefficacy of all the common modes of practice, vomit- ing, purging, bleeding, blistering, issues, &c. They have been found ineffectual not only in the gout, but all other chronic cases. All sensible practitioners must know [51] know their effects to be but temporary, and that they are meant and used only as means of present relief. Let us see therefore by what practicable plan or regimen the person herein described, when a fit of the gout is hap- pily ended, may forever prevent its return, and so con- firm his general health that it shall not again be overset by every slight cold or trifling accident. I have already shewn that a certain degree of activity or bodily motion is necessary at intervals every day, to raise the circulation to that pitch, that will keep the fine vessels open and the old blood pure, and also make new from the fresh juices. If the patient cannot be brought to this, he has no chance of recovering to perfect health. If therefore he can neither walk nor ride at all, he must by degrees be brought to do both by the assist- ance of others, which may be given him in the follow- ing manner: Let a handy active servant or two be em- ployed to rub him all over, as he lies in bed, with flan- nels, or flannel gloves, fumigated with gums and spices, which will contribute greatly to brace and strengthen his nerves and fibres, and move his blood without any fatigue to himself.* This may take up from five to ten minutes at first, but must be repeated five or six times a day, supposing him totally unable to help himself. But if he can walk an hundred yards only, it will for- ward him greatly to walk those hundred yards every two hours, and if he can bear a carriage, let him go out in it every day, till he begins to be tired. The first day or two all this may disturb, and fatigue him a lit- tle; * This may seem but a trifling prescription to those who have never tried it sufficiently, but is of the utmost consequence, and its effects are amazing, especially to all those who are too weak to use any muscular motion themselves. A little friction may have little or no effect, but long continued, and repeated often, with fumigated flannels, it will do more to recover health, and support it afterwards, than most other things or methods. it promotes circulation and perspiration, opens the pores, forces the fine ves- sels, strains and purifies the blood, and this without the assistance of any internal stimulation. It is this that keeps horses in tolerable health, with very little exercise. [52] tie; but if he has patience to persevere to the fourth, I dare promise him some amendment and increase of strength, which he must employ, as young merchants do a little money, to get more. Thus he must go, on rubbing, walking, and riding a little more and more every day, stopping always upon the first sensation of weariness to rest a little, till he be able to walk two or three miles at a stretch, or ride ten without any weari- ness at all. This is recommended with an intention to dislodge and throw of all remains of crude gouty con- cretions that may have obstructed his joints, or lain concealed in any of the lacunæ or recesses of his body, to free the circulation in minimis, and all its secretions, perspirations, and discharges whatever; and though this intention can never be but very defectively answered by medicines, it may certainly be assisted and greatly promoted by a few well-chosen, mild, antimo- nial, absorbent and saponaceous deobstruents and sweetners, that, like putting foot or gravel into a bot- tle, with a good deal of agitation, will greatly help to make it clean, but without agitation will do nothing.* While we are thus endeavouring to resolve all old ob- structions, to open the fine vessels, and strain and pu- rify the blood, and by degrees to enable the man to use a certain degree of exercise or labour every day; great care must be taken in the choice of his diet, that no new acrimony be added to the old, to thwart and frustrate this salutary operation. His food must be soft, mild, and * The Asiatics, understanding luxury much better than we do, and knowing that it is not to be had without some degree of de- licate health, do just enough to keep them, in this languid es- seminate state, free from pain, Those who are rich among them employ people called Champoers, to rub, chafe, and pat them all over at least twice a day, to move their blood and keep their vessels free, without any labour or exertion of their own powers. This daily practice in hot countries, where they live in the most sloth- ful indolence, is not only necessary to them, but a great luxury. The Greeks and Romans too, when they became luxurious, fell into habits of this kind, and were strigilled, and curried, and bathed, and oiled, almost every day. [57] and spontaneously digesting, and in moderate quantity, so as to give the least possible labour to the stomach and bowels; that it may neither turn four, nor bitter, nor rancid, nor any way degenerate from those qualities necessary to make good blood. Such things are, at first, new-laid eggs, boiled so as not to harden the white creamy part of them, tripe, calves feet, chickens, partridges, rabbits, most sorts of white mild fish, such as whiting, skate, cod, turbot, &c. and all sorts of shell- fish, particularly oysters raw. Very soon he will be strong enough to eat beef, veal, mutton, lamb, pork, venison, &c. but these must all be kept till they are tender, and eaten with their own gravies, without any compounded sauces or pickles whatever; instead of which, boiled or stewed vegetables, and salads of let- tuce and endive, may be used; and the luxury that is not unwholesome may be allowed, light puddings, cus- tards, creams, blanc-manger, &c. and ripe fruits of all kinds and seasons. But because * wine undoubtedly produces nine in ten of all the gouts in the world, wine must be avoided, or taken very sparingly, and but sel- dom. How is this to be done? Can a man used to it every day, who thinks he cannot live without it, and that his existence depends upon it, leave it off safely? If * I have made what enquiries