AN
INQUIRY
INTO THE
NATURE, CAUSE, AND CURE
OF THE
GOUT,
AND OF
SOME OF THE DISEASES WITH WHICH IT IS
CONNECTED.
BY JOHN GARDINER, M. D.
FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS,
AND FELLOW OF THE ROYAL SOCIETY
OF EDINBURGH, &C.
Si a podagra liberari cupis, ut pauper sis opportet, ut aut pauper
vivas.—PETRARCH.
PHILADELPHIA:
PRINTED AND SOLD BY WILLIAM SPOTSWOOD.
1793.



PREFACE.
AMONG the chronic diseases which
afflict mankind, none deserves
more a serious investigation than the
Gout. When we consider the preva-
lence of this disease in all ages, its seve-
rity, the great variety of complaints,
some of them of an alarming nature,
which attend its irregular forms, it is
somewhat extraordinary, that professional
men of genius have not, with sufficient
ardour, endeavoured to explain the true
nature and cause of this distemper. For,
from the time of Galen to this day, I
cannot discover that any advancement
has been made, either in our knowledge
of this disease, or in the plan of cure.
The ancients, who have given accurate
descriptions of this disorder, appear to
have known the remote causes; but of
the immediate cause of a fit of the gout,
and how various symptoms were pro-
duced, from the adion of the arthritic
matter on the system, they were igno-
2A 

iv PREFACE.
rant. Their method of cure was of
course empirical, and so it continues
to this day, notwithstanding the many
advantages of the moderns in their su-
perior knowledge in anatomy and phy-
siology.
If the human body could be subjected
to such decisive experiments, as have
so wonderfully improved our knowledge
in natural philosophy, during this cen-
tury, then the causes of internal disea-
ses might be investigated with ease and
certainty. But, as such tests are, from
the nature of the human frame, impos-
sible, we are obliged, at the commence-
ment of every disorder, to confine our-
selves to the observation of such ap-
pearances, and complaints, as from ex-
perience point out the nature of the dis-
ease. In this way we give names to dis-
eases, and, when ignorant of the origi-
nal cause, the method of cure must be
empirical. In such cases, the modern
physician is indebted for his success in
the cure, to the experience of his pre-
decessors, as well as to his own, and 

v PREFACE.  
that of his contemporaries. With such
helps, it is admirable to perceive with
what ease and art the physician of expe-
rience conducts the cure of the disorder,
when he is acquainted with the nature
of the symptoms, though he knows not
the cause which originally produced
them. On many occasions, physicians
proceed in this manner, with success,
judging as well as they can of the invi-
sible cause, from its visible effects in the
course of the disorder. But, when we
are so fortunate as to trace the cause,
we become then more dogmatical and
regular in our practice. For, from a
more intimate acquaintance with the na-
ture of the disease, our medicines and
applications are better suited to counter-
act its progress, or to favour the expulsi-
on of the morbific matter.
But the existence of a morbific matter
is denied by several medical writers, who
derive every disorder from a defect or
morbid affection of the solids; while
others allege, with equal probability,
that the fluids are primarily affected in
A3 

vi PREFACE.
every disease. These two opinions have
been litigated with great ingenuity, but
with too much keenness to produce a
fair representation of facts; for neither
of them are strictly true. But, from
the following short review of the subject,
I humbly apprehend they may be recon-
ciled. To examine the theories on ei-
ther side, would lead to a prolixity in-
consistent with the brevity of a preface;
I shall therefore content myself with a
short appeal to the diseases themselves,
and to such facts as I imagine will be ge-
nerally allowed.
Those who maintain the solids to be
originally affected, in the production of
every internal disorder, ascribe to an ori-
ginal defect in the system, all the variety
of scrophula we meet with in practice.
This disorder, with all its consequences,
as glandular swellings, suppurations, dis-
eases in the bones in various parts of the
body, consumptions, withered limbs,
fits of insanity, &c. are said to origi-
nate from debility alone. But it seems
equally probable, that the debility ac- 

vii PREFACE. 
companying certain species of the scro-
phula, is rather an effect of the general
disorder in the system from the scrophu-
lous acrimony, than the cause of it.
Because we not only meet with conside-
rable degrees of debility, and of long
continuance, without discerning the
smallest tendency to scrophula; but find
persons affected with that disease, who
are endowed with a considerable degree
of bodily strength. For it is not until
the disorder has made some remarkable
advancement in the habit, or that some
of the viscera are thereby affected, that
great debility takes place. But, what-
ever is the original cause of this disease,
an acrimony of a peculiar nature is ge-
nerated in the fluids, which produces
indolent swellings, inflammations, and
suppurations; from which arise those
sores, acting as so many drains of that vi-
tiated humour, which, if retained in the
habit, would prove fatal. In slight
cases, therefore, of the scrophula, issues
have been found to be of great service;
but where the disorder is of great mag-
A4 

viii PREFACE.
nitude, they are insufficient for the ne-
cessary discharge of the scrophulous
acrimony.
It is certain, that by a proper regulati-
on of the diet of scrophulous persons,
in which a due proportion of meat and
wine should be allowed, sea bathing, a
moderate use of sea water, to prevent
crudities in the bowels, exercise, and
other means of corroborating the habit,
have been of service in some scrophu-
lous disorders. It is likewise known,
that in this disease, the sores often dry
up towards puberty, when the system
has acquired a greater degree of strength
than it formerly enjoyed; nay, the same
persons, from their strength being reduc-
ed by other diseases, or by old age, get
a return of their scrophulous com-
plaints. Besides, as we have not hither-
to discovered any effectual remedy in
the cure of this disease, which acts
chiefly on the fluids; these observations
seem to favour the idea of a defect in
the solids being the original cause of this
disease. Any attempt to invalidate these 

ix PREFACE. 
presumptive proofs would be improper;
they are facts known, and ought there-
fore to be admitted in support of the
above opinion.
That such a defect may produce this,
and other chronic diseases, I shall not
dispute, but the word debility gives no
distinct idea of the true nature of that
defect. This may be different in diffe-
rent diseases, and always producing an
acrimony peculiar to the nature of the
cause; for every considerable deviation
in the action of the solids, from that
which is peculiar to a healthy state, will
produce an acrimony in the fluids, cor-
responding to the manner in which the
solids have been affected; and this va-
riety of acrimony or disease, cannot be
supposed to arise from debility, which is
as much a consequence of the morbid
affection of the solids as the acrimony
itself.
The scrophula being hereditary in
some families for several generations, has
been adduced as an argument for this
disease being derived from some defect
A5 

x PREFACE.
in the solids. I shall not dispute this
point; though perhaps it would be dif-
ficult to ascertain which of the two, the
solids or fluids, is in fault on such oc-
casions. To the idea of its being here-
ditary there are some exceptions; be-
cause we see it arise from other diseases,
in persons where the distemper could not
be traced to any of their progenitors,
while the other children of the same fa-
mily kept perfectly free from that disor-
der. The word hereditary gives a most
discouraging prospect to those families,
where the scrophula has subsisted for two
or three generations; but I have reason
to believe, and from experience can as-
sert, that, where a proper regard is paid
to the health and constitution of the per-
sons, these unfortunate people take in
marriage, the disorder gradually disap-
pears in their children and grand-chil-
dren. The same may be said of the
gout, and some other diseases, which are
thought to be derived from parents.
There are other diseases, in which
an affection of the solids, seems to be 

xi PREFACE. 
more unequivocally the original cause
of the subsequent disorders; as in
the application of cold to the bo-
dy, in the produdion of rheums in
the head, creeks in the neck, a cat-
tarrh, rheumatism, and other inflam-
matory disorders.
Those who adopt a contrary opinion,
and derive every disease from some
change in the fluids, adduce as an argu-
ment in their favour, that, from the
nature of animal life, some small porti-
on of our fluids is continually becom-
ing unfit for circulation, or the salutary
purposes of the economy. This in ge-
neral goes on without any injury to
health, because nature has provided cer-
tain emunctories, by which such acrid
or useless fluids, are thrown out of the
body. It is, however, evident, that
this balance between the generation,
and elimination of acrid fluids, may be
sometimes disturbed, and an acrimony
thereby prevail in the habit. This
may be increased by the application
of an excess of heat, or of cold to 

xii PREFACE.
the body, and by violent exercise under
a warm sun, in all which cases, the so-
lids appear to be first affected; or it
may be occasioned by unwholesome diet,
by which the fluids are primarily affect-
ed. In treating of infection *, I have
endeavoured to prove, that its action,
in the production of fevers, is first on
the fluids. But it must be remarked,
that an acrimony is no sooner generated,
than its action on the solids is perceiv-
ed, and particularly on the vascular sys-
tem. This increased action of the ves-
sels, may not only accelerate the change
in our fluids, introduced by the febrile
ferment, but may produce other chan-
ges, peculiar to an increased action of
the vessels, and different from the ori-
ginal acrimony which occasioned the fe-
ver; and this acrimony will, in its turn
act on the folids. Thece remarks are
made, not only to show that some disea-
ses may arise from a morbid affection of
the solids, and that others derive their
origin from certain morbid changes in
* Vide my observations on the Animal Economy,
&c. sect. 4. 

xiii PREFACE. 
the fluids, but that no permament afec-
tion  of the solids, or considerable
change in the fluids, can take place,
without their mutually affecting each
other.
This is only a short review of the sub-
ject, which might be extended to great-
er length; but is sufficient to show the
reciprocal action of the solids and flu-
ids. This takes place even in health,
and is the chief cause of those wonder-
ful changes which gradually take place
in the crude nutritive juices, taken up
by the absorbents of the primae viae,
till they are elaborated into the nature
of the other circulating fluids. But it is
their effects on each other, when in a
diseased state, we are at present to con-
sider, which we shall have some oppor-
tunities of recognizing in the following
treatise on the Gout. I am sensible of
the intricacy of this subject, and of my
inability to clear it from the great obscu-
rity in which it is involved. If, howe-
ver, I shall be so fortunate as to remove
some part of this obscurity, and give a 

xiv PREFACE.
more distinct idea of the true nature and
cause of this distemper, our practice in
the cure will then become more regular,
and less uncertain, than formerly.
This point I have prosecuted with ar-
dour, chiefly from a strict observance
of the gout under its various forms,
and in a great variety of cases. I have
likewie received advantage from a close
attention to the operation of medicines,
and applications that have been used in
the cure with good and bad success.
The remote causes, their effects on the
body, the generation of the arthritic
matter, the proximate cause of a fit of
the gout, and the other remarkable phe-
nomena in the course of this distemper,
have been considered with great care.
Some of these particulars I have viewed
in the light of experiments; for by ex-
amining them with attention, they have
led me to what I apprehend to be the
true nature of this disease, and in some
instances have shown the manner by
which the arthritic matter acts on the
system in exciting particular symptoms. 

xv PREFACE. 
My explanations of these, and many
other circumstances relative to the gout,
are not the best that might be given,
were the subject in abler hands, but
they are the best I can, at present, offer
to the public. The same may be said
of the whole of the following treatise,
though written with the best intention,
to introduce a more regular practice, and
to take the unhappy sufferers out of the
hands of ignorant empirics and quacks,
to whom they have been for the most
part consigned, to the great reproach of
the medical art. 



CONTENTS
OF
SECTION FIRST.
Par.
1. 2. and 3. INTRODUCTION.
4. Remote causes of the Gout.
5. —act differently in diffe-
rent constitutions.
6. Remote causes apply not always to the Hereditary
Gout; but, in such cases, act with double force.
7. Occasional causes of the Gout.
8. Genius falsely accused of predisposing to the Gout.
9. Corpulence often attends gouty constitutions; but it is
not strictly connected with the cause of the Gout.
10. Regular Gout most frequent in robust habits, after
they have been exposed to the remote causes of the
disease, and not otherwise.
11. The gout to be traced only from its remote causes.
12. and 13. Nature allows a considerable latitude in
the quantity of our food with impunity.
14. Too full a diet long continued, produces disorders in
the primae eviae, and weakens the digestive powers.
15. and 16. Too full a diet in delicate constitutions
is often the cause of Nervous, Hypochondriac, and
Hysteric disorders.

xviii CONTENTS.
Par.
17. In delicate constitutions, wine and other strong li-
quors often disturb digestion.—General plan of
cure in certain Nervous disorders.
18. In stronger constitutions nervous complaints are few-
er; but pains of the Rheumatic and Gouty kinds,
more frequent.
19. Rheumatic and Gouty pains often owing to a specific
acrimony, sometimes to sympathy.
20 and 21. Proofs of an acrimony generated in our fluids.
22. Affinity between certain periodical, erysipelatous in-
flammations, and the Gout.
23. and 24. The variety of complaints not so much from
a difference in the species of acrimony, as from a
peculiarity in the constitution.
25. Men and women of robust constitutions; long exposed
to the remote causes of the Gout, become subject to
regular attacks of that disorder.
26. A steady course of intemperance seldom produces the
true Gout, but a variety of other chronic diseases.
27. The arthritic acrimony overcome in proportion to the
strength of the system.
28. The arthritic acrimony from some deficiency in the
digestive powers, the too great quantity, or acrid
quality of the chyle; its accumulation in the habit 
extremely slow, in proportion to the strength of the
system.
29. The accumulation of the arthritic acrimony, not in
proportion to the generation of it in the body.
30. Perhaps a diminution of perspiration is partly the
cause of the accumulation af the arthritic matter
in the body.
31. The earlier in life the first paroxysm. the longer are
the first and second intervals; but they afterwards
shorten considerably.
32. The intervals are shorter, the stiffness and weakness
of the joints and the Atonic Gout, arrive earlier
in the Hereditary, than in the Acquired Gout.
33. Symptoms of the Atonic Gout. 

xix CONTENTS.     
Par.
34. The later in life the Gout makes its appearance, the
longer the intervals, and the less of the Atonic
Gout in extreme old age.
35. Gradual effests of repeated paroxysms of the Gout,
in producing weakness, stiffness, and swellings of
the joints.
36. Reasons why the intervals shorten, and for the regu-
lar returns of paroxysms during life, or until the
Atonic Gout takes place.
37. The Gout from a defect in the functions of the primae
viae.
38. The principle of life a considerable agent in animal
digestion.
39. In weak stomachs a change takes place in the secreti-
ous in the primae viae, which often produces acidity.
40. The stomach being the centre of sympathy, the great
irritability of that organ, is in part communicated
to the rest of the system.
41. 42. and 43. Ardent spirits keep up a debility in the
nerves of the stomach.—Their use prevents not the
generation of acid in the stomach.
44. Different effects from the remote causes of the Gout
in different constitutions.
45. The effects of the remote causes of the Gout in robust
constitutions, are, for many years, chiefly confined
to the primae viae.
46. Excess of irritability in Hypochondriac and Hysteric
patients, prevents fits of the Gout.
47. The failure of the powers of digestion extremely slow,
in robust habits, exposed to the remote causes of the
Gout.
48. and 49. The manner in which occasional causes act
in producing the Gout.
50. A certain degree of the strength in the system, neces-
sary for the production of a regular fit of the Gout.
51. Debility to a certain degree produces a proportional
irritability, beyond which it has a contrary effect.
52. Fits of the Gout seldom take place in persons under 

xx CONTENTS.
Par.
the influence of the depressing passions of the mind.
53. Sympathetic affections and nervous complaints in-
crease with the delicacy of the system.
54. The nerves are affected in every disease, but it is only
a particular class of diseases that is denominated
nervous.
55. The Regular Gout an inflammatory distemper; but
under its irregular forms it is attended with sym-
pathetic and nervous complaints.
56. The symptoms of pyrexia often precede and attend the
accession of regular fits of the Gout.
57. Gradual progress of inflammation from one joint to
another, as the disease advances.
58. In a mild and regular Gout nervous symptoms are few
—Critical evacuations by perspiration and urine.
59. Under a regular and mild Gout, men live to a great
age.
60. From the greater or less delicacy of the constitution,
the strength of the hereditary disposition, and the
power of the remote causes, are derived the vari-
ous states of the Gout.
61. Sudden deaths probably owing to the immediate action
of the arthritic matter on the brain.
62. Nature oft the Atonic Gout—Remedies.
63. The Atonic Gout from debility.
64. Division of the Gout into Regular, Irregular, and
Atonic.
65. Evidences of a materies morbi.
66. Review of the doctrine of a late celebrated author.
67. The Irregular and Atonic Gouts accompanied with
many nervous symptoms.
68. Method of discovering the Irregular Gout.
69. Visceral complaints in the Irregular Gout—Costive-
ness and diarhoea in Gouty constitutions.
70. and 71. The irregular Gout from a greater debility
in the nerves of the primae viae, and perhaps of
the system in general, than usually attends the
Regular Gout. 

xxi CONTENTS. 
Par.
72. A preternatural irritability of some viscus, or part
of the body, often the cause of chronic disorders.
73. and 74. Atonic Gout.
75. Erysipelatous inflammations, boyles, and imposthumes,
give relief and protract the intervals of the Gout.
76. In the Atonic Gout, the nerves are remarkably af-
fected.
77. The difference between a nervous disease, and ner-
vous complaints in the Gout.
78. Numbness of the legs, &c. previous to a regular pa-
roxysm of the Gout.
79. These symptoms arise from the action of the arthritic
matter, on the extremities of the nervous filaments.
80. Reasons suggested for morbid affections in the primae
viae previous to a fit of the Gout; and for an un-
usual keen appetite the day preceding a paroxysm
of that disorder.
81. and 82. Explanation of the studden movement of the
seat of the pain and inflammation from one foot
to the other.
83. and 84. Reasons for the pain and inflammation shift-
ing from one part of the foot to another, until the
paroxysm of the Gout is completed.
85. Probable cause for the seat of the disease shifting from
the feet to the knees, hands, and other joints, in
advanced stages of the Gout.—Swelling on the
feet, hands, &c. explained.
86. 87. and 88. Inflammations from internal causes
owing to an acrid matter secreted from the blood.
89. and 90. Proofs of the foregoing doctrine from the
inflammation of a joint in the Rheumatism, a fit
of the Gout, and other inflammations from inter-
nal causes.
91. The importance of the subject oft inflammation in the
practice of physic.
92. Causes which increase the natural stimulus of the
blood.
93. Inflammation from irritation.

xxii CONTENTS.
Par.
94. and 95. Progress of inflammation from an extrane-
ous substance.
96. Inflammation from the external application of acrid
substances in proportion to their activity.
97. Blistering plasters—Their effects.
98. The effects of heat, similar to those of acrid substances.
99. The difference between inflammations from external
and internal causes.
100. The operations of nature in the production of in-
flammations from internal causes, similar to those
which arise from the external application of acrid
substances.
101. The cure of inflammation by resolution, not always
adviseable.
102. The effects of venesection, low diet, and purging in
the cure of inflammation.
103. The cure of inflammation by resolution, chiefly by
the absorbents, partly by the excretories opening on
surfaces.
104. Some of the intentions of nature in exciting pain in
the cure of diseases.
105. Other useful effefts from pain, the effects of blisters,
setons, issues, &c.
106. The effects of pain sometimes hurtful.
107. Fits of the stone, their general cause, probable proofs
of the state of the vesica urinaria.
108. Different acrimonious fluids affect each a particular
part from a specific stimulus peculiar to each.
109. Different stimuli affect the nerves of a particular
constitution and sensibility.
110. The diversity of irritability in the system, the pro-
bable cause of particular symptoms from certain
stimuli.
111. Brief analysis of the foregoing doctrine.
112. The remedies and other means in the cure of the
Gout, can only be suggefied from an intimate know-
ledge of the nature of that disorder. 

CONTENTS
OF
SECTION SECOND.
Par.
113. Temperance and exercise, the opposites of the remote
causes of the Gout, the best means of cure.
114. Curative indications.
115. The general opinion of the Gout being incurable,
not warranted by experience.
116. and 117. Difficulties to be encountered in the cure
of the Gout.
118. The preservation of the strength of the patient, a
chief circumstance in the plan of cure.
119. Method of regulating the diet.
120. Strong liquors conduce more to the production of the
Gout than animal food.—Method of regulating
the quantity of wine.
121. Manner of conducting exercise.
122. Diet in Gouty constitutions.
123. Wine rather as a cordial, than as an article of diet.
124. and 125. The greatest benefit from a free perspi-
ration, kept up by exercise, friction, and warm
cloathing.—The effects of warm bathing.
126. 127. and 128. Bath water—Its contents and ef-
fects.
129. Perspiration by exercise and other gentle means pre-
ferable to that obtained by active medicines—No 

xxiv CONTENTS.
Par.
specific for the Gout yet discovered.
130. Infusions of tansy and other aromatic bitters—Their
use.
131. Stomach bitters—Their use.
132. The cure of the Gout not to be attempted by Peru-
vian bark, bitters, or aromatics.
133. 134. 135. 136. and 137. Gout powders, their
history, composition, and effects.
138. and 139. The beneficial effects of flowers of sulphur.
140. Alcaline remedies of use in the Gout.
141. Reciprocal sympathy between the urinary passages
and the primae viae; the cause of their mutually
affecting each other.
142. 143. 144. and 145. Reasons for the relief afforded
to calculous patients, from the use oft alcaline re-
medies, though they seldom have any effect as sol-
vents.
146. and 147. Lixivial salts, their operation on the pri-
mae viae in mitigating the severity of the Gout,
and in protracting the intervals.
148. The preference of a solution of mild alkali in water
saturated with fixed air, when phlegm and acidity
prevail in the primae viae.
149. and 150. The advantages derived from natural
drains, and artificial issues, in Gouty constitutions.
151. Empiricism obstructs the advancement of medical
knowledge
152. The history of a disease, and the effects of medi-
cines, often lead to the nature of the cause.
153. The cure of the Gout not to be obtained by medi-
cine alone.
154. Management of the patient during a paroxysm.
155. and 156. Particular method of  wrapping up, and
increasing the perspiration of the feet, by flannel
socks, and oiled silk bootikens, during a fit of
the Gout.
157. The good effefts of the socks and bootikens, in
shortening a paroxysm of the Gout, and in re-
moving complaints in the Irregular Gout. 

xxv CONTENTS.   
Par.
158. and 159. A remarkable instance of the salutary
effects of the socks and bootikens.
160. Great part of the arthritic matter carried off by
a copious perspiration in the feet.
161. The causes of sympathetic affections various.
162. Emetics when necessary.
163. Method of treating the disorder, when the Gouty
pains cease, and are followed by complaints in
the head and viscera.
164. Blisters.—Their use.
165. Leeches.
166. and 167. The beneficial effects of leeches exam-
plified in the case of a gentleman.
168. Further observations on the use of leeches.
169. and 170. Poultices and cataplasms.
171. Bathing the feet in cold water, dangerous.
172. The term repellant, to certain applications, im-
proper.
173. Solutions of metallic and other neutral salts, their
operation in lessening inflammations.
174. and 175. The retention of acrid fluids in the habit,
dangerous; but when secreted and again ab-
sorbed, less noxious.
176. Specious objection to the above fact.
177. Reasons why noxious fluids when secreted and
again absorbed, become less powerful.
178. Cases of so extraordinary a nature, that no useful
inference can be drawn from them, are of little
or no benefit to the advancement of medical know-
ledge—The operation of medicines sometitnes
leads to the cause of uncommon cases.
179. Case of the Gout repeatedly cured, by eating salt
herrings broiled.            
18o. and 181. Explanation of the above cure from
the powerful excitement of the functions of the
lymphatics.
182. General management in the Atonic Gout in old men.
183. Ashort recapitulation of some of the principal
parts of the Author's doctrine in this Section.
B 



AN
INQUIRY
INTO THE
NATURE, CAUSE, AND CURE
OF THE
GOUT.
SECTION I.
1. IF, in the following treatise, I shall en-
deavour to investigate the nature and
cause of the gout, a subject. which has hi-
therto eluded the inquiries of many learned
and ingenious men, great allowance ought
to be made for the imperfections and inac-
B2 

28 AN INQUIRY
curacies of a person of moderate abilities.
The remote causes of this disease appear to
have been long known; but their effects on
the system have not been explained; nor is
the constitution most susceptible of the re-
gular gout strictly ascertained. The imme-
diate cause of a fit of the gout is involved
in great obscurity; and we are ignorant of
the manner by which those symptoms which
precede a paroxysm, or accompany the con-
valescent state of that disorder, are excited.
The regular returns of the paroxysms, nearly
at stated intervals in the regular gout, is a
a curious circumstance in the disease, and
deserves to be particularly considered. We
do not rightly understand how, in different
constitutions, such a variety of complaints
should arise from the same cause, as in the
irregular gout, and some of the diseases
strictly connected with that distemper. The
manner in which occasional causes act in
producing the gout, is not fully explained
by authors, and we comprehend not pre-
cisely the nature of the atonic gout. The
arthritic matter uniformly affecting the joints
is a singular circumstance, and merits our
consideration. The inflammation of a par-
ticular part of the body is a common occur-
rence in inflammatory and febrile disorders,

29 CONCERNING THE GOUT.  	
as well as in a fit of the gout. The imme-
diate cause, however, of inflammation seems
hitherto to have eluded the observation of
authors on that subject.
2. But these are not the only difficulties
we have to encounter. There are others
equally important, and some of them equal-
ly obscure, which deserve our attention.
The task here is arduous; and I doubt whe-
ther it shall be in my power to satisfy my
readers in explaining these several particu-
lars; but the difficulty of the subject ought
to claim some indulgence, if my inquiries
shall fall short of their expectations. I am
likewise afraid, that, in a subject so intri-
cate, where our attention-must be drawn to
so great a variety of circumstances, it will be
difficult to preserve that regularity of plan
which might be observed in treating of a
disorder of greater simplicity.
3. As the history of the gout, under its
various forms, is fully and accurately given
by practical authors, who have in general
followed Sydenham, it is needless to be te-
diously particular in the description of a dif-
order fo well known. This is the less neces-
sary, as I shall, in the following dissertation,
have occasion to take notice of the most re-
markable syptoms that attend both the re- 
B3

30 AN INQUIRY
gular and irregular gouts, in my endeavours
to explain what I apprehend to be the true
nature of that distemper.
4. From practical authors and general
observation, we learn, that the gout is more
a disease of cold, than of warm climates, of
the winter, than of the summer months.
Its attacks are from about Christmas to
March, or on the approach of the cold
weather in autumn, which are the usual pe-
riods of those who are afflicted twice a-year
with that distemper. How far the cold
of the climate, or of, the season, may con-
tribute to the production of fits of the gout,
shall be hereafter considered. When the
disease is not hereditary, the principal re-
mote causes are usually ascribed to intem-
perance, a full diet, and a sedentary life.
However, we often meet with persons af-
flicted with that disorder, who cannot be
strictly accused of intemperance; but, upon
a review of their manner of living, on a
full diet, with a regular, though moderate,
quantity of strong liquors twice a-day, and
a sedentary life, it falls little short of the
general charge brought against gouty per-
sons.
5. But the remote causes of this disease
act not with the same force in all; for their
effefts are more severely felt in some than in 

31 CONCERNING THE GOUT.
others; and there are several who have es-
caped the disorder, notwithstanding their
having exposed themselves for many years
to the action of the remote causes of the ac-
quired gout. Hence a probability arises,
that the generation of the arthritic acrimo-
ny in our fluids depends in some degree on
a peculiarity of constitution.
6. The remote causes just mentioned, ap-
ply not always to the hereditary gout;
for we have some instances of it, notwith-
standing great attention to exercise and tem-
perance. This hereditary disorder may arise
from a peculiarity in the structure of the
body; and, as children often inherit not
only the figure and features, but dispositi-
ons of their parents, so a propensity to the
pleasures of the table and indolence may,
in some degree, be the result of such a con-
formation. It may likewise be remarked,
that, from the influence of example, an in-
clination to this practice is apt to be acqui-
red by the children of those who have been
addicted to it. Although I have, in many
instances, observed such a propensity in per-
sons affected with what was supposed to be
the hereditary gout, yet I do not give it as
a general consequence of a such a conforma-
tion, but mention it merely as a conjecture.
However, in such constitutions, these causes
B4 

32 AN INQUIRY
always act with double force in the produc-
tion of this disease.
7. There are many other causes enume-
rated by authors, but when carefully exa-
mined, they seem rather to be exciting, or
occasional, than remote causes of this dis-
order. These are whatever produce debili-
ty, and its concomitant a preternatural ir-
ritability of the system. Long and intense
study or application to business, particular-
ly in the night, excess in venery, purging
and other evacuations, violent exercise long
continued, especially walking any consider-
able way with short, or tight shoes *, catch-
ing cold, and the application of cold to the
feet, weak claret, other subacid weak wines,
such fruits and vegetables as are apt to fer-
ment and become acid in the stomach, de-
bilitate the digestive organs, and render the
whole system more irritable than usual. In-
digestion, to which gouty constitutions are
extremely liable, and a collection of bile
from costiveness, have nearly the same ef-
fects.
8. Men of genius, in the habit of prose-
cuting their studies during the night, are
* This I have frequently known to bring on the
first fit of the gout, about the third day after, with
considerable redness, similar to an erysipelatous inflam-
tion. 

33 CONCERNING THE GOUT.
said to be more than usually subject to this
disease; and, I believe, it may be so, when,
from their easy circumstances, they keep a
plentiful table. But the possession of ge-
nius can have no other concern than as it
often leads to a sedentary life, which, when
accompanied with a full diet, may have the
same effects on men of genius, in producing
the gout, that they are known frequently
to have on others of the meanest capacities.
9. It is also remarked by practical wri-
ters, that full and corpulent habits are par-
ticularly obnoxious to this disease. Corpu-
lency, in many persons, depends on a pecu-
liarity of constitution, and while they con-
tinue temperate and active, are seldom af-
flicted with the gout. But it oftener arises
from a full diet and indolence. In some
degree corpulency precedes the first fits of
this disorder, and increases with the age of
the person, and advancement of the disease,
which gradually brings on an inability to
proper exercise, from weakness and stiffness
in the joints of the lower extremities. Nor
is it at all suprising that, from so nutritive
a diet, and a want of due exercise, such
persons should become plethoric and corpu-
lent, which increase their dislike to action,
and, in some degree, render them unfit for
proper exercise. This is more or less the
B5

34 AN INQUIRY
situation of gouty persons in general; but
obesity seems not essential to the gout, be-
cause we every day meet with this disorder
in persons no way inclined to corpulency,
and in others of remarkably thin and spare
habits.
10. It is likewise aleged, with more ap-
pearance of truth, that men with large bo-
dies and robust constitutions, are particu-
larly liable to this distemper. Such are,
undoubtedly, the constitutions in which we
most frequently meet with the regular gout;
but it is not the strength of the system alone,
as will appear more fully in the sequel, that
produces this disease. The remote causes
must act for some time on the digestive or-
gans, and on the system in general, before
the arthritic acrimony, which we suppose to
be the immediate cause of the gout, can be
generated in the body; and the stronger the
constitution the greater will be the powers
exerted in the system to overcome this acri-
mony, or to throw it off by the usual
emunctories; and of course the strongest
may escape the disorder altogether, or have
it in a milder way than those of less robust
habits, even when they have been equally
expofed to the remote causes *. For it must
* A gentleman, 32 years of age, inclining to a full
habit, and of a good constitution, was, in the year
1762, seized with a very severe, but regular, fit of the 

35 CONCERNING THE GOUT.
be observed that private soldiers in the army,
common sailors, and those who earn their
bread by constant labour, and keep tempe-
rate, are seldom, if ever, seized with the
gout.
11. These circumstances, and others I
shall have occasion to consider in the follow-
lowing treatise, as they sometimes occur in
gouty habits, have created a general belief
of their being intimately connected with
the cause of the gout. But while these ill
grounded suppositions maintain their credit,
they have a tendency to obstrust our inqui-
ries into the true nature and cause of this
distemper. Another difficulty in the regu-
lar investigation of the cause of the gout, ari-
ses from the various appearances of this dis-
ease in different persons, in the same person at
different times, and from the great variety
and discrepancy of its symptoms, especially in
gout in both feet. For some days, during the severity
of the paroxysm, he had a remarkably free and copi-
ous perspiration; it was several weeks before he could
walk across his room, when his feet and ancles became
oedematous, with great weakness in both legs. After
his recovery he observed not any particular regimen of
diet, living much in his usual way; but, from the
strength of his constitution, and using a good deal of
exercise, he has not had a second fit of the gout, and
is now in perfect health. 

36 AN INQUIRY
the irregular gout. From the different ap-
pearances of this disorder in its irregular
state, authors have reasoned so differently on
the nature of this distemper, that we are at this
day in great doubt with regard to its origin.
Notwithstanding this diversity of opinion,
there is nothing more general than a belief
in the remote causes of the acquired gout,
as above enumerated. It is therefore surpri-
sing, and much to be regretted, that men
of abilities, in treating of this disorder,
have not prosecuted with sufficient ardour
the effects of these remote causes on the
constitution.
12. A certain quantity of food and drink
is necessary for the support and nourishment
of the body; but nature allows a considera-
ble latitude with impunity. Men, as well
as other animals, require a quantity of ali-
ment proportioned to their bodily labour.
Any considerable diminution or augmenta-
tion of that necessary quantity, long conti-
nued, will tend to the production of disease,
according to the nature and magnitude of
the cause. In the active time of youth,
when the exercise of the body is greater,
and the digestive powers are stronger, than
at any other period, a little indulgence in
more food than is requisite for the mainte-
nance of health, is not in general followed 

37 CONCERNING THE GOUT.
by any bad consequence: For it is not till
some time after, when men begin to lose
their agility and ease in their motions, and
incline more to a sedentary life, that a
plumpness, and sometimes even corpulency,
gradually steals on them.
13. The alteration of the general appear-
ances with more or less increase of bulk in
the body, which insensibly take place in men
from their twenty sixth to their fortieth year,
is well known. About this period the body
has acquired that firmness of texture, which
gives more the idea of strength than agility.
Some time previous to this, men in general
begin to discover a greater propensity to se-
dentary amusements and avocations than for-
merly, and this disposition increases by de-
grees, as age advances. But when the con-
stitution is tolerably good, and the sedenta-
ry life not carried to excess, men after this
period commonly enjoy good health for
many years, although their diet be rather
full than otherwise, and especially if they
indulge not in strong liquors. For while
the organs of digestion continue completely
to perform their office, no harm is to be ap-
prehended from the sedentary life and full
diet, unless becoming a little fatter than
usual should, in some cases, be thought an
inconvenience. 

38 AN INQUIRY
14. However, when the exercise of the
body corresponds not to the quantity of ali-
ment taken, disorders in the primae viae
will sometimes occur, even in the strongest
constitutions, especially if, at the same
time, they indulge in strong liquors, with
a view to help their digestion; which, for
the most part, has a contrary effect. These
complaints are at first easily removed by
medicine, temperance, and exercise; for,
as no material injury is done to the stomach
and bowels, they soon return to their former
healthy state. But, from the frequent re-
currence of these disorders, the stomach
and bowels become weaker, more irritable
than formerly, and the digestive powers de-
cline. It is only from this period, in con-
stitutions most liable to the regular gout,
that we can suppose an acrimony to be
slowly generated in our fluids, from the
function of digestion being incompletely
performed. In most instances, this arises,
not so much from any natural defect in the
digestive organs, as from a long continued
habit of taking a quantity of food, and
strong liquors, disproportioned to their pow-
ers, or to the exercise of the body. For
the same persons, or others of a similar con-
stitution, who take less food, and more ex-
ercise, are seldom, if ever, afflicted with the 

39 CONCERNING THE GOUT.
gout, unless a strong hereditary disposition
to that distemper prevails in the constitu-
tion.
15. Persons more delicate, and with
greater irritability of system, are, from the
same causes, affected with want of appetite,
indigestion, heart-burn from acidity in the
stomach, flatulency, general debility, low
spirits, and, in a variety of cases, almost
the whole train of nervous, hypochondriac,
and hysteric symptoms. For a general de-
bility, proceeding from a diseased state of 
the stomach and bowels, tends greatly to
the production of nervous disorders. Such
complaints are common to men and women
of delicate constitutions; but, on account
of this delicacy of system, they are seldom
seized with fits of the gout: For although
the remote causes of this disorder may be
numbered amongst those of nervous diseases,
yet, when they produce in delicate habits
such effects as are just mentioned, the ap-
petite fails, and they are afflicted with in-
digestion, which are in a great degree in-
consistent with the generation of that spe-
cies of acrimony in our fluids, supposed to
be the cause of the gout.
16. know not how it may have happen-
ed to others, but in my younger days I
was often led away from the consideration 

40 AN INQUIRY
of the true cause of nervous, hypochon-
driac, and hysteric disorders, by the deli-
cate appearance of my patients. I did not
suspect persons who had become thinner
than usual, complaining of acidity in the
stomach, want of appetite, and indigestion,
to have brought on their complaints by too
full a diet. This deception continued for
some time, from the sick complaining that
they could neither eat nor digest the lightest
food. No doubt this was the case, in a
great degree, with several of them, who,
from the great irritability of their stomach,
could not bear such a moderate quantity of
aliment as could have been easily taken in a
more healthy state. Upon a strict inquiry,
however, there were some who, notwith-
standing of their taking but a small quan-
tity of food at once, yet, upon their repeat-
ing it frequently, the quantity was little
less than should be taken by a person in
health, and more than they could digest in
the weak state of their stomach and bowels.
But there are others whose appetites are in
general too keen for their powers of diges-
tion, and such persons often bring on them-
selves, by a full diet, great disorders in the
primae viae, which produce an uncommon
sensibility on the nerves of these viscera,
and subject them for some time to a variety
of nervous complaints. 