I could upon this capital article from living witnesses; for I do not always pin my faith upon books, knowing it to be no uncommon thing for authors, instead of framing their system from observation and experience, to wrest and explain both to support their opinions. I have been assured by a physician who practised above thirty years in Turky, that from the Danube to the Euphrates he had never seen a gouty Turk. I have also been informed by some of our Ministers, who had resided many years at Constantinople, that the gout, and other diseases of the same class, were not uncommon at court; but the courtiers, it seems, were not as good Mahometans as those who lived in the country; for they drank wine, drams, liquors of all sorts, without restraint. I have also been very credibly informed, that the Gentoos, or Marrattas, a people of India, living in the most temperate simpli- city, chiefly upon rice, have no such thing as the gout, or indeed any other chronic disease among them. [54] If he thinks he must die of the experiment, doing it all at once, he may do it by degrees, and drink but half the quantity of yesterday, till he has brought it to nothing. But the danger of attempting it in this man- ner is, that it will never be done; and, like a procras- tinating sinner, he will forever put off his penitential resolution till tomorrow. If he did it all at once, I would be hanged if he died of the attempt; he would be uneasy for three or four days, that's all. He may change his liquor, and drink a little good porter, or soft ale, and by degrees come to small-beer, the whole- somest and best of all liquors, except good soft water. I do not mean that this rigorous abstinence from wine is to last for life, but only during the conflict with the disease. As soon as he has recovered health and strength to use exercise enough to subdue it, he may safely indulge once a week, or perhaps twice, with a pint of wine, for the sake of good humour and good company, if they cannot be enjoyed without it; for I would not be such a churl as to forbid, or even damp, one of the greatest joys of human life. If any man should say, it is better to have a little gout than take all these pains, and submit to this dis- cipline; this is not the alternative. Perhaps it may be more eligible to live at large, and have but a little gout now and then, that goes off well, and leaves no trace behind; but this is very seldom the case. The misfortune is, that a little gout most commonly comes again and again more severely, till it becomes a great gout, till it cripples the man, and shortens his life at least twenty years, embittering all the latter part of it. If any one thinks this description of it, which is the real state of the case nine times in ten, preferable to that gradual exertion of his own powers and strictness of regimen, or rather attention to himself, with very moderate abstinence or self-denial for a year or two, as here recommended; I have no reply to make him, but must give him up to his own choice. The severity of these efforts, and this abstemious care [55] care need be continued no longer than the disease or the effects of it remain. When by perseverance in the practice of them, together with the medical aids here recommended, the patient shall have recovered his strength and locomotive powers, he may preserve and perpetuate them, and make good his title to longevity, upon the following plan. He must never lose sight of the three great principles of health and long life, Activity, Temperance, and Peace of Mind. With these ever in view, he may eat and drink of every thing the earth produces; but his diet must be plain, simple, solid and tender, or in pro- portion to his consumption; he must eat but of one thing or two at most at a meal, and this will soon bring him to be satisfied with about half his usual quantity; for all men eat about twice as much as they ought to do, provoked by variety; he must drink but little of any liquor, and never till he has done eating; the drier every man's diet is, the better. No wine oftener than once or twice a week at most; and this must be con- sidered as a luxurious indulgence. If he be sometimes led unawares into a debauch, it must be expiated by abstinence and double exercise the next day, and he may take a little of my magnesia and rhubarb, as a good antidote; or if he cannot sleep with his unusual load, he may drink water, and with his finger in his throat throw it up. I have known some old soldiers, by this trick alone, never taking their dose to bed with them, live to kill their acquaintance two or three times over. One moderate meal a day is abundantly sufficient; therefore, it is better to omit supper, because dinner is not so easily avoided. Instead of supper, any good ripe fruit of the season would be very salutary, pre- venting costiveness, and keeping the bowels free and open, cooling, correcting, and carrying off the heats and crudities of his indigestion. His activity need be no more than to persevere in the habit of rubbing all over night and morning for eight or ten minutes, or walking three and four miles every- day, [56] day, or riding ten, or using any bodily labour or ex- ercise equivalent to it. In bad weather I can see no great evil in throwing a cloak round his shoulders and walking even in the rain; the only difficulty is to sum- mon resolution enough to venture out; and a little use would take off all danger of catching cold, by hardening and securing him against the possibility of it upon that and all other occasions. If he dares not risque this, some succedaneum must be used within doors, more es- pecially when bad weather continues any time. I re- commend it to all men to wash their feet every day, the gouty in particular, and not lie a-bed above seven hours in summer, and eight in winter. Whoever thinks there cannot be luxury enough in this course of life, I am persuaded will not find more in any other; for good health, with all its natural appe- tites and sensations in perfect order, is the only true foundation of luxury. And whoever cultivates it upon the false principle of culinary or