41 CONCERNING THE GOUT. 
17. When valetudinarians of the above
description cannot take, or suppose they
cannot take, a sufficient quantity of aliment
for their support, recourse is had to small
quantities of strong liquors after meals, to
supply that deficiency. The exhilirating
qualities of these liquors deceive them into
a belief of their giving strength and firm-
ness to the body; but these effects are only
temporary, and in the end tend rather to
exhaust than raise the spirits, from the ex-
citement they occasion. In some few cases
a small quantity of wine, or mild malt li-
quor, may be taken with advantage; but
they ought never to take both at the same
time, because such a mixture, in weak sto-
machs, is apt to disturb the digestion, and
to hurry on the acid fermentation. Those
who have naturally great appetites, in some
cases, owing to an uncommon sensibility of
the nerves of the stomach, are often seized
with cholics, vomiting, and purging; and
when, from a mistaken notion of assisting
the digestion, they fall into the habit of
drinking strong liquors, this never fails in
time to impair the constitution, and increase
the number of their complaints, These
patients have in general such large secreti-
ons of phlegm in the primae viae, that we
are often obliged to have recourse to gentle

42 AN INQUIRY
emetics and laxatives, before we can, in the
intervals, with corroborants, a proper regu-
lation of their diet and exercise, bring their
stomach and bowels to their former healthy
state. In most of such cases, the cure is
more speedy and complete when water alone
is their beverage; for wine and other vinous
liquors should never be given but as a cor-
dial.
18. Those of a firmer habit, who indulge
in a full diet and sedentary life, suffer not
so much from nervous symptoms, as the
above delicate class of people. Their com-
plaints are nearly of the same kind; but,
from the greater strength of their stomach
and bowels, are not so numerous, so vio-
lent, or so permanent, as in the more deli-
cate men and women. Between the attacks
of their disorders, they at times enjoy a to-
lerable state of health, complaining only of
pains similar to those of the rheumatic kind
in different parts of their body, and some-
times they are seized with slight fits of the
gout, with an alleviation of their other
complaints for a short time. For the inter-
vals of ease and freedom from complaints
are neither so long nor so complete as in
those who, from the greater strength of
their constitution and digestive organs, have
have regular fits of the gout; and of course, 

43 CONCERNING THE GOUT.
they suffer more from the more frequent re-
turns of their complaints.
19. These disorders, which are so vari-
ous, according to the greater or less deli-
cacy of the body, and sometimes from a pe-
culiarity of constitution, differ likewise in
degree, in proportion as the remote causes
have acted with more or less force on the
nerves of the primae viae, and of the system
in general. But in such cases, the digestion
being incomplete, and the assimilation of
the chyle into the nature of our fluids im-
perfect, I suspect an acrimony, generated
in the blood, to be the principal cause of
those pains, which so often shift from one
part of the body to another, and they may
sometimes arise from sympathy with the
nerves of other parts, but oftener with those
of the stomach and bowels. This supposi-
tion of an acrimony generated in the body, is
supported by practical observations, which
show that, by inflammations, suppurations,
and eruptions on the skin, nervous and hy-
pochondriac disorders have been alleviated,
and sometimes suspended for a time.
20. The bad consequences sometimes
arising from the drying up of setons, issues,
old sores, the stoppage of the hemorrhoidal
flux, or other accustomed evacuations, and
the salutary effects that follow the renewal 

44 AN INQUIRY
or return of them, are generally known;
and satisfy most persons that something
noxious to the system was thereby thrown
off from the circulating fluids. Practical
authors are so full and satisfactory on this
subject, and especially my late learned
friend Dr. Whyte, in his ingenious treatise
on nervous diseases, that I judge it unne-
cessary to add such similar observations as
have so frequently occurred to me in prac-
tice.
21. But there are other proofs that have
struck me more, and so evident, though
not so generally attended to, of an acrimo-
ny in the blood being the cause of pains in
the stomach and bowels, sickness, asthma,
headachs, pains shifting from one part of
the body to another, mania, and other mor-
bid affections of the brain and nerves, that
I have not the lead doubt as to the fact.
These are, periodical attacks of an erysipe-
latous inflammation, for the most part in
the legs of men and women after forty years
of age, seemingly, in other respects of a
healthy constitution, but who had lived full
and much at their ease, from an indolent
disposition. In many instances, these in-
flammations return in eighteen months, or
two years, sometimes sooner, at other times
the interval is longer; but in the same per- 

45 CONCERNING THE GOUT.
son, the attacks are nearly as regular as fits
of the gout in others, and seem to be
equally salutary in freeing them from a va-
riety of irregular complaints.
22. In a practice of many years, I have
met with such a number of cases of this
kind, that I doubt not of their having like-
wise occurred to others, though I do not re-
collect any author who has remarked those
periodical returns of erysipelatous inflamma-
tions, being so similar to fits of the gout.
How far I have been in the right, must be
submitted to the judgment of others; but,
in some cases, I have suspected a great affi-
nity between this species of erysipelatous
inflammation and that brought on by a fit
of the gout, especially in the first fit of this
disorder, occasioned by a long walk with
short or tight shoes; in some of which I
have known the gouty inflammation to ex-
tend from the ball of the great toe, over
most part of the leg, which were evidently
of the nature of an erysipelas.
23. The acrimony generated in the blood
in those diseased states of the body, though
probably of the same nature in all persons,
yet may differ in degree, or even in its qua-
lities, and may approach more or less to
that species of acrimony which produces
fits of the gout, according to the greater or 

46 AN INQUIRY
less degree of power in the digestive organs,
and other circumstances. The great diver-
sity of complaints arises, not solely, how-
ever, from a difference in this species of a-
crimony; much depends, sometimes, on a
peculiarity of constitution; at other times,
on the greater or less irritability of the
nerves; but more still on the powers of the
system to throw off such noxious fluids by
the usual emunctories, or by some critical
external inflammation.
24. Dr. Whyte appears to have had the
same ideas with regard to the above cir-
cumstances producing that variety of com-
plaints we meet with in hypochondriac and
hysteric patients. 'From what has been
said,' he remarks, 'it may appear, that the
'morbid matter in the blood, either arthri-
'tic, or of another kind, may be often the
'cause of nervous complaints. It is to be
'observed, however, that the kind and vio-
'lence of the symptoms occasioned by this
'morbific matter, will not only be different
'according to the parts which it affects, but
'in proportion to the greater or less deli-
'cacy or sensibility of the patient's nerves,
'Hence it seems to be, that men of other-
'wise hale and strong constitutions, and
'some robust women, are liable to a regu-
'lar gout, but little to nervous complaints. 

47 CONCERNING THE GOUT.  
'Their firmer fibres and less delicate nerves
'do not predispose them to the latter, and
'the strength of their digestive organs and
'vascular system enables them to throw
'off the arthritic acrimony on the extremi-
'ties, by which means the body is cleared
'of it. Men of a middling constitution,
'between the delicate and the strong, are,
'from this morbid matter, affected with
'pains of the cold rheumatic kind and va-
'rious nervous symptoms, in a less degree;
'and sometimes also with a fit of the true
'gout. But in them this distemper is not
'commonly so completely formed, as to
'clear the habit of the arthritic matter, at
'least for any considerable time; for, soon
'after the imperfect fit of the gout, their
'old complaints begin to return. On the
'other hand, women of a more delicate
'habit, and men of weak fibres and more
'sensible nerves, have more rarely any dis-
'order like the true gout; either because in
'such constitutions the arthritic acrimony is
'imperfectly formed, or, what is more pro-
'bable, because the vital organs are unable
'to throw it off on the joints and extremi-
'ties *.' After this general view of the ef-
fects of the remote causes of the gout on
* Whyte on nervous, hypochondriac, and hysteric
disorders. Edin. 1765, page 162. 

43 AN INQUIRY
delicate habits, and on those of a middling
constitution, or who, in point of strength,
hold a place between the delicate and those
approaching to the robust habit, we shall
proceed to consider the consequences of their
long continued action on this last class of
people.
25. It has already been observed, (par.
10.) that men and women of robust consti-
tutions, with strong powers of digestion,
while they continue temperate and active,
are seldom, if ever, seized with the gout.
It is this strength of constitution that ena-
bles them to bear with impunity such degrees
of intemperance as would subject others,
with less firm fibres, to various complaints,
and to the gout itself. But when such per-
sons come to be long exposed to the conti-
nued action of the remote causes of this dis-
ease, their powers of digestion become less
complete, and their system in general suf-
fers some diminution of its former strength.
This diminution of the digestive powers,
and of the strength of the body, is howe-
ver so slow and gradual, as scarcely to be
perceived by the person so exposed for a con-
siderable time. This freedom from com-
plaints, and the pleasure such people enjoy
in convivial societies, are a great encou-
ragement to the continuance of that mode 

49 CONCERNING THE GOUT.
of living from which they receive so much
enjoyment, until disease gives the alarm,
and brings them to a more temperate way
of living.
26. But the effect of intemperance is not
always the gout; in many instances, want
of appetite, great disorders in the stomach
and bowels, visceral obstructions, especially
in the liver, consumptions, dropsies, and o-
ther chronic diseases, and sometimes inflam-
matory fevers, are often the consequences of
such irregularities. For it is not those who
have persevered in a steady course of intem-
perance that are most subject to the regular
gout; with such persons the functions of
the digestive organs are much injured, which
is incompatible with the production of that
distemper, but is often the cause of chronic
diseases, and sometimes of the irregular
gout. It is persons, with strong constituti-
ons and good appetites, that have not ma-
terially hurt their digestive organs by intem-
perance, but who, from a full diet, a regu-
lar though moderate quantity of strong li-
quors twice a-day, and now and then, from
the pleasure they receive in cheerful society,
an accidental indulgence in strong liquors,
with a sedentary life, that are most liable to
the true gout.
27. Men who are remarkable for the
C

50 AN INQUIRY
strength of their constitution, have been
known to continue in such a life of indul-
gence for many years, without having their
health materially hurt: For though their di-
gestion, and the assimilation of the chyle,
be on some occasions incomplete, and of
course some degree of acrimony introduced
into the blood, yet such is the strength of
their fibres and force of their circulation, as
to free them of it in a short time, by the
excretory vessels of the skin and other natu-
ral emunctories of acrimonious fluids. But
as age advances, sometimes with a degree
of corpulence, their activity fails, and the
secretion by the skin, the most natural out-
let for this species of acrimony, lessens.
Such persons commonly retain a keen ap-
petite, and have apparently a good diges-
tion; but in process of time they begin to com-
plain of wind in the stomach, sickness, slight
cholie pains, cramps in the legs and thighs,
and other symptoms of indigestion and dis-
order in the primae viae. This shows at least
a temporary diminution of the powers of
digestion; and some slight pains shifting
from one part of the body to another, indi-
cate an accumulation of the above acrimony
in the blood. This affects the body vari-
ously in different persons for some time, till
it is at last, by the strength of the system and 

51 CONCERNING THE GOUT.
force of the circulation, thrown upon the
membranes and ligaments of some joint,
most commonly in the first fits of the gout,
on the first joint or ball of the great toe.
28. The generation of the arthritic acri-
mony in the blood is so very gradual, as
scarcely to be perceived until it accumulates
to such a quantity as is necessary for the
production of a paroxysm, or is so altered
by the internal powers of the animal body,
as to fit it to be thrown out in a critical in-
flammation on some particular joint. We
suppose this acrimony to arise from some
deficiency in the digestive powers, or from
the too great quantity, or acrid quality, of
the chyle to be assimilated into the nature
of our fluids, by the force of the circula-
tion, and other functions in the animal bo-
dy. Although, from the long intervals be-
tween the paroxysms of this disease, the ac-
cumulation of the arthritic matter must be
extremely slow; yet we see that it may exist
for a considerable time in the habit, with-
out affecting materially the system. The
length of these intervals will be in propor-
tion to the strength of the constitution, di-
gestive powers, and to the force with which
the remote causes have acted on the body
during that interval; so that it may be pro-
tracted to one, two, three, or more years.
C2

52 AN INQUIRY
But when, from repeated fits of the gout,
the strength of the constitution, begins to
decline, the intervals become shorter, till
at last the fits return twice a-year, com-
monly in the spring and autumn; and per-
sons so afflicted are, during those short inter-
vals, seldom free from some arthritic com-
plaints, except in the summer months.
29. We are not however to suppose, that
the accumulation of any species of acrimo-
ny will be in proportion to the generation
of it in the habit. For nature is through-
out life constantly employed in throwing
off from the blood, by the skin, kidneys,
intestines, and lungs *, not only such fluids
as have become acrid, by their long reten-
tion in the body, but likewise those which
have been introduced into the circulation
by the lacteals and other absorbents, or are
generated in our fluids in certain diseased
states of the body. But when the balance
between the generation and elimination of
these noxious fluids is disturbed, an acrimo-
ny in the blood will be thereby accumula-
ted. This may happen without the system
* We know that as constantly as the vital principle
is absorbed from the air in respiration, for the mainte-
nance of the vital motions, a noxious fluid is separated
from the blood, which, is retained, would prove hurt-
ful to the system. 

53 CONCERNING THE GOUT. 
being sensibly injured by it; because nature
confines not herself in the quantity of per-
spiration, in the secretions of the kidneys
or intestines, to a mathematical exactness;
for in these respects she is variable, accord-
ing to the diet, drink, temperature of the
air, and other circumstances. It is only
when these functions are considerably impe-
ded, or disturbed, that the system is remarka-
bly affected by the accumulation of acrid
fluids. By the abolition of any one of these
functions no doubt life could exist only for
a short space; but, by the regular perform-
ance of them, health is preserved, and those
diseases which arise from an acrimony are
greatly alleviated. It is of course an eva-
cuation of the arthritic matter, by these
emunctories, and especially by perspiration
kept up by exercise, which protracts the in-
tervals between the fits of the gout.
30. Although it is a question with me,
whether or not the full habit of gouty peo-
ple in general, may not, in some degree,
be owing to their perspiration not being in
proportion to their food and drink; yet the
following observations incline me to believe,
that a diminution of perspiration is partly
the cause of the accumulation of the arthri-
tic acrimony in the body. 1st, The benefi-
cial effects which arise in gouty habits from
C3 

54 AN INQUIRY
a vigorous perspiration, kept up by exer-
cise, and, in some cases, by warm bathing.
2d, Between the intervals of the fits of the
gout, thece is in general a free and copious
perspiration by the feet; the stoppage of
this evacuation is usually followed by disor-
der in the body, and often by a paroxysm.
3d, This is in general a disease of cold wea-
ther, and of cold climates. 4th, This sup-
position is corroborated by the observation,
that men who are remarkable for a copious
perspiration, tho' they live freely, are sel-
dom afflicted with this disease.
31. Though the usual period of the first
fit of the gout is about the fortieth year,
yet there are instances of regular paroxysms
of this disease before twenty years of age.
The earlier the first attack of this disease
takes place, the longer in general is the in-
terval between the first and second fits, this
being commonly from three to seven years,
and sometimes to double of this last period.
But in most of those cases, after two or three
regular paroxysms, the intervals shorten con-
siderably; so that, by the fortieth year, the
fits return usually every two years or eigh-
teen months, and sometimes annually.
32. In the hereditary gout, which is
commonly the case in early attacks of this
disorder, and in those who have not guard- 

55 CONCERNING THE GOUT.
ed sufficiently against the accumulation of
the arthritic matter by temperance and ex-
ercise, the intervals still continue to shorten;
so that, by their fiftieth year, the paroxysms
in many persons return every six months.
By this time, from the frequent attacks of
this disease, a stiffness and weakness in the
feet, ancles, knees, and other joints, render
them incapable of much exercise, and in
this unhappy situation they continue for
some years; but the atonic gout takes place
in them much sooner than in those where
the intervals between the fits have been
longer.
33. The atonic gout succeeding to that
severe state of the disease just mentioned,
brings with it great disorders in the stomach
and bowels, such as sickness, nausea, vomit-
ing, and flatulency. But as the system in
general is more or less affected by the reten-
tion of the arthritic matter in the habit,
they become subject to a variety of other
complaints, namely, headachs, asthma, faint-
ings, palpitations of the heart, fits of the
gravel, a concomitant of the advanced state
of the gout *, general weakness of the bo-
* When persons afflicted with the gout are attacked
with gravelish complaints, these usually occur during
the convalescent state of that disorder. At that peri-
od, after a severe paroxysm, the urine becomes turbid,
C4 

56 AN INQUIRY
dy, pains shifting from one part to another,
spasmodic contractions, giddiness, loss of
memory, imbecillity of mind, with a vari-
ety of anomalous complaints. Sometimes
they are seized with a mania; but previous
to their death, they often become paralytic,
apoplectic, or comatose; in some particular
cases, without any of these last disorders be-
ing distinctly marked, they seem rather to
sink under the magnitude and severity of
the disease, and at other times they die sud-
denly.
34. When the first fit of the gout takes
not place till between forty and fifty years
of age, the interval between the paroxysms
is usually from two to three years; but af-
ter a few regular fits, they shorten to eigh-
teen, and at last to twelve months. The
later in life this disease makes its appearance,
the longer and more complete are the inter-
vals, the milder the disorder, and the less of
the atonic gout in extreme old age.
35. Before we proceed further, it may not
be improper to consider how far the obser-
from a critical discharge of the arthritic matter. This
probably gives rise to the gravelish complaints, and the
generation of sand, from the irritation of which, in the
kidneys, or urinary passages, there is a considerable se-
cretion of a viscid phlegm, which may lay the founda-
tion of gravelly stones.

57 CONCERNING THE GOUT. 
vations in the preceding paragraph, as part
of the history of the gout, agree with our
general doctrine. When this disease attacks
persons early in life, an hereditary disposi-
tion towards it is to be suspected. But in
the vigour of youth, when the activity of
the body is greatest, and the powers of di-
gestion are in their full force, seven or
more years may pass before the return of a
second paroxysm. The length of the inter-
val, and the levity of youth, are probably
the reasons why a proper attention is not
paid to obviate the effects of the natural
propensity to this disorder, by temperance
and exercise. This inattention is not per-
haps the sole reason for the interval shorten-
ing between the succeeding paroxysms:
For when nature is accustomed to a particu-
lar mode of acting, to free the habit from
an acrimonious fluid, she will more readily
and easily renew the same process, when
similarly stimulated. Besides, in every fit
of the gout, there is more or less of a noxi-
ous sluid deposited in the cellular substance
of the ligaments and tendons, or in the
neighbourhood of them. The stiffness which
this occasions in the joint affected, is not at
first perceptible; but after the repetition of
a number of paroxysms, and the parts come
to swell, from the accumulation and indu-
C5

58 AN INQUIRY
ration of this fluid, a proportionable stiff-
ness of the joint takes place. Such valetu-
dinarians begin to walk slow, then to creep
along as is their feet were covered with
corns, and at last arrives the laboured hob-
bling step of martyrs to the gout *
36. After every fit of this disorder, when
all pain has ceased, there remains a weak-
ness and stiffness of the limb, and particu-
larly in the joint that was affected; but in a
few days the former strength and suppleness
of the joint gradually returns, and the per-
son comes to walk, seemingly with his usual
agility and firmness. This weakness is not
so remarkable after the first fit of the gout,
as it is after the paroxysms, in the advanced
state of this disease, when the foot and an-
cle often become oedematous. From this
* In this last advanced state of the disease, the swell-
ings in the feet and hands are, in many instances, re-
markably large. In one case under my care, the fin-
gers of both hands were so swelled and distorted, that
they constantly gave me the idea of so many ill shaped
potatoes. Such swellings commonly suppurated from
time to time, and with the matter issuing from the sores,
may be observed the appearance of small grains, like
mustard seed, of a whitish colour, involved in a muci-
laginous fluid. In the above patient, a collection of
them, about the size of a hen's egg, sell from a sore
in the heel, after suppuration; but soon dried up to
one third of that size, and is now in the possession of
professor Monro. 

59 CONCERNING THE GOUT. 
and the preceding paragraph, it appears,
why, after two or three regular attacks of
this disorder, the time between the fits must
necessarily shorten, until the patient arrives
at that length of interval which corresponds
with the accumulation of the gouty matter
in the habit. Neither is it difficult to per-
ceive why, in most cases, after several pa-
roxysms, the person so afflicted becomes sub-
ject to regular returns of this distemper dur-
ing the rest of his life.
37. After examining the most reputable
theories, with the greatest attention, on the
origin of the gout, and considering, with
care and impartiality, every circumstance in
the history of this disease, it appears to me
more probable that the disorder arises from
some defect in the functions of the primae
viae, than from any other cause I can sug-
gest. In many patients this seems to be
owing to a morbid condition of the nerves
of the stomach and bowels, derived from
their parents. But we find, from every
days experience, that the same morbid state
may be induced on the nerves of these vis-
cera, by an indulgence in the remote causes
of this disorder. In almost every case of an
early fit of the gout, and when this disease
was known to be hereditary, I have, in ge-
neral, found, that a full diet was partly the 

60 AN INQUIRY
cause of the first paroxysm. But the same
full diet, and moderate quantity of strong
liquors, being used by others with impunity,
because of a different and a stronger consti-
tution of nerves in the primae viae, the pa-
roxysm is attributed solely to the hereditary
disposition; whereas it is partly owing to a
want of due attention to a proper regulation
of diet and exercise. For, though even a
moderate indulgence in the remote causes of
this disease, for some time, seldom fails to
produce a paroxysm in those who have a
strong hereditary disposition to this distem-
per, yet we know that a strict perseverance
in milk and vegetable diet, and an absti-
nence from fermented liquors, with proper
exercise, are sufficient, in most cases, to
prevent a return of the gout.
38. Notwithstanding what authors have
written concerning digestion, and the con-
version of the nutritive part of our aliment
into chyle, I doubt much is this subject is
sufficiently understood. The vain and fri-
volous attempts that have been made in ela-
boratories to imitate the digestion of our
food, which never did, nor ever can suc-
ceed, give us no perfect idea of the chan-
ges which take place during that process in
ihe animal body. For where life exists not,
it is beyond human art to produce animal

61 CONCERNING THE GOUT.
digestion. For the principle of life, diffu-
sed through the whole of the living body,
of which the nerves are the chief conduct-
ors, and which gives energy and force to
every action of the animal machine, I
strongly suspect to have a considerable share
in carrying on this animal process. We
know at least, that by this principle all sub-
stances are preserved from putrefaction, and
that the stimulating property of all fluids is
thereby increased; but what farther energy
it may have in the completion of digestion,
and in perfecting the chyle, I know not;
though, from our want of success in the
most accurate experiments, I suppose it to
be a considerable agent *.
39. But, as the nerves are the conductors
of this principle, whatever injures them in
their faculty of conducting, must have a
proportionably bad effect on those operati-
ons in the system, that depend on the steady
and regular performance of this function.
* When the stomach and bowels are in a healthful
state, we suppose the principle of life to be properly
conducted by the nerves distributed to these viscera.
At such times the digestion, and the propulsion of the
remains of our aliment through the small intestines,
are quick, and they continue sweet. But in a con-
trary state of the primae viae, digestion is slower, and
the substances subjected to it remain longer in the sto-
mach and bowels, and tend more to putrefaction.

62 AN INQUIRY
It is therefore probable, that, when any
morbid change is brought on the nerves of
the primae viae, and particularly of the sto-
mach, a proportionable alteration will take
place in the secretion of the gastric fluids;
and of course, the digestion will not pro-
ceed in the same manner as in a more
healthful state of the nerves. In a weak
stomach, or in a diseased condition of the
nerves of that viscus, digestion, after a full
meal, is imperfectly performed, and all the
symptoms of indigestion usually follow.
While the stomach continues in this state of
debility, wine, malt liquors, fruits, and al-
most every article of a vegetable nature,
soon become sour, which subjects such per-
sons to frequent heartburns, acid eructati-
ons, and other symptoms of indigestion.
But as this acidity, when the same articles
of diet are used, does not take place with
those of more firm fibres, nor with the same
valetudinarian after his stomach has recover-
ed its former strength, I suspect that in
weak stomachs an acid fermentation is
quickly induced, from some morbid change
in the gastric fluids, and which subsists no
longer than while the nerves of the stomach
continue in a diseased state.
40. By the long application of this acid
to the nerves of the stomach, its functions 

63 CONCERNING THE GOUT.
are greatly disturbed, and a weakness in the
nerves is not only kept up, but seems to be
communicated from this organ to the rest
of the system. A quantity of bile, or a-
crid substances, from indigestion, appear to
have the same effect in producing general
debility. Every man whose stomach is weak,
knows, that when this organ is disordered,
his system is less firm and more irritable
than usual, and that every sudden noise is
apt to make him startle, which would not
give him the smallest disturbance were his
stomach in its usual healthful state. This
circumstance shows the intimate connexion
between the stomach and the system in ge-
neral; and though the fact be generally
known, yet, I imagine, this connexion is
not always sufficiently recognised, for the
primae viae, and particularly the stomach,
must be considered as the centre of sympa-
thy, either with regard to morbid affections
received from, or communicated to, distant
parts. Inattention to this general sympathy
with the stomach, often prevents us from
tracing the causes of certain diseases, and
of course considerably protracts the cure.
41. On account of that general diminu-
tion of strength in the system, which always
accompanies a state of debility in the primae
viae, we seldom in such cases, meet with 


64 AN INQUIRY
a regular paroxysm of the gout. In such
persons the symptoms mentioned in para-
graph 15. more frequently take place.
Valetudinarians of this kind are taught by
experience to abstain from those articles of
diet which are apt to turn sour, and which
heighten and increase the number of their
complaints. To avoid acidity in the sto-
mach, ardent spirits and water are usually
prescribed for their beverage. The relief
they receive, in the languid state of their
mind, from the cordial quality of this drink,
induces them to indulge more than is con-
sistent with the restoration of their health.
Besides the observations made in the pre-
ceding part of this section (par. 17.—25.)
on the effects of a too free indulgence in
strong liquors, it may not be improper to
make the following remarks on this subject.
42. Ardent spirits, the result of a vinous
fermentation, is itself not only incapable of
fermentation, but resists every process of
this kind when mixed with substances that
have a natural tendency to ferment. This
property in ardent spirits being universally
acknowledged, leads us to believe in their
power of preventing fermentation, and of
course the generation of acidity in the sto-
mach; but experience contradicts this sup-
position. For almost in every case, where 

65 CONCERNING THE GOUT.   
persons are distressed by acidity in the sto-
mach, from a debilitated state of that or-
gan, notwithstanding the greatest care in a-
voiding every article of diet and drink which
they suspect would have the smallest ten-
dency to become sour in the stomach, yet
they continue to be now and then afflicted
with heartburn and acid eructations, though
not so often as formerly, while they per-
severe in spirits and water as their beverage.
But where the same attention has been paid
to the regulation of their diet, and water
has been their only drink, they are seldom
troubled with acidity, their health returns
sooner, and in proportion to the exercise
which accompanies this plan of recovery.
43. It is apparently inconsistent and con-
tradictory to assert, that ardent spirits pos-
sess the power of resisting fermentation out
of the body, and that they lose that pro-
perty when taken into the stomach; or ra-
ther, that an acid fermentation is more pre-
valent in the stomach when ardent spirits
and water, than when water alone is used,
which is the fact in many instances. The
loss of this power in ardent spirits cannot
be owing to their being absorbed, their lo-
sing part of their strength in vapour through
the gullet, from the heat of the body; or
that this power is in part lost when mixed 

66 AN INQUIRY
with a quantity of gastric fluids. Each of
these circumstances may contribute to a gra-
dual diminution of their strength: but the
true reason why the acid fermentation takes
place, must perhaps be chiefly ascribed to a
morbid secretion of the gastric fluids, from
a debility of the nerves being kept up, by
the frequent application of ardent spirits.
44. Such is the obscurity in which the
cause of almost every internal disorder is in-
volved, that it is impossible to solve every
objection that may be made to the belt the-
ories on these subjects. This is particular-
ly the case with the gout, on account of the
number of discrepant circumstances which
attend the history of this disease. Could
we reconcile some of these with what I have
supposed to be the cause of this disorder, it
would be an additional proof of the above
doctrine. We say, for example, that men
of robust constitutions, who have subjected
themselves to the remote causes of the gout
for a considerable time, are most liable to
regular attacks of this distemper. But it is
not till these remote causes have brought a
debility on the nerves of the stomach and
bowels, and the functions of these viscera
are somewhat impaired, that the disease
takes place; besides, after the disease com-
mences, we know, that ah debilitating cau- 

67 CONCERNING THE GOUT.
ses heighten the disorder and increase the
frequency of the fits. Notwithstanding,
when, by the action of the same remote
causes on a more delicate constitution, the
nerves of the primae viae are considerably
weakened, and a general debility of the
system is induced, it is rarely the gout, but
in general symptoms of the hysteric and hy-
pochondriac diseases which affect such per-
sons.
45. The action of the remote causes of
the gout on these two different constitutions
produce similar effects on the primae viae,
but which have different consequences on
the system. In both cases, a weakness and
preternatural irritability is brought on the
nerves of the stomach and bowels, but these
effects are most remarkable in delicate con-
stitutions: For the number and severity of
the symptoms are in proportion to the mo-
bility of the system. In some instances so
uncommon a degree of irritability extends
itself through the whole of the alimentary
canal, as creates considerable disturbances
from the application of acrid substances,
wind in the bowels, and sometimes the na-
tural stimulus of the ingesta, or even from
the gastric fluids themselves, and hence arise
many sympathetic affections, commonly call-
ed nervous complaints. If, therefore, from 

68 AN INQUIRY
this state of the primae viae, digestion is in-
complete, and an acrimony is generated in
our fluids, its effects on the system will be
more constant and various than in more ro-
bust constitutions.
46. This great irritability of the system,
in hysteric and hypochondriac patients, I
suspect to be the true cause why the arthri-
tic acrimony in such habits accumulates not
to a quantity sufficient for the production
of a regular fit of the gout. That in such
persons a small degree of acrimony exists in
the fluids, I infer not solely from their los-
ing their complexion, or their flesh, because
these circumstances may be owing to a de-
ficiency of nutritive juices. But, when this
is not the case, we must suppose an acrimo-
ny in the blood to be the cause of those
signs of bad health. This is rendered pro-
bable by the temporary relies which such
valetudinarians receive from eruptions, ery-
sipelatous and other inflammations of the
skin, and sometimes from pains of the rheu-
matic kind. These diminutions of part of
the acrimonious fluid generated in the body,
occur only occasionally, and are no wise re-
gular in their appearance. But in habits so
delicate, in which almost a constant irritati-
on is kept up in the body, it must frequent-
ly happen that there will be a proportiona- 

69 CONCERNING THE GOUT.
ble excitement in the system, to throw off
part of this acrimony by the usual emuncto-
ries, which must prevent any considerable
accumulation of it in the body.
47. In robust habits, the injury done by
intemperance is at first chiefly confined to
the primae viae; for, from the strength of
the system, they are little liable to sympa-
thetic affections or nervous complaints, and
in this state of these viscera, digestion is not
so completely performed as formerly. Al-
though this deficiency in the digestive pow-
ers, at the commencement of the disease, is
inconsiderable, and a slight degree of indi-
gestion is, the only consequence, yet it is,
in process of time, sufficient for the produc-
tion of the arthritic acrimony. For, on ac-
count of the strength of these viscera, in
firm and robust habits, the appetite being
kept up, and the digestion carried on with-
out much disturbance, it is some years be-
fore the primae via are suspected to be the
original seat of this disorder. But as the
disease advances, the intervals shorten, the
symptoms of indigestion increase, become
more and more troublesome, and are often
attended with sympathetic affections in dis-
tant parts, especially in the irregular gout,
and sometimes towards the approach, and
on the going off, of a regular paroxysm. 

70 AN INQUIRY
For, notwithstanding the resistance made to
sympathetic affections, at the commence-
ment of this disorder, from the strength of
the system; yet, by the steady, though
slow, action of the remote causes, and from
the repetition of a number of paroxysms,
the constitution loses by degrees that firm-
ness and stability it at first possessed, and
becomes every year more and more delicate,
and of course more irritable.
48. If I have, in the preceding para-
graph, and in a former part of this section,
attempted to show that the strength of the
system, at the commencement of this disor-
der, in robust habits, is capable of resisting
the action of the arthritic acrimony for a
considerable time, and of protracting the
intervals between the fits; also, that, as the
strength of the system declines, and the
body becomes more irritable, the intervals
shorten; it is from experience, in a prac-
tice of many years, I endeavour to establish
these facts. The effects of this irritability of
the system, in the advanced state of this
disease, helps us to explain the manner in
which occasional causes act in producing fits
of the gout. For as night-watching, in-
tense study, and the other occasional causes
mentioned in par. 7. produce debility and a
proportionable irritability of the body, if

71 CONCERNING THE GOUT.   
the arthritic acrimony prevails in the habit,
there will be of course, from this increased
irritability an excitement of the system in
the production of a paroxysm.
49. In like manner, after repeated pa-
roxysms of the gout, when the nerves of
the primae viae have lost a good deal of
their former energy, an indulgence in sour
punch, weak French wines, and particularly
claret, often prove the occasional causes of
fits of the gout, or of disorders in the sto-
mach and bowels. Because, in the weak
state of these viscera, such liquors produce
an acid fermentation, which is sometimes
carried to a great height. The consequen-
ces of an application of this acid to the pri-
mae viae, are not only a further debility
and increased irritability of their nerves,
but a proportionable extension of those mor-
bid affections to the rest of the body, which
will operate on the system by producing the
gout, or gouty complaints, in the manner
just mentioned; and the same way of rea-
soning will apply to all other occasional cau-
ses which produce general debility.
50. If, by the action of an occasional
cause, such an increased irritability of the
body shall arise, as usually brings on a pre-
mature fit of the gout, we must always sup-
pose such a state to be accompanied with a 

72 AN INQUIRY
sufficient degree of strength in the system to
produce that effect. For, unless a certain de-
gree of firmness exists in the habit, no re-
gular paroxysm can take place. The in-
creased irritability of the nerves of the pri-
mae viae, and of the system in general, may
occasion a variety of complaints in the stom-
ach and bowels, and shooting pains may be
felt in different parts of the body; but a re-
gular fit of the gout is not to be expected
while an excess of debility prevails.  It is
on such occasions, when symptoms of an ir-
regular gout are tedious and troublesome,
that we endeavour, by preparations of iron,
stomachic bitters, and a proper regulation
of diet and exercise, to restore the strength
of the body. This method, is attended with
success, and is the arthritic matter prevails
in the habit, is usually followed by a regular
paroxysm of the gout.
51. Although I have said that every de-
gree of debility, except such as depend on
some paralytic affection, is attended with a
proportionably increased irritability, and of
consequence that the body becomes less ca-
pable of resisting the effects of stimuli, than
in a healthy state, or, in other words, that
the excitement of the system will be in pro-
portion to the decreased debility; yet this
has its limits. For when debility takes place 