medical art, urging to excess by stimulating provocatives of any kind, instead of pleasure and enjoyment, will meet with pain and dis- gust. Some perhaps may be reasonable enough to observe and say, this plan of yours is very simple; there is nothing marvellous in it; no wonderful discovery of any of the latent powers of medicine: But will a regi- men so easy to be complied with as this cure the gout, stone, dropsy, &c.? Will it repair broken constitutions, and restore old invalids to health? My answer is, that if I may trust the experience of my whole life, and above all the experience I have had in my own person, having not only got rid of the gout, of which I have had four severe fits in my younger days, but also emerged from the lowest ebb of life, that a man could possibly be re- duced to by cholic, jaundice, and a complication of complaints, and recovered to perfect health, which I have now uninterruptedly enjoyed above ten years; I say, if I may rely upon all this, I may with great safety pronounce and promise that the plan here recommended, assisted [57] assisted at first with all the collateral aids of medicine peculiar to each case, correcting many an untoward concomitant symptom, pursued with resolution and patience, will certainly procure to others the same be- nefits I received from it, and cure every curable dis- ease. If this be thought too much to promise, I beg it may be considered, that a life of bad habits produces all these diseases; nothing is therefore so likely as good ones long continued to restore or preserve health. What can the best physician do more than discover and point out to his patients the real causes of their diseases? You will say, he must find a remedy: This he will do for you also as long as he can. But I will tell you a secret; his remedies are chiefly evacuations; as long as your body can bear scouring and cleansing,* he will do you some temporary apparent service; but when it begins to wear out, his remedies will answer no longer; you must try better methods; you must not repeat the cause so often; for he cannot forever build up as fast as you can pull down. In short, you must reform your life, and change all your bad habits for good ones; and if you have patience to wait the slow operations of nature properly assisted, you will have less reason to regret your former luxuries. We are all so much the creatures of habit, which forms and fashions us to good or ill almost as much as nature itself, that we ought to be very attentive and careful that our daily habits may ever tend to the con- firmation, not the destrustion of health. It is not what we do now and then that can injure greatly, but what we do every day must either do us great good or H harm; * Paracelsus was a good chymist, but a miserable physician: He invented the medicine which he most ridiculously called Elixir pro- prietatis; and from its efficacy, fit as he was, promised himself the years of Methuselah. At first it did wonders, scoured and carried off all his crapulary indigestions, and kept him some time in health and spirits; but trusting to it too long, and repeating it too often, it not only lost all its power of doing good, but hurt him greatly, and he died, I think, at six-and-thirty, notwithstand- ing his Elixir. [58] harm; either establishing our health, or fixing our diseases, for life. If, after all, any man should say, these restraints, this care in chusing what is wholesome, this constant watch- ing over all we do, Would make life so grievous, that health were not worth having upon these terms; I wish him to stop a little, and consider them well, before he rejects them entirely; and whether there be any better for him. It can do him no great harm to try a month or two; if he does, I flatter myself he will find that custom will take off the greatest part of the grievance, and perseverance; make them not only tolerable but pleasant. If he thinks health will be enjoyed upon easier terms, I fear he will be miserably deceived; for health, like beauty, may be won by your own attention, efforts, and assiduities, but cannot be had by purchase. Whoever thinks to buy either, will have the misfortune to find it not long his own, though he has paid for it. But there may be others whom long suffering has made more patient and reasonable; these may be glad to hear that a little health is to be had on any terms; and it may be very comfortable to them to know that there is scarcely any state of weakness so low, supposing the vitals not mortally hurt, from which they may not recover into very desirable health and strength, and by these means, exerted with persevering patience. I say this to invalids in general; for thus may be cured not only the gout, but very bad rheumatisms, ischiaticas, rickets, stone, jaundice, dropsy, asthma, cachexies, and complications of many kind; not excepting even can- cers, if they are not too far gone; for a cancer is nothing more than a place where nature deposits the bad humours of the blood, as appears by its almost con- stant return to some other part after extirpation. Whatever chronic disease will not give way to this system of medication, will be found, I greatly fear, too hard for any other. And should there be a particular case, in which some fortunate violence or chance may have apparently succeeded for a time, the return of the evil, [59] evil, or change to something worse, can no way be so well guarded against and prevented, as by some ra- tional and natural institution of life. Thus have I endeavoured to set forth the real causes of chronic diseases in general, and the true principles of convalescence, health, and longevity. If I have ha- zarded any thing new, or contrary to received opinions, it has been from a thorough conviction of its truth, however dangerous to same and fortune; both which I know are more easily acquired by complying with the world, than attempting to reform it; but it must be somebody equally indifferent to both, as I am, who will venture to tell such truths as are more likely to re- coil and hurt the author, than to convince and conciliate the bulk of mankind. FINIS.