73 CONCERNING THE GOUT.
to a certain degree, the external and inter- 
nal senses begin to fail, and the irritabili-
ty of the system is proportionably diminish-
ed, as is evident towards the end of ma-
lignant fevers, and of chronic diseases that
have a fatal termination.
52. This species of debility seems to
take place in a remarkable manner, when
a person is under the influence of any
of the depressing passions of the mind.
For when grief to a considerable degree
takes possession of a person who is subject
to regular fits of the gout, especially is
advanced in life, during the operation of
this passion on the mind, there will be no
fit of the Gout, though near the usual pe-
riod of a regular paroxysm. Such persons
lose their appetite, flesh, strength, com-
plain of flatulency, and other disorders in
the primae viae, make large quantities
of pale urine, sometimes they are seized
with a cholera, asthma, and other symptoms
of the atonic gout. In such a situation the
arthritic matter is apt to fall on the brain
and nerves, with the usual consequences
mentioned towards the end of par. 33.
But in cases of this kind, we must not
perhaps ascribe the atonic state of the
disorder solely to that diminished irritabi-
lity of the nerves, which, in other diseases,
D 

74 AN INQUIRY
commonly attends great debility; for,
from the known sympathy between the
mind and body, it is highly probable that
no great excitement in the system can be
raised to free the body from an acrimoni-
ous fluid, while the mind is under any
considerable depression.
53. From the commencement of the
gout, to its most advanced state in old
age, or until it becomes atonic, the body
loses gradually that firmness it formerly
possessed, and becomes more and more
subject to sympathetic affections and ner-
vous complaints. This progress in strong
and robust habits is so slow as scarcely to
be perceived for many years; for during
the intervals they commonly enjoy good
health, and the attack of a fit is seldom
preceded, or followed, by those disturban-
ces in the body which usually attend pa-
roxysms in more delicate habits, or at a
more advanced period of the disorder.
But however slow the cause of this disease
may act on some constitutions, by reason
of their greater powers of resistance, yet
in time they become equally delicate, and
liable to a variety of nervous complaints
with those who enjoyed not originally so
great a degree of strength: Besides, from
the general imbecile state of mind and 

75 CONCERNING THE GOUT.  
body in the atonic gout, there is reason
to believe that, at that period of the dis-
ease, the arthritic matter acts chiefly on
the brain and nerves. These remarks
made by every physician of observation
and experience in the gout, and by the
unhappy patients themselves, have given
occasion to some persons to assert, with
great considence, that the gout is entirely
a nervous disorder, and to deny the exist-
ence of any morbific matter.
54. In an extensive sense, almost every
disease to which the human body is liable,
maybe said to be nervous; because in
them the nerves are more or less affected,
and the functions depending on their in-
fluence are proportionably disturbed.
The impropriety, however, of such a lan-
guage is so obvious, that physicians have,
for the most part, restricted the word ner-
vous to those disorders and complaints
which in certain persons, from the great
delicacy and unnatural sensibility of their
nerves, are produced by causes which, in
people of a sound constitution, would
either have no such effects, or at least in
a much less degree.
55. But the gout belongs not to this
last class of diseases, being in its regular
attacks evidently an inflammatory disor-
D2 

76 AN INQUIRY
der. It is true, that, in the course of the
gout, many nervous symptoms occur,
especially in the advanced state, and under
its irregular forms. But it is certainly
improper to charasterise a disorder from
such accidental symptoms as may super-
vene during the continuance of it, or
when the natural course of the disorder
is obstructed by particular causes. It is
highly probable, however, that the
great obscurity in which this disease is in-
volved, is chiefly owing to the various
forms of its appearance in different con-
stitutions, and at certain periods of the
disease, which has likewise given rise to
various opinions relative to its origin.
To arrive, therefore, at a just notion of
the nature of the gout, a strict and impar-
tial view should be taken of its true state
in different constitutions, and at its most
remarkable periods.
56. In robust habits, and during the
vigour of youth, when no material inju-
ry has been done to the constitution by
repeated paroxysms of the gout, these pa-
roxysms are in general regular, and their
accession, in many cases, similar to those
of other inflammations, being attended
with some degree of rigour and chilliness,
succeeded by a feverish heat, thirst, and

77 CONCERNING THE GOUT.  
quickness of pulse *. At other times,
the fit comes on without any of these last
symptoms, and with very little forewarn-
ing of its approach †, the person being a-
waked at one or two o'clock in the morn-
ing, by the severe pain of an attack of
the disease, in the first joint of the great
toe, or some other part of the foot. But
when the severity of the pain abates,
which is usually in ten or twelve hours,
though in some cases, it is protracted to
double that space, the patient begins to
eat and drink much in his usual way, and
is not, during the continuance of the fit,
or his recovery, afflicted with any remark-
able nervous symptom. Sometimes a
* Some persons are more susceptible of the symp-
toms of pyrexia than others; this seems to depend
on the greater or less irritability of the system, and
on the degree and extent of the inflammation. In
the more advanced stages of the regular gout, when
one inflammation succeeds another until most of the
joints in both feet and ancles have been affected by
it, every new inflammation is, at its commencement,
accompanied with more or less of the usual symp-
toms of an ardent inflammation.
† Some fits of the gout are said by authors to
take place without any previous warning; but this
coincides not with my experience, for there is al-
ways some intimation of the approaching fit, though
the feelings are often so slight as to be forgotten
in the severity of the paroxysm.
D3 

78 AN INQUIRY
little flatulency, sickness, or pain at the
stomach, occur, which may be occasioned
from sympathy, by any severe pain, but
more particularly while a person is under
a fit of the gout; because, this disease is
supposed to arise originally from some
defect in the primae viae. This implies
an excess of irritability in the nerves of
these viscera, which must increase their
natural propensity to suffer from sympa-
thy when distant parts are strongly affect-
ed.
57. It is true, that the gout, in its first
attacks, may seize the ancle, the heel,
the wrist, or the elbow; but, in such ca-
ses, the patient is strongly inclined to be-
lieve the disorder to be rheumatic; from
the great aversion he has to suppose him-
self afflicted with a disease, which so rare-
ly admits of a complete cure. But such
a commencement of this disorder is un-
common; for the usual seat of inflammation,
in the first fits of the gout, is the ball of the
great toe: In future poroxysms it extends
to the ligaments surrounding the tarsus,
the heel, or the ancle, and the disease is
in general confined to one foot. For it
is not till after several fits, that the
patient is seized with the gout, first in
one foot, and afterwards in the other,
during the same paroxysm. As the 

79 CONCERNING THE GOUT. 
disease advances, the knees, wrists, el-
bows, and sometimes the joint of the
shoulder, come to be affected, and in in-
veterate cases the inflammation seizes
most of these joints one after another, be-
fore the paroxysm is completed, which
is protracted in proportion to the quantity
of arthritic matter necessary to be dis-
charged. In such advanced states of the
gout, the disorder continues regular for a
longer or shorter space, then becomes ir-
regular, and at last atonic.
58. When, from the regularity and
mildness of the fits, the length of the in-
tervals, the general freedom from com-
plaints during these periods, and the
strength of the constitution, we perceive
the disorder to be of a mild nature; per-
sons under so mild a gout are seldom af-
flicted with nervous complaints; especi-
ally is temperance and exercise are used
to obviate the severity of the disease.
For by the regular return of these inflam-
matory paroxysms, the body is freed from
so much of the arthritic matter, as insures
an interval of ease, until it again accumu-
lates in the habit, when nature is stimulat-
ed to a renewal of those actions to which
she has been accustomed to free the body
from that acrimonious sluid. These cri-
D4 

80 AN INQUIRY
tical emotions of the system are com-
monly attended with a more free perspi-
ration than usual, and with turbid urine
towards the end of the paroxysm, part of
the arthritic matter being probably thrown
off, by these emunctories.
59. When the paroxysms of the gout
are regular, under such circumstances as
are just mentioned, and the intervals not
less than a year, it is not uncommon for
men under such annual returns of the
disease, to live till they are considerably
advanced in life; and without any dimi-
nution of that vigour in the exercise of
their mental faculties they formerly en-
joyed, than what is commonly the result
of old age. It sometimes happens, how-
ever, under these mild appearances, that
the distemper becomes irregular; in such
cases nervous and anomulous complaints
are more frequent; and if towards the
end of life, the disorder becomes atonic,
it is usually attended with such symptoms
as are mentioned in par. 33.
60. From the general view I have tak-
en of the nature of the gout, it is easy to
perceive, that, in proportion to the deli-
cacy of the constitution, the strength of
the hereditary disposition, and the power
with which the remote causes have acted on 

81 CONCERNING THE GOUT. 
the system, the intervals will begin to
shorten, and the paroxysms to become ir-
regular, at a more or less early period of the
distemper. For, in a variety of cases,
we see all the different states of the gout;
and when the disease is severe, some per-
sons die of it before their 50th year, while
others, from those circumstances which
are known to aggravate the disease being
less prevalent, withstand the repeated at-
tacks of the disorder to 60 or 70 years of
age, and even to a later period; and al-
though the disorder in some cases seems
not to shorten their days, because they en-
joy tolerable health during the intervals,
yet, almost in every instance, it appears
to have that effect.
61. The sudden deaths which some-
times happen to persons afflicted with the
gout, at different times of life, and par-
ticularly between their 70th and 80th
year, are usually, with some reason, a-
scribed to the immediate action of the
cause of the disease on the brain. But,
in old age, a frequent termination of the
gout, is in what is called its atonic state.
This change in the form of the gout,
from regular paroxysms of an inflamma-
tory disposition, and attended with the in-
flammation of some particular joint, to 
D5

82 AN INQUIRY
its atonic state, is a very remarkable cir-
cumstance in the history of the disease.
62. In this last mentioned stage of the
gout, the patient is seldom attacked with
any febrile disorder, or topical inflamma-
tion, unless excited by a catarrh, or some
of the general causes of fever. It is the
stomach, and bowels, that are at first chief-
ly affected, from whence seem to arise va-
rious sympathetic affections of the head,
lungs, heart, and in general the praecor-
dia. These at first are excited, not with-
out the action of some strong stimulus on
the nerves of the primae viae: But after
they have been often produced in a simi-
lar manner, from a morbid irritability be-
ing thereby induced on the parts affected,
they come at last to be excited by very
slight causes. These disorders are, at their
commencement, sometimes removed or
alleviated by gentle emetics, and laxa-
tives; but, after they have become habi-
tual, our best medicines, for a tempora-
ry relief, are opium, camphire, aether,
volatile alkali, ardent spirits, ginger, a-
safoetida, and other medicines of a simi-
lar nature. The morbid affections of the
liver and kidneys, under the forms of
cholera and diabetis, I suspect to be ow-
ing to the immediate application of the 

83 CONCERNING THE GOUT. 
arthritic matter to the secretory organs of
these viscera. A tenesmus and strangury,
in gouty constitutions, must, in general,
be attributed to the same cause, though
they may sometimes arise from sympathy.
63. Several reasons are given by au-
thors, for that Angular transition from
the regular to the atonic gout; but the
true cause appears to be debility, from
whatever source it is derived. For, al-
though the arthritic matter may be pre-
valent in the body, yet we know that a
certain degree of strength is necessary, for
the formation of a regular paroxysm.
But, if from a delicacy of constitution,
a long course of intemperance, the debi-
litating effects of some previous disorder,
or from the long continuance and severity
of the gout itself, there remains not in
the system a sufficient degree of strength
to produce a regular fit of the gout, the
arthritic acrimony, accumulating in the ha-
bit, will affect the system variously; and
this variety of complaints, in different
persons, seems often to arise from a pecu-
liarity of constitution. That diminution
of strength, which attends the advance-
ment of age, is slow, but steady; and
being progressive, such a degree of debi-
lity must at last take place, as is inconsist- 

84 AN INQUIRY
ent with the formation of a regular pa-
roxysm of the gout. This, with the de-
bilitating effects of the gout itself, seems
to be the principal cause of the atonic
gout in old men; for the arthritic matter
continuing to be generated, and critical
discharges of it ceasing to be made, the
system is affected by it in the manner
mentioned. The effects of this acrimo-
nious fluid, when in some cases it acts on
the brain and nerves, are not so painful,
as they are humiliating to our humanity,
in the diminution of memory and judg-
ment, often to that degree, that there
seems to be an almost total abolition of
the mental powers, sometimes attended
with insanity and even mania.
64. Notwithstanding the great variety
of forms, in which the gout makes its ap-
pearance, in different persons, and at dif-
ferent periods of the disease, the whole may
be arranged under the three following
heads; the regular, the irregular, and the
atonic gout, in advanced periods of the dis-
ease, and in old men. This division seems
to me natural, and sufficiently comprehen-
sive of the various states of this distemper;
for minute distinctions seldom eludicate, 

85 CONCERNING THE GOUT.    
but often perplex, a subject *. Indeed
from the observations already made on
these divisions, it is unnecessary to be
* Persons subject to the gout, are, in common
with the rest of mankind, liable to other diseases,
either when an hereditary disposition to some par-
ticular disorder prevails in the constitution, or when
they are accidently exposed to the causes which pro-
duce them. But when a disease distinct from the
gout exists in a gouty habit, it seldom fails to dis-
turb the natural course of that distemper; and as the
disorders are different, so the method of cure for
each must likewise differ. When the disease is of
a chronic nature, the cure can only be attempted
during the intervals of the paroxysm of the gout,
and must be carried on with prudence and caution,
to prevent, as much as possible, the natural progress
of the gout from being interrupted. These acci-
dental conjunctions of other diseases with the gout,
have induced Musgrave and others to divide the
gout into as many different species, as there happen
to be chronic disorders connected with it. I even
suspect that some of their divisions do not strictly
belong to this distemper; and that they have been
led into the mistake from some symptoms of chro-
nic diseases, which we know resemble those of the
gout. For Musgrave gives us different species of
the gout under the denomination of arthritis symp-
tomatica, arthritis rheumatismo superveniens, ar-
thritis ex chlorosi et ex mensium suppressione, ar-
thritis hydropi superveniens, arthritis melancholica,
arthritis fixa scorbutica, arthritis lui venereae suc-
cedens, arthritis asthmatica, arthritis febri succed-
ens, arthritis ex colica, arthritis morbis quibusdam
euticularibus subjecta. Each of these diseases, 

86 AN INQUIRY
very particular in a farther description of
them. It will be sufficient if, by a short
review of them separately, and by consi-
dering some circumstances peculiar to
each, we shall be led to a more distinct
idea of the true nature of this disease.
65. It has always been my opinion,
that a regular fit of the gout should be
considered as a salutary paroxysm, excited
by certain laws in the system, to free the
body of a morbid matter, generated in
our fluids, which, is retained, would
prove hurtful to the constitution. From
the periodical returns of those fits, we
may presume a farther generation of ar-
thritic matter, during the intervals, which
is sufficient for their production. The
disorders of the stomach and bowels, and
other irregular complaints which some-
times occur, for a few days before the ac-
cession of a fit, when the arthritic matter
is prevalent in the body; and the return
of these complaints for some time, dur-
which he connects with the gout, and many others
not mentioned, I have known to accompany that
disorder. Some of them are consequences or symp-
toms of the irregular and atonic gouts; but from
the best observations I have been able to make, I
never knew this disorder originate from those sup-
posed causes; and, of course, I have always thought
the above distinctions frivolous and injudicious. 

87 CONCERNING THE GOUT.
ing the recovery from a paroxysm, and
before the arthritic matter is completely
discharged by the emunctories, prove the
existence of a materies morbi. The en-
joyment of greater alacrity of body and
mind after a fit of the gout, than for a
considerable time before, likewise shows
it to arise from some noxious fluid, thrown
off during the paroxysm. The duration
of the paroxysm, with the number and
extent of the inflammations succeeding
one another, in different joints, appear
to correspond with the quantity of ar-
thritic matter, to be thus critically dis-
charged. Besides, our sight and feeling
bear testimony of the disposition of a
morbific matter on the joints, in every
fit of the gout, not only from the inflam-
mation thereby excited, accompanied with
excruciating pain, but from the remarka-
ble perspiration of the part affected on the
declension of the inflammation, the great
itchiness of the part, on the disease going
off, and other signs of a critical discharge.
66. It was the opinion, however, of a
late celebrated author, that these inflam-
mations were raised by the vis medicatrix
naturae, to overcome an atony in the ex-
tremities, communicated to the rest of
the system. This vis medicatrix natural,
in most cases, is an expression of doubt- 

88 AN INQUIRY
ful import, being somewhat similar to
Van Helmont's Archaeus; and, as to the
atony mentioned, there is no proof that
it ever exists. But, to accommodate our
reasoning to such a theory, we must give up
the evidence of our senses; which would
be equally absurd as the adoption of the
Bishop of Cloyne's doctrine of Ideas.
67. If those who insist on the gout be-
ing entirely a nervous disorder, had ad-
mitted the existence of a morbific matter,
their theory would have been more easily
comprehended. For no disease is attend-
ed with a greater variety of nervous com-
plaints, or sympathetic affections, than
the gout in its irregular and atonic states;
nor is there any acrimony more capable
of producing them, if we may judge
from its effects, than the arthritic. In the
irregular gout I comprehend not only
what is called the retrocedent, and the
misplaced gout, but every other morbid
state of the body and mind, arising from
a defect in the critical discharge of the ar-
thritic matter. The atonic gout may be
here also comprehended; but I shall con-
sider this state of the disorder in old men
separately.
68. It would be tedious and almost
impossible to describe the different forms 

89 CONCERNING THE GOUT.  
of the irregular gout, because of the
great variety of their appearance in dif-
ferent constitutions; and it sometimes
happens, that they are not easily distin-
guishable from other complaints, which
are not of a gouty original; and, there-
fore require the careful examination of the
physician to distinguish them. It is neces-
sary to observe how far they correspond,
or are similar to other symptoms of the
irregular gout, we have formerly met
with in practice; we should be informed
if there is reason to believe, that the
gout is hereditary in the family; likewise
how far the patient may have exposed
himself to the remote causes of this dis-
order; if the complaints have alternated
with pains in the joints; if the person has
ever had a regular fit of the gout, and
with what effect in regard to his other
complaints. These, and some other in-
quiries, which will naturally occur from
the particular history of the disorder, will
in most cases fix the true nature of the
disease.
69. Although in the irregular gout the
primae viae are in general the parts mostly
affected, yet no sensible part of the body
is exempted from its effects. The external
parts of the head, brain, and with it the 

90 AN INQUIRY
mind, are variously affected. The visce-
ra of the thorax, abdomen, and pelvis,
suffer by turns *. The complaints arising
from a morbid affection of these parts,
often alternate with disorders of the sto-
mach and bowels, and with pains in the
joints, or some other external parts.
This last case is usually attended with an
alleviation of symptoms; but of no long
duration, unless the inflammation amounts
to a complete fit of the gout. The dis-
orders in the irregular gout are often of 
the chronic kind, accompanied with de-
pression of spirits, despondency, and ap-
prehension of danger. Costivenes seems
natural to gouty constitution; but, when
the faeces and bile stagnate for some-time
in the bowels, they become acrid, and
produce a diarrhoea.
70. It is believed in general, and with
* In a singular case of a gentleman of forty years
of age, with a robust and full habit, who came un-
der my care, the arthritic matter had affected him
with violent pain, which shifted from the abdomen
to the testicles, and sometimes to the back, and
vice versa; this disorder had attacked him, from
time to time, for many years, but was chiefly con-
fined to the testicles, or abdomen, but never in both
places at the same time.
The cure was accomplished by warm-bathing,
temperance, exercise, and laxative stomachic medi-
cines. 

91 CONCERNING THE GOUT.  
reason, that most complaints in the irre-
gular gout arise from the absence of re-
gular paroxysms, and from the incom-
plete discharge of the arthritic matter by
the usual emunctories; but how these in-
flammatory paroxysms come to be ob-
structed in particular constitutions, when
the arthritic matter prevails in the habit,
is difficult to ascertain. This cannot, in
all cases, be ascribed to general debility,
because we see, from time to time, per-
sons afflicted with the irregular gout for
a considerable time, who are not defective
in bodily strength. It is not probable
that any specific difference exists between
the acrimonious fluid affecting the system
in the irregular gout, and that which pro-
duces regular paroxysms; because, in the
former case, there is sometimes a regular
fit of the gout, and in the latter symp-
toms of the irregular gout often proceed
a complete paroxysm. It is more likely
that the irregular gout arises from some
peculiarity of constitution, not always in
our power to discover, or from a defect
in the nerves of the primae viae. This
last circumstance, in conjunction with the
action of the predisposing causes, is more
likely to produce an irregular gout, than
any thing else I can suggest. 

92 AN INQUIRY
71. For, not withstanding I have al-
leged, that the regular gout arises from
some deficiency in the digestive organs,
yet I am also of opinion, that a certain
degree of firmness in the primae viae, and
in the system in general, is requisite for
the formation of a regular paroxysm.
But, when this degree of firmness is
wanting, and the stomach and bowels are
in their debilitated state, approaching to
that of hypochondriac patients, it is the
irregular gout that commonly takes place.
In conformation of this supposition, per-
sons who have a regular gout possess, in
general, for many years after the com-
mencement of this disorder, and especi-
ally is the intervals exceed a year, a tole-
rable appetite during those intervals, ap-
parently a good digestion, and enjoy in
other respects good health. Whereas,
those who are afflicted with the irregular
gout have seldom a regular appetite, nor
are they uniform in their quantity of
food; for sometimes their meals are mo-
derate, and at other times from a depra-
ved sensibility of the nerves of the sto-
mach, they eat more than is consistent
with the weak condition of the primae
viae, and of course their digestion is pro-
portionally less perfect.

93 CONCERNING THE GOUT.  
72. Besides, in this less firm state of
the body, the system in general is not only
proportionably more irritable, but there
is commonly some viscus, or part of the
body, possessed with a greater degree of
irritability than the rest, which, in differ-
ent constitutions, gives rise to the vari-
ous complaints we meet with in the irre-
gular gout. Several of these complaints
arise at first from sympathy with the sto-
mach and bowels morbidly affected, as
giddiness, headachs, palpitations, and o-
ther irregular motions of the heart, asth-
ma, &c. By the frequent repetition of
them, however, a morbid delicacy is
thereby induced on the brain, heart, and
lungs, and of course these disorders be-
come habitual. But care should be taken
to distinguish between the chronic disor-
ders from an arthritic acrimony in our
fluids, and those of the same denomina-
tion arising srom other causes. The on-
ly sure means of being satisfied that these
disorders are of a gouty original, are,
their alternating with pains in the joints,
or their being removed by a regular pa-
roxysm of the gout. For it is wrong to
suppose the arthritic acrimony to be so
general a cause of chronic complaints as
some imagine. 

94 AN INQUIRY
73. Although the word Atonic is no
doubt applicable, in many instances, to
what is usually denominated the Irregular
Gout; yet I wish to confine it to those per-
sons in whom the arthritic acrimony pre-
vails, but in whom no effectual exertion
of the system takes place, to free the
body from the arthritic matter. Of
course, in this state of the disease, we sel-
dom meet with such inflammatory pains
in the joints, as usually relieve disorders
of the head, or viscera of the thorax and
abdomen, in the irregular gout. It is
such complaints as are mentioned in par.
33. that afflict the unhappy patients, with
others that indicate more particularly the
nervous system in general to be affected.
These disorders are not constant, but
come and go in an irregular manner, be-
ing accompanied, even in the intervals,
with a general debility of body, and
sometimes of the mind. The duration
of such a valetudinary state is various;
with some it is only for a few days, weeks,
or months, and with others it is for se-
veral years previous to their death. When
this atonic gout takes place in a constitu-
tion, worn out by numberless paroxysms
of the gout, and especially is to these are
added the infirmities and debility of old 

95 CONCERNING THE GOUT.  
age, it seldom fails to put a period to their
existence in a short time. Notwithstand-
ing, there are instances of men, even in an
advanced age, living under these compli-
cated disorders for several years. Such ca-
ses are usually attended with more or less
want of vigour in the exercise of the men-
tal faculties, and for the most part the pa-
tients die of a palsy or apoplexy.
74. From this view of the atonic gout,
it is easy to perceive that I consider it on-
ly as a more advanced stage of the irre-
gular gout; likewise that the causes,
mentioned in par. 70. and 71. of this last
disorder, are the same with those of the
atonic gout; but, in producing this last
effect, their action is more powerful and
extensive in the system, and, of course,
the disease is in general of greater mag-
nitude and danger. For, although the
pains in the irregular gout, moving from
one part of the body to another, similar
to those of the rheumatic kind, and alter-
nating with disorders of the viscera, ap-
pear seldom to produce any complete in-
tervals from complaints, yet they seem
to contribute somewhat to the expulsion
of the arthritic matter. It is probable
that those fits of illness returning after
uncertain intervals, and continuing for 

96 AN INQUIRY
some days or weeks, in gouty constituti-
ons, as the asthma, palpitations of the
heart, strangury, morbid affections of the
kidneys, and even of the primae viae,
have nearly the same effect, though per-
haps less powerful in the expulsion of the
arthritic matter.
75. If, in the irregular, or atonic gouts,
an erysipelatous inflammation, bile, or
imposthume occur, as is sometimes the
case, they seldom fail of giving consider-
able relief, in some degree producing
the same effect as a fit of the gout. The
relief thereby obtained will in general be
found proportionable to the extent and
duration of the inflammation, the size
of the imposthume, and its subsequent
discharge, which is an additional proof
of the existence of a materies morbi.
76. It is remarkable in the atonic
gout, in which, from the great debility
of the system, so few exertions are made
to free the habit from the arthritic acri-
mony, that its action and effects should
be chiefly on the brain and nerves. The
same thing happens in other diseases, as
convulsions before the irruption of the
small-pox and measles; the nerves are some-
times remarkably affected before the ap-
pearance of an erysipelatous inflammati- 

91 CONCERNING THE GOUT.
on, and other cutaneous eruptions. But
this is more especially the case, when the
ordinary course of the gout, by regular
paroxysms, is obstructed, and the arthri-
tic matter is thereby accumulated in the
habit. I have, in many instances, known
this to be effected by bathing the feet in
cold water, which stopped the progress
of an incipient inflammation in the foot,
an indication of the approach of a regu-
lar paroxysm of the gout; by some tak-
ing the bark; others, Portland's powder,
as a cure for this distemper. But the
more successsul they are in preventing,
by these means, regular fits of the gout,
the greater is the danger to the constitu-
tion, and to life itself, by producing
chronic diseases and sometimes mania;
but in most of the cases I have known
treated in these different ways, the pati-
ents have died suddenly. This is proba-
bly occasioned by the accumulation of
the arthritic matter, and its immediate
action on the brain and nerves, by which
their powers are speedily destroyed.
77. Indeed, in all the forms of the ir-
regular gout, there are in different per-
sons, such a number and variety of sym-
pathetic and nervous complaints, that it
can be no matter of surprise, if every ir-
E

98 AN INQUIRY
regular state of this distemper should by
some, without examining minutely the
nature of the disease, be denominated
nervous. In par. 54. I have mentioned
what is commonly understood to be a ner-
vous disease, which enables us easily to
distinguish between nervous symptoms
which may accompany an ague, jaundice,
dropsy, or any other disorder in which the
nerves in general are not supposed to be
particularly affected, and those which arise
from a morbid delicacy and irritability of
the whole nervous system. In the regu-
lar gout, for it is only from the regular
form of a disease we should draw its cha-
racter, there are few or no symptoms
that can be called nervous. The disease
is inflammatory, terminates in an inflam-
mation, and when the paroxysm is com-
pletely finished, the patient's health usu-
ally returns to as firm a state as before the
accession of the fit. But when, for rea-
sons already given, and there remains not
in the primae viae, and in the system in
general, a sufficient degree of strength,
for the production of a regular paroxysm,
the disease becomes irregular, or atonic,
the nervous symptoms come then to be
frequent. For the arthritic matter accu-
mulated in the body affects particularly
the nerves, as has been observed. 

99 CONCERNING THE GOUT.   
78. The idea of the gout being a ner-
vous disorder, will occur to superficial
observers, who are inclined to adopt this
opinion, from certain nervous symptoms,
which sometimes, but not constantly,
precede a regular fit of the gout. These
are, the ceasing of that copious perspira-
tion of the feet, which usually attends
gouty constitutions, when in their best
health; sometimes a numbness, with a
sense of coldness in the legs and feet, al-
ternating with an uneasy prickling sensa-
tion in those parts; cramps in the muscles,
and, in some cases, these symptoms are
felt in both legs, though the approaching
fit is confined to one foot. The great
difficulty which in general attends the in-
vestigation of the causes of diseases, and
sometimes of symptoms, often incline au-
thors to pass them over in silence, even
when they are capable of some explanati-
on. This seems to be the case with re-
gard to those symptoms previous to pa-
roxysms of the gout, and of the leg be-
ing similarly affected, in which no fit
takes place. These very symptoms show,
that the operations of nature are more
slow and gradual, than the sudden attack
of violent pain in a fit of the gout would
lead us to conclude.
E2 

100 AN INQUIRY
79. Here is a process begun, which is
to produce a paroxysm of the gout; and
this I suppose to be a secretion of the ar-
thritic matter, amongst the ligaments and
tendons of the joint, in which the inflam-
mation and pain are to take place in the
approaching fit *. For some little time
the quantity of this matter is smaller, and
perhaps less acrid than it becomes after-
wards, but of a sufficient degree of pow-
er to affect the nervous filaments of the
part where the secretion is made, which
is capable of producing all the uncom-
mon feelings in the foot and leg just
mentioned. This supposition seems to be
supported by those slight pains in the
foot, for some days before the accession
* From the painful exercise of a long walk with
strait or short shoes, there remains a tenderness in
the feet for some days. If the person perform-
ing this journey is of a gouty disposition, it is
highly probable, from the great irritability thereby
induced on the joints of the feet, and particularly
on the ball of the great toe, on which we step for-
ward, that a morbid secretion of the arthritic mat-
ter begins to take place immediately after the walk,
though the fit makes not its appearance till the
third day after, as more particularly mentioned in
par. 7. and is attempted to be explained in my Ob-
servations on the Animal Oeconomy, and on the
Causes and Cure of Diseases, sect. 5. par. 148. 149.
and 150. 

101 CONCERNING THE GOUT. 
of the fit. The same disagreeable feel-
ings in the opposite leg are entirely sym-
pathetic, from a similarity of texture and
constitution of nerves in both legs at
their terminations. Similar to this is the
sympathy of an eye, kidney, teslicle, or
mamma, with those of the opposite side,
as has been more fully explained in sect. 2.
par. 42. of the above mentioned publica-
tion.
80. The sickness, pain, flatulency, and
other disagreeable symptoms felt in the
stomach and bowels for some days previ-
ous to the accession of a fit of the gout,
are probably owing to the same cause, as
is more particularly explained towards
the end of par. 56. When, from a great-
er firmness in the nerves of the primae
viae, no such symptoms occur, it some-
times happens that an unusual, keen, and
unnatural appetite takes place the day
preceding the fit. This remarkable cir-
cumstance is mentioned by authors, par-
ticularly by Sydenham, and I have observ-
ed it on many occasions. If this singular
phenomenon admits of any explanation,
we perhaps must say, that it arises from
sympathy with the nerves of the part in
which the inslammation is to take place.
For the morbid matter secreted, stimulat- 
E3

102 AN INQUIRY
ing these last, may increase the sensibility
of the nerves of the stomach, and with-
out affecting them so far as to create either
pain or sickness.
81. There is another circumstance
which inclines some medical men, but
more particularly the patients themselves,
to believe that this disease is a nervous
disorder; this idea often arises from the
sudden and almost instantaneous move-
ment of the pain from one foot to the
other, which is often succeeded by the
usual ardent gouty inflammation. This
transition is often accompanied with a
quick disagreeable sensation in both legs,
seeming to move from the diseased to the
sound foot with the swiftness of an electri-
cal stroke. This, say they, is entirely a
nervous affection; and in so saying they
are right: but we ought to inquire how
the nerves come to be thus affected. In
the subsequent part of this section, my
reasons for supposing the secretion of the
arthritic matter to commence some days
before the accession of the gouty inflam-
mation, shall be more fully stated. From
the first application of this acrid fluid to
the delicate nervous filaments of the ten-
dons and membranes of the joint, it will
gradually induce a preternatural irritabi-
lity in those parts. This preternatural ir- 

103 CONCERNING THE GOUT. 
ritability will be sufficient not only to
produce the symptoms mentioned in par.
78. but to render the nerves, from which
these filaments are derived, extremely sus-
ceptible of being sympathetically affected
in their course through the whole of the
lower extremities.
82. But such is the nature of this dis-
order, that the pain arising from the ar-
thritic matter is often so instantaneous and
severe, that it readily accounts for the
sympathetic affection of the nerves of one
extremity with those of the other. This
is the more easily comprehended, if we
allow both set of nerves to have acquired
a morbid irritability, from the preceding
effects of the disease, and especially if we
admit the reasoning in par. 79. on the
same subject. That the seat of the pain
and inflammation, shifts from one foot to
another, for reasons afterwards to be as-
signed, is certain; but that an elastic va-
pour, or aura, should fly up one leg and
thigh, and down the other, from the dis-
eased to the sound foot, as patients have
often expressed themselves to me, and ap-
pear to carry with it the active cause of
the succeeding inflammation, is a mere de-
ception. For when the nerves of the dis-
eased, or of the opposite foot, where the
E4 

104 AN INQUIRY
pain and inflammation are soon to take
place, are forcibly stimulated by the ar-
thritic matter, the nerves in the leg and
thigh of both extremities will be simul-
taneously affected, similar to the striking
of a musical string, which will cause others
to vibrate that are in unison with it.
83. The shifting of the pain and inflam-
mation successively from the first joint of
the great toe, to the heel, ancle, tarsus,
metatarsus, and afterwards, in advanced
stages of the disease, to the same parts in
the sound foot, before the paroxysm is
completed, merits our further considera-
tion. For, when the arthritic matter is
secreted amongst the ligaments and ten-
dons of any part of the foot, it may be
asked, why this secretion continues not
till most of the arthritic matter is thrown
out from the circulating fluids, or till
the fit of the gout is completed? In a
question of such difficult solution, it may
not be in my power to give so clear and
satisfactory an explanation as might be
desired; but such probable reasons for the
movement of the inflammation from one
place to another, as occur to me at pre-
sent, I shall humbly offer to the consider-
ation of my reader.  In attempting this
explanation, our best method will be to
observe, as well as we can, the operations 

105 CONCERNING THE GOUT.  
of nature, and the phenomena of the dis-
ease. Let us, therefore, consider the
effects of the arthritic matter secreted
amongst the ligaments and tendons of the
joint, when it is become extremely acrid,
and excites the most excruciating pain,
and an high degree of inflammation.
84. From par. 78. I have endeavoured
to show, that the secretion of the arthritic
matter is prior to the pain and inflamma-
tion of the joint; and from the symptoms
mentioned in par. 79. this acrid matter
continues to be thrown out from the circu-
lating fluids, for some days preceding the
paroxysm. On the accession of the pain,
and for some time after, for the reasons to
be mentioned when we come to consider
the effects of pain, the secretion of the ar-
thritic matter appears to be considerably
increased. But as the severity of the pain
begins to abate in less than 24 hours, we
must suppose that this abatement of pain
arises from a ceasing, or diminution of the
morbid secretion, assisted by the power-
ful effects of the absorbents. This ina-
bility in the secretory vessels to continue
the morbid secretion, is probably owing
to their having lost, in some degree, their
tone, from an access of irritation and the
great distension of the vessels in the pre- 
E5

106 AN INQUIRY
ceding inflammation. In this debilitated
condition of these secretory organs, they
cannot be again excited to renew the mor-
bid secretion, till they have recovered their
wonted irritability, and healthful state,
which seldom happens during that parox-
ysm, or at most in an inconsiderable de-
gree. When the deep seated pain in the
joint begins to abate, the morbid secretion
and inflammation take place in the cellular
substance, and integuments covering the
joint, with a greater degree of redness and
swelling. In this state, the disorder con-
tinues longer, commonly for several days,
but with less pain than on its first attack,
and at last terminates in a copious evacu-
ation of the morbid matter by the excre-
tories of the skin. The same debility,
with the other effects of an excess of stimu-
lus which took place in the vessels more
deeply seated amongst the ligaments of the
joint, appear likewise to take place amongst
those of the integuments, though more
slowly, as the pain is less; for the se-
cretion of the acrid matter at last ceases,
and the disease in that part gradually dis-
appears.
85. Such an attack of the gout as I have
just described, may complete the parox-
ysm in the first fits, or when it is of a mild
nature. But in the more advanced stages
of this disorder, when the arthritic matter 

107 CONCERNING THE GOUT.   
is so abundant in the habit as to render
it impossible, for the reasons given, to be
thrown out from the blood in one topical
inflammation, nature will then exert her
powers in exciting a second, third, or fourth
inflammation, succeeding one another in
different ligamentous parts of the foot and
ancle, which appears to be the natural seat
of this distemper. When so many inflam-
mations, succeeding one another, suffice
not for the discharge of the arthritic matter,
then the secretion and consequent inflam-
mation take place in a similar manner, in
the tendinous and ligamentous parts of the
sound foot. In par. 57. I have mention-
ed, what we often observe in practice,
that the gouty inflammations move from
the feet to the knees, or to the hands, and
other joints of the upper extremities before
the paroxysm is completely finished. I
have known the knees, and sometimes the
wrists, and hand, attacked in the first fit
of the gout, without the feet being in the
least affected, but such cases are rare. For,
in general, it is not till the secretory ves-
sels in the feet have lost in a great degree
their aptitude for secreting the arthritic
matter, from repeated and severe fits of
the gout, that the knees, hands, wrists,
and other joints of the arms, are seized
with the gouty inflammation. In such pa- 

108 AN INQUIRY
tients we observe those swellings on the
joints of the feet and hands, mentioned in
par. 35. They probably arise from a fluid
thrown into the cellular substance, which
by means of the absorbents, thickens into
a gelatinous consistence, probably different
from that which excited theardent, inflam-
mation; because I have known them to
be produced on the joints of arthritic pa-
tients, without any previous inflamma-
tion.
86. The manner in which I have al-
leged this inflammation to be produced,
is not peculiar to the gout; for every spe-
cies of inflammation from internal causes,
seems to be excited in the same way, by
the secretion of an acrid matter, stimula-
ting the soft parts to which it is applied.
The irruptive spots in the measles, is a ru-
bifaction tending to a slight superficial in-
flammation of the skin, brought on, and
kept up by an evacuation of the morbific
matter, through the secretory vessels of the
skin. But, when this disease has nearly
run its course, and there remains not a suf-
ficient quantity of the morbific matter to
keep up the slight inflammation of the
spots, their redness gradually declines,
and they, at the ordinary period of five
or six days, entirely disappear. The mat-
ter of the small-pox, which is specifically  

109 CONCERNING THE GOUT.
different, is secreted from the blood in the
same manner, and its being in a greater
quantity, and perhaps more acrid, produ-
ces a higher degree of inflammation, and
even suppuration, in the form of pustules.
87. The immediate exciting cause of
an erysipelatous inflammation, I have
always considered to be an acrid fluid,
thrown out from the blood on the surface,
and in the interfaces between the fibres,
and the vessels of the skin. When the
quantity of this acrid matter is greater than
can exude through the cuticle, this in-
tegument is raised into vesicles, or blisters,
and from its great sharpness it often produ-
ces small sores, and even gangrene, by
occasioning the death of the parts to which
it is applied.
88. If we carefully attend to the acces-
sion and progress of the acute and chronic
rheumatisms, a similar secretion seems to
take place, though less in view than in the
instances just given, because of the deeper
seat of the disease. In the inflammatory
rheumatism, the pains in the joints, from
their commencement, speedily increase to
a great degree; but during the severity of
this pain, from the deep seat of the
inflammation amongst the ligaments and
tendons, which are not very capable os
inflammatory distension, there is scarcely 

110 AN INQUIRY
any perceptible swelling or inflammation
of the joint. Soon after this, the inflam-
mation and swelling of the integuments
become apparent; and, as the swelling
increases, the deep seated pain lessens,
and at last almost ceases, unless the joint
is moved.
89. The only explanation of these phe-
nomena, I can suggest, is the secretion of
the rheumatic matter, and its application
not only to the surfaces in general of the
ligaments and tendons, but to those of the
small vessels and fibres which compose
their substance, by the irritation of which
the inflammation and pain are excited.
This secretion I suppose to be made by the
exhalent arteries which open on every sur-
face. It commences, and continues for
some time amongst the ligaments and ten-
dons of the joint, as is mentioned above;
then moves to the integuments with an al-
leviation of pain, though with considera-
ble inflammation, swelling, heat, and
dryness of the part, and is at last perform-
ed by the exhalent arteries and excretory
vessels of the skin, which produce a co-
pious perspiration, towards the declensi-
on of the inflammation. This divides
the progress of the inflammation into three
distinct stages, and is perfectly similar to
a fit of the gout. 

111 CONCERNING THE GOUT. 
90. If this doctrine is true, we must,
from the uniformity of nature in her ope-
rations, suppose, that all other inflamma-
tions from internal causes are produced
in a similar manner. For the inflamma-
tions at the commencement of inflamma-
tory fevers, as the pleurisy, peripneumo-
ny, inflammations of the liver, &c. like-
wise those inflammations which sometimes
occur towards the crisis, and during the
convalescent state of fevers, seem all to
be excited by an acrid matter previously
secreted from the blood. I know not if
the quantity of fluid matter of a whitish
colour, found on the surface of the intes-
tines after death, occasioned by the puer-
peral fever, is a proof of this doctrine.
But the fluid, similar in its appearance to
what is called pus, with which the lungs,
pleura, &c. have been observed to be
covered, without our being able to discover
the smallest sore, or imposthume from the
preceding inflammation, I humbly appre-
hend to be an evidence of its truth, as is
the perspiration which accompanies in-
flammations ending in resolution. Fur-
ther testimonies of inflammations being
excited by a fluid secreted from the blood,
are, a thickening of the ligaments and
membranes of the joint, after repeated
fits of the gout, and swellings which arise

112 AN INQUIRY
from a collection of gelatinous matter in
the cellular substance under the skin, as
described in the note to par. 35. The
same appearances, though seldom, and
always in a less degree, which happen af-
ter several attacks of the inflammatory
rheumatism, and likewise the schirrous
swellings which sometimes remain after
inflammations of the glands, and other
soft parts, evince this fact.
91. In our endeavours to investigate the
causes of certain symptoms, which some-
times precede a regular fit of the gout,
and of the subsequent inflammation, I
have been naturally led to consider the
cause of inflammation in general. This
is no doubt one of the most important
subjects in the hisiory of diseases; for the
inflammation of particular parts of the
body is common to fevers in general, and
at the commencement of those of the in-
flammatory kind, often constitutes the
most essential circumstance of the disease,
to which the greatest attention ought to
be paid. Besides, the cause of this in-
flammation is often so connected with the
original cause of the fever, that it is diffi-
cult to take a different view of them.
For these reasons, and because the several
theories I have seen on inflammation are 

113 CONCERNING THE GOUT.   
so obscure and unsatisfastory, with regard
to its origin, I am inclined to proceed
with some further observations in confir-
mation of the above theory.
92. Besides the natural stimulus of the
blood, and that of the vital fluid absorb-
ed from the air in respiration, applied to
the internal surfaces of the heart and arte-
ries, by which the circulation is chiefly
carried on, as will be fully demonstrated
in a dissertation on the Vital Motions
soon to be presented to the public; it
is accelerated by various other causes.
These are heat, exercise, stimulants ap-
plied to the stomach and bowels, pain,
passions of the mind, and acrid substances
absorbed, or generated in the body, by
which the natural stimulus of the blood
is increased. If, by the action of any of
these causes, the circulation is quickened,
and the blood carried through the arte-
ries with considerable force, the skin ac-
quires more or less of a reddish colour,
especially in some fevers, and febrile dis-
orders, previous to an eruption on the
skin. Such an increase of stimulus to the
internal surface of the small arteries, may,
on certain occasions, produce a secretion
by the excretory vessels of a morbid mat-
ter, when it exists in our fluids; but I 

114 AN INQUIRY
doubt much is any increase of stimulus in
the blood, is capable of producing a per-
manent inflammation, previous to such a
secretion.
93. The simplicity of this doctrine
ought not to be any objection to its pro-
bability, especially as it is perfectly simi-
lar to the manner by which every inflam-
mation is excited, from irritating sub-
stances externally applied to the skin, or
to any organised part of the body. It is
to this last circumstance of irritation, we
must look for the cause of every species
of inflammation, which are extremely dif-
ferent, according to the nature of the ir-
ritating substances. But to give us a dis-
tinct idea of the manner by which in-
flammation is raised from irritation alone,
let us take a view of the effects of me-
chanical violence on any part of the body,
and of acrid substances applied to its sur-
face.
94. If a thorn, or other extraneous
substance is lodged in, or under the skin,
the pain which it produces, not only from
the laceration of the soft parts through
which it has passed, but by its pressure on
the surrounding substance, and especially
by its angles and points, a greater quan-
tity of blood, than in a natural state, is 

115 CONCERNING THE GOUT.   
propelled through the small vessels of the
part affected, from their oscillatory moti-
ons being proportionably increased. Un-
der these circumstances of irritation, and
of increased action of the small arteries,
their diameters are enlarged. This en-
largement of these vessels, is gradually
extended to the adjoining small arteries,
until the inflammation has acquired its ut-
most extent. In this advancement of the
disorder, the redness becomes more vivid,
from the violent extension of the vessels,
and from those that were invisible in their
natural state having come into view; a
swelling, of course, is observed, accom-
panied with an increase of heat, pain, and
throbbing of the part affected. During
this period, some impediment, or ob-
struction, seems to be given to the free
circulation of the blood, through the
small arteries to their corresponding veins,
probably at that point of partition where
the artery is said to terminate, and the
vein to begin. This appears not to arise
from any contraction, or diminution of
the diameters of the small arteries, but
from a larger quantity of blood being pro-
pelled through them in a given time than
formerly, which should naturally produce
a contrary effect. From the great force 

116 AN INQUIRY
exerted by the small arteries in this state
of obstruction, to propel their fluids, the
very small vessels arising from these arte-
ries, carrying in their natural states pellu-
cid fluids to the cells of the cellular sub-
stance, and other surfaces, are gradually
enlarged, and carry to their terminations
thicker fluids than when in a healthy state,
and sometimes the blood itself.
95. Such an inflammation as is just des-
cribed, may terminate in resolution, sup-
puration, or mortification. If the extra-
neous body is early removed, and before
the surrounding parts have been raised to
any considerable degree of inflammation,
which precludes large incisions for its ex-
traction, then it usually terminates in re-
solution; such a degree of inflammation
only remains as is the unavoidable conse-
quence of wounds. In tracing an inflam-
mation from an extraneous substance, I
have carried it no further than was con-
sistent with the idea of its being still capa-
ble of terminating by resolution. For my
present intention is only to give, to the
best of my judgment, a true repesenta-
tion of the manner in which inflammations
are in general excited.
96. The effects of acrid substances, as
the mineral acrids, common caustic, lu- 

117 CONCERNING THE GOUT.  
nar caustic, and others of a similar na-
ture, externally applied, are somewhat
different, according to the particular spe-
cies of acrimony they possess, but chiefly,
to the degree of activity with which they
are endowed, in irritating, or destroying
the soft parts to which they are applied.
For, from the very weak condition in
which they may be used, to their most con-
centrated and active state, rubifaction, in-
flammation, blistering, or even the de-
struction of the skin and subjacent parts,
may be produced. Hence it appears, that
acrid substances applied to the skin, oc-
casion an inflammation, proportionable to
the degree of irritation thereby excited;
and that the above mentioned substances,
in their greatest degree of strength, are
not only capable of destroying, in a short
time, the soft parts to which they are ap-
plied, but even, under certain circum-
stances, of dissolving them; however, their
usual effect is similar to that produced by
the application of a red hot iron to the
skin, from which they have obtained the
name of caustics.
97. Our daily practice with Spanish flies
in powder, mixed with unctuous ingredi-
ents, in form of a cerate or plaster, and
applied to the skin, exhibits, in the clear- 

118 AN INQUIRY
est manner, the gradual effects of acrid
substances externally applied. Unless in
persons who have their skin uncommonly
delicate, it is three or four hours after
such an application, before the rubifaction
takes place, and from the continued irri-
tation of the Spanish flies, gradually in-
creases to a high degree of inflammation.
Soon after this, the cuticle is raised in
blisters, from the quantity of fluid thrown
out by the lymphatic arteries terminating
on the surface of the skin; and the ulti-
mate effect in blistering the part, is com-
monly obtained in ten or twelve hours af-
ter the application of the plaster.
98. Heat applied to the body, in any
considerable degree above its standard,
has effects on the skin and subjacent parts,
similar to those of acrid substances. Like
them also, its powers of inflaming, or in
destroying the soft parts, is always in pro-
portion to the degree of heat, and time
of its application.
99. So far was necessary to show the ef-
fects of mechanical irritation, and that of
acrid substances applied to the skin, in
the production of inflammation. But to
proceed farther on this subject, or to the
consideration of the several ways in which
inflammations terminate, so well known 

119 CONCERNING THE GOUT. 
to practical physicians and surgeons, is
here unnecessary. It may, however, be
remarked, that these artificial inflamma-
tions differ, in some respects, from those
arising from internal causes. The former
are more similar to one another, termi-
nate more readily in resolution, and their
consequences are not of such magnitude
and danger to the system. Unless where
their effects have extended beyond the
skin, their similarity is evident. On the
removal of the irritating cause, a stop is
in general put to the inflammation, espe-
cially is proper means are used for destroy-
ing, or washing off such parts of the acrid
substances as may have insinuated them-
selves into the pores of the skin. Acrid
substances externally applied, are no doubt
capable of producing the same fatal ef-
fects, either from a destruction of a consi-
derable portion of the soft parts, or when
a large surface of the skin is violently in-
flamed by them. But, where their effects
are more circumscribed, and do not pro-
ceed further than the production of a few
blisters, there is little or no danger; and
a temporary inconvenience is in general
all that is to be apprehended in such cases.
But inflammations arising from internal
causes are more dissimilar, as the gout and 

120 AN INQUIRY
erysipelatous inflammations differ from a
phlegmon, and this last from an indolent
scorbutic inflammation, &c. When an
inflammation from an internal cause takes
its seat on the surface of the body, the
danger and the consequences of it are in-
finitely less than those which affect the vis-
cera, or internal parts of the body, which
are more fatal.
100. Since, from the preceding pars. it
is evident, that irritation externally ap-
plied uniformly produces inflammation;
it is reasonable to suppose that the opera-
tions of nature must be similar, when the
same or similar disorders are excited from
internal causes. For the same effects be-
ing observed, which we have known to
take place from a particular cause, we
must suppose the same, or a similar cause,
to have produced them. Such is the dif-
ference, however, amongst acrimonious
fluids, that some appear to act on the
blood-vessels and nerves, and excite
an inflammation immediately after they
have been secreted from the blood; while
others seem to remain in a state of ftag-
nation for some time, besore they acquire
a suficient degree of acrimony to produce
the same effect.
101. Though I consider every inflam- 

121 CONCERNING THE GOUT.  
mation, from an internal cause, to arise
from an acrid matter thrown out from the
circulating fluids, yet the quantity is of-
ten so small, and of so mild a nature, as
to terminate by resolution without injur-
ing the body. But, when the quantity of
matter is larger, more acrid, and suppos-
ed to be a critical discharge, all attempts
to a cure by resolution, or to check such
inflammations, are found to be injurious
to the system. No physician of judgment
ever attempts to stop the progress of the
inflammation of the joint in a fit of the
gout, in an ardent erysipelatous inflam-
mation, or a large phlegmon; though he
may attempt to lessen the symptomatic
sever attending these two last cases, by
bleeding, and gentle purges, which some-
times have also the effect to lessen the ex-
tent of the inflammation.
102. The objection just made to the
cure by resolution, can be only applica-
ble to such external inflammations as are
above specified. For every internal in-
flammation being attended with danger,
our utmost efforts ought to be used to re-
move it. This we endeavour to accom-
plish by the means just mentioned, low
diet, and the application of a blistering
plaster, opposite to the part inflamed. 
F

122 AN INQUIRY
This last is one of our most successful re-
medies in lessening a deep seated inflam-
mation, or in removing it entirely to the
blistered part, as shall be more particu-
larly explained in a subsequent paragraph.
Venesection, when freely used, is of the
greatest benefit towards a cure by resolu-
tion; by it the impulse of the blood is
proportionably lessened, and the sympto-
matic fever abated. The other good ef-
fects of bleeding in the cure of inflam-
mations are known only by our success;
for they are not rightly explained. This
evacuation makes a corresponding deple-
tion of the blood-vessels; low diet and
purging have the same effect, and is this
antiphlogistic regimen is not carried to
excess, the action of the absorbents is
thereby proportionably increased.
103. But the most powerful means em-
ployed by nature in the cure of inflam-
mation by resolution, is absorption. For
the mouths of the lymphatics, opening
on every surface, and ever active, absorb
the superabundant fluid thrown out by the
exhalent arteries, whether in a natural or
morbid state. But I have supposed a mor-
bid matter from the exhalent arteries, ir-
ritating the soft parts, to be the original
cause of inflammation, which must cease

123 CONCERNING THE GOUT.  
on its being carried off by the absorbents.
In its passage through the lymphatics, and
lymphatic glands, to the subclavian vein,
it probably undergoes some change; and
afterwards, in the course of the circulati-
on, its morbid condition is so corrected,
as to fit it to be thrown out by the usual
emunctories. These powers of the lym-
phatics are more particularly explained in
a separate treatise on Absorption, which I
hope to be able to publish in a short time,
and to which I must refer for a further
elucidation of this subject. It must, how-
ever, be remarked, that, in some inflam-
mations of the skin, viscera, and pleura,
so great a discharge of the morbid matter
is made by the excretory vessels, as con-
tributes to lessen, and often produces an
entire resolution of the inflammation.
It is the remains of a discharge of this na-
ture with which we find the pleura, lungs,
and other viscera, covered after death, as
mentioned in par. 90. We must not how-
ever, in such cases, suppose the absorb-
ents on these surfaces to be altogether in-
active; but it is the thinner parts of these
fluids that is most readily absorbed. The
rest, therefore, must acquire a thicker
consistency, and as it approaches the na-
ture of coagulable lymph, will, from its
F2

124 AN INQUIRY
agglutinating quality, prove the cause of
those adhesions of the viscera to one ano-
ther, and to the sides of the cavities of the
thorax and abdomen, which so often take
place after inflammations.
104. As pain is the most grievous cir-
cumstance which attends a regular parox-
ysm of the gout, and other ardent inflam-
mations, it may not be improper to sug-
gest what, perhaps, are some of the inten-
tions of nature in exciting pain in the cure
of diseases. It, in the first place, calls our
attention to the seat of the disorder, and to
apply such means as experience has taught
us to be usesul in alleviating the pain, and
in the cure of the disease. When the cause
is external, the further progress of the in-
flammation is usually stopped, by remov-
ing the irritating or acrid substances.
105. But the greatest benefit derived
from pain, excited by inflammation, is a
proportionably increased secretion of the
morbid matter, which first produced it.
By what laws in the economy, this deri-
vation of acrid fluids from the blood,
where it must be equally diffused, to the
part first inflamed, takes place, I know
not, though we are certain, of the fact *.
* Sydenham, and others who were afflicted with
the gout, have observed, that the more violent the

125 CONCERNING THE GOUT. 
For this we can imitate; or rather we can,
by the application of a blistering plaster,
excite nature to a true representation of it.
By this means we often remove deep seat-
ed pains, slight inflammations, and lessen
those of considerable magnitude, by so-
liciting the discharge of the morbid mat-
ter to the blistered part. Most of the ad-
vantages obtained from blisters in fevers,
are produced by an evacuation of part of
the morbfic matter, which, in some fe-
vers of a malignant nature, smells very
offensively. We must reason in the same
manner on the benefit derived from issues,
and setons, in certain diseases; for nature
has a wonderful tendency to throw off
acrid fluids by the skin, especially when
solicited by art.
106. In confirmation of these observa-
tions, it may be remarked, that, when an
acrimonious fluid exists in the blood,
though the person under that circumstance
inflammation and pain, the shorter and more com-
plete will be the paroxysm, and the longer the suc-
ceeding interval. It has also been observed by phy-
sicians of practice, that, when the severity of the
pain was taken off by opium, the duration of the fit
was protracted; and the same thing is known to take
place in the chronic asthma, when opium is daily ex-
hibited. These observations, and the obvious ex-
planation of them, are proofs of the above doctrine,
F3 

126 AN INQUIRY
may enjoy good health, yet, when a severe
pain is raised, or a wound inflicted on any
part of the body, the bad state of the blood
is often discovered by an afflux of morbid
humours to the part affected. A conside-
rable bruise or wound in a scrophulous ha-
bit, though the person has been apparent-
ly free from the disease for many years,
usually brings on a return of his former
disorder. The erysipelatous inflammati-
ons which sometimes follow the applica-
tion of a blistering plaster, which are dif-
ferent from those railed by the Spanish flies,
may, in certain cases, be owing to a pe-
culiarity of constitution in the nerves of
the skin. But at other times, this inflam-
mation, and especially when accompanied
with small boils and ulcers, must be ascri-
bed to an acrimonious fluid thrown on the
part inflamed. In rheumatic constitu-
tions, a return of the disorder is often
owing to a strain in the ancle, knee, lum-
bar vertebrae, or some other joint; the
same accidents often produce premature
symptoms of the gout. But it is unneces-
sary to enlarge further on a subject so well
known to the practical physician. How-
ever, notwithstanding the most frequent
cause of fits of the stone may be easily un-
derstood from the above remarks, yet, as

127 CONCERNING THE GOUT. 
it has not hitherto been explained, I think
it proper to subjoin the following obser-
vations on that subject.
107. A fit of the stone may be occasi-
oned by a catarrh, by sympathy with the
primae viae, when oppressed with acidity
and phlegm, and by the motions of a car-
riage, or other exercise. But its attack
often occurs without any apparent cause,
and, on such occasions, an afflux of an
acrid fluid on the internal coat and neck
of the bladder, is to be suspected. This
afflux is solicited by the preternatural ir-
ritability of these parts, from the motion
of the stone; and the paroxysms are al-
ways accompanied with a morbid secretion
of mucus, which is conspicuous in the
urine. If the fit was occasioned merely
by the friction of the stone, it should con-
tinue till the stone was extracted; but,
after a few days, or weeks, the patient re-
covers his usual health, or at least a state
of ease, in which he can walk, or use other
exercise moderately, without much incon-
venience. For, as the afflux ceases, the
inflammation, and increased irritability
depending on it, will likewise cease. The
intervals of ease are various in different per-
sons, depending, perhaps, on the strength,
or general health of individuals. From
F4 

128 AN INQUIRY
the inflamed state of the internal coat and
neck of the bladder, and from so exqui-
site a sensibility of these parts, that they
cannot suffer the smallest quantity of urine
to lie on their surfaces, arise those invo-
luntary spasmodic exertions to free the
bladder of its contents, in which consists
the agonizing part of a fit of the stone.
When the intervals between the parox-
ysms are complete, or when the motion
of the stone gives no great uneasiness, we
may suppose the coats of the bladder to be
found. But, after a great number of pa-
roxysms, and from the nature and size of
the stone, there is no complete interval
of ease, the paroxysms return more fre-
quently, continue longer, and are more
severe; it is then probable, that the blad-
der is in a diseased state. This is occasi-
oned by the repeated inflammations in
the fits of the stone, during the course of
the disease; and always indicates the dan-
ger which would attend the operation for
the stone in such cases.
108. Although the excretory vessels of
the skin, and of the kidneys, are the most
usual emunctories, by which the blood is
freed from every species of acrimony, yet,
in the great variety of acrid fluids gene-
rated in the body, there are several, which,

129 CONCERNING THE GOUT. 
when accumulated to a certain degree,
have a tendency to affect a particular part
of the body. This is so uniformly the
case, that practitioners often judge of the
nature of the acrimony, from the parts
affected. The primae viae and the lungs
suffer in a particular manner from the mor-
bific matter in the chin-cough; certain
red spots on the skin, accompanied with
a fever, and troublesome cough, charac-
terise the measles; the lymphatic glands
suffer in the scrophula, the bones in this
last disease, and in the rickets; the skin
is the chief seat of erysipelatous inflamma-
mations; the joints of the arthritic mat-
ter; and, were it necessary, similar obser-
vations might be made on a variety of
other acrid fluids, which affect certain parts
of the body, and constitute distinst dis-
eases.
109. But, in what manner these mor-
bid fluids act on the system, so as to pro-
duce such symptoms as readily show the
nature of the disease, resulting from their
action, cannot with certainty be explain-
ed. One naturally relinquishes a subject
so obscure without bellowing a thought
on it, from an impression of the impossi-
bility of tracing nature in so mysterious
a process, with any degree of success. Al-
F5

130 AN INQUIRY
though in this respect I incline to follow
my predecessors, yet I beg leave to refer
my readers to what I have said on the na-
ture of different stimuli, and of the vari-
ety of constitution of the nerves at their
terminations, in different parts of the bo-
dy, in the four last paragraphs of section
2d of my Observations on the Animal
Economy, &c. There it is shown, that
the nerves, originally the same in the brain,
and perhaps throughout their course, ac-
quire, for their different offices in the eco-
nomy, a variety of powers and sensibility,
corresponding to the structure and organi-
zation of the parts in which they termi-
nate.
110. This diversity of sensibility is the
most probable cause of the mobility of
certain parts of the system, on the appli-
cation of particular stimuli; while the
rest of the body is no otherwise affected,
than usually happens from general sympa-
thy. It is from this circumstance, that
we must account for the action of morbid
stimuli, which appear to be extremely dif-
ferent from one another, each acting in a
manner peculiar to itself, or with what is
called a specific stimulus, irritating the
nerves of a particular part, while the rest
are little affected. For, is morbid flu- 

131 CONCERNING THE GOUT.   
ids in circulation are so equally diffused
through the whole mass, that every drop
of blood contains its exact proportion of
them, and certain parts only of the system
are thereby affected; then we must sup-
pose this to arise from a specific stimulus,
or a particular constitution of nerves in
the part affected, or from both these cir-
cumstances. It is in this way only, that
we can account for the action of various
morbid fluids in the production of differ-
ent diseases. Notwithstanding these re-
marks, it must be confessed that this sub-
ject is far from being exhausted. But, as
my intention is to give a general idea of
it only, I shall leave the further considera-
tion of critical and morbid discharges to
those who may have more time and abili-
ties for such pursuits. My principal in-
tention in introducing this subject was, to
offer the best reasons that I could suggest,
for the morbid matter which produces the
rheumatism and gout, affecting constant-
ly the joints, and especially in the regular
paroxysms of this last disorder.
111. Hitherto the greatest attention in
my power has been employed to trace the
origin of the gout to the effects of the re-
mote causes on the primae viae, and the,
system in general. Some pains have been 

132 AN INQUIRY
taken to show the generation, and gradu-
al accumulation of the arthritic matter in
the habit, until a considerable portion of
it is thrown off from the circulating fluids,
in the periodical paroxysms of the gout.
The manner in which occasional causes
operate, in producing fits of the gout,
has been explained. From the symptoms
which accompany regular paroxysms, the
inflammatory disposition of this distemper
is made evident. Such proofs are given
of the existence of this, and other acri-
monious fluids, with their effects, accord-
ing to the variety or species of the morbid
matter affecting the system, as are estab-
lished by numberless practical observati-
ons. Some analogy between the cause of
the gout and that of certain nervous, hy-
pochondriac, and hysteric disorders, and
the various effects of the arthritic matter
in different constitutions, are pointed out.
The cause of the numbness in the legs,
and other anomalous complaints, previous
to a regular fit of the gout, is suggested.
In considering the sudden movement of
the pain, and inflammation, from the dis-
eased to the sound foot, some light has
been thrown on the cause of that extraor-
dinary phenomenon. The pain and in-
flammation shifting from one part of the 

133 CONCERNING THE GOUT. 
foot to another, until the paroxysm is
compleated; the knees, hands, and other
joints becoming the seat of gouty inflam-
mation, in advanced stages of the disease,
and the origin of swellings on the joints,
have been explained. The action of acrid
fluids, secreted from the blood, in produc-
ing inflammations, is shown to be similar
to the action of mechanical violence, of
acrid substances applied to the skin, and
other soft parts. The powers of the ab-
sorbents, and exhalent arteries, in the
cure of inflammation by resolution, are
exhibited. There are some observations
relative to digestion, the effects of ardent
spirits, on the utility of pain, and several
other particulars, all tending to explain
the true nature ofthe gout, and its cause;
but which I forbear to mention in this
short analysis of the present subject.
112. How far I have succeeded in my
endeavours to satisfy my readers on these
several subjects, must be left to others.
But, as I prefer the character of being
usesul, to that of being ingenious; so I
would pride myself more on the discovery
of an effectual cure for the gout, than on
the most approved treatise that could be
written on this disease. But, as no such
remedy is yet known, our best plan at pre- 

134 AN INQUIRY
sent, for the unfortunate sick, perhaps, is
to free the history of this disease, as much
as can be done, from the obscurity in
which it has hitherto been involved. By
this method, which has been here at-
tempted, we shall be led to the use of such
medicines and means, as, from the nature
of the disorder, seem best suited, either
to savour the cure, or to obtain relief to
the patient. From a more intimate know-
ledge of this distemper, we are enabled
to adopt or reject such medicines and
means, with whose properties we are ac-
quainted, as may have been strongly re-
commended to our patients on the empi-
rical plan of cure. This circumstance alone
is of material advantage, as we can there-
by prevent the exhibition of such reme-
dies and applications, as experience has
shown to have a tendency to obstruct the
natural course of the disorder, which can-
not be done with impunity, and seldom
without danger. For there is no disease
in which greater mischief is done by
counteracting nature, than in the gout, as
will evidently appear from the following
observations on the cure of that disease. 

135 CONCERNING THE GOUT. 
ON THE
CURE OF THE GOUT,
AND
THE MANNER BY WHICH THE MEANS PRO-
POSED PRODUCE THEIR SALUTARY EF-
FECTS.
SECTION II.
113. THERE is no history of a dis-
ease, in which the plan of cure
is more distinctly pointed out, than in
that of the gout: For it has been the uni-
form opinion of physicians, to which man-
kind in general have assented, that a full
diet and sedentary life, are the remote
causes of the acquired gout. It naturally
follows, that temperance and exercise, the
opposites of the remote causes, must be

136 AN INQUIRY
the most effectual means in the cure of
this distemper. When pursued with per-
severance and attention, even in such cases
as admit not of a complete cure, they con-
tribute to the general health of the pati-
ent, the prolongation of the intervals, and
the regularity and mildness of the fits.
It, is, however, much to be regretted,
that, amongst the great number of exam-
ples of this disease, very few are capable
of a complete cure. This is chiefly ow-
ing to the nature of the disorder, but in
a great measure to the neglect of it at its
commencement, and the want of resolu-
tion in the patients to submit to that re-
gulation of diet and exercise, in which
the cure must chiefly consist. By a strict
and constant adherence to this plan, I am
persuaded that this disease, in many in-
stances might be cured; but, when ne-
glected, I know no medicine that can pro-
duce the same effect, notwithstanding the
impudent boastings of quacks to the
contrary.
114. In the gout there are two princi-
pal curative indications; the first is to
prevent, as much as possible, the genera-
tion of the arthritic matter; and, second-
ly, to promote the expulsion of it, when
generated, by the excretories of the skin, 

137 CONCERNING THE GOUT.  
and the other emunctories. The former
is obtained by temperance, the latter by
labour and exercise. This is a short re-
presentation of facts, but sufficient to give
a general idea of the plan of recovery, in
all such cases where it can be prosecuted,
with propriety and success. For, at cer-
tain periods of this disease, after the
strength of the constitution has been reduc-
ed by a number of paroxysms, and especi-
ally is the person is advanced in life, such
a plan of cure is far from being admissi-
ble; because, the reduction of the diet of
such persons, and even of their cordial
drink, when taken in moderation, would
be to reduce their strength, and render the
disorder atonic, which might otherwise
continue in regular fits for many years.
For it is only at the commencement of
this disorder, before any material injury
has been done to the constitution, either
by repeated paroxysms, or by age advanc-
ing, and while the body still retains its
usual firmness and aptitude for motion,
that we can hope to succeed in the cure
of this disease, by a strict regimen of diet
and exercise.
115. From the few cures of the gout
that have been accomplished, when com-
pared to the great number of cases in 

138 AN INQUIRY
which the disorder has continued during
life, an opinion prevails, that it is altoge-
ther incurable. This is certainly contra-
ry to experience, in many instances; but
it is much to be regretted that such a be-
lief should have become so general, as it
discourages the unfortunate patient from
the prosecution of the plan of recovery,
with that ardour and steadiness which is
so necessary to insure success. There are
other circumstances which tend greatly to
frustrate the best intentions; such as the
love of society, so productive of infor-
mation, improvement, and happiness to
mankind. From this source arises a pro-
pensity to convivial meetings, which, from
the common intercourse of men, can scarce-
ly be avoided. It is only the hermit and
the miser, that can resist the temptation
to those pleasures and amusements, which
are so calculated to extend our knowledge
of men, and our friendlhip with one
another. Besides, it seldom happens that
the constitution is materially injured by
the moderate enjoyment of such societies;
it is only the abuse of such pleasures, by
too frequent an indulgence in them, that
we should guard against, as injurious to
the health, and even to the exercise of the
mental faculties. For we are no other- 

139 CONCERNING THE GOUT.  
wise apprehensive of the pleasures of the
table for a day, than that in delicate con-
stitutions it may occasion some disorder in
the stomach, or head-ach next day, pro-
vided that temperance is practised for a
reasonable time after. The hazard of dis-
ease, is from intemperance becoming ha-
bitual; or what is, perhaps, more certain
in producing the gout, though slower in
its effects, is a full diet, with strong li-
quors to exhilaration twice a day, with an
inactive sedentary life.
116. But the great difficulty we have,
in entering on the cure of the gout, is to
get rid of those indulgences, which, from
a long practice, have become habitual,
and of course are given up with pain and
reluctance. The valetudinary, as well as
the man in health, wishes to avoid singula-
rity, and strives to hide the necessity he is
under of paying attention to his health,
which subjects him to inconveniences, and
sometimes to an increase of his disorder.
A great obstruction to our progress in the
cure of the gout, arises from the indepen-
dant situation of most of the persons af-
flicted with that distemper. They are of-
ten men of rank, men in public office, or
employed in some of the learned prosessi-
ons; and a number of others, who, from 

140 AN INQUIRY
the nature of the business in which they
are engaged, are obliged to lead a seden-
tary life, and from their opulence, or ea-
sy circumstances, live fully, and much at
their ease. The exercise necessary for the
cure of the gout can scarcely be effected
by such persons, who have been so little
in the habit of bodily exertions. Besides,
when either the disease has become inve-
terate, or they are advanced in life, the
temperance and exercise, prescribed in the
cure of the young and robust, are by no
means adviseable in such cases.
117. Another, and perhaps not the
least, difficulty we have to encounter in
the cure of this distemper, is the too
strict regimen prescribed on that account.
For as there is no disease that appears in
different persons, with a greater or less de-
gree of severity, than the gout; so the
regimen prescribed ought likewise to vary,
according to the circumstances of the dis-
order. If the gout is so prevalent in the
habit, as in the case of Thomas Wood,
miller at Billericay, in the county of Es-
sex, and the patient has fortunately equal
strength of constitution, and the same re-
solution with him, as to persevere in so
slender a diet, as a pound and a half of
flour pudding twice in the twenty four 

141 CONCERNING THE GOUT.  
hours *; I believe that the balance be-
tween health, and a painful disorder, will
be greatly in his favour. But such cases
are rare; and, when they happen, we are
seldom successful in them, either because
of the want of the qualifications just men-
tioned, or that advice is not asked, till
the disease is advanced so far as to render
a complete cure, by such means, imprac-
ticable or doubtful. For our success in
the cure of the disease by temperance and
exercise, will always be in proportion to
the distance of time from the first, or se-
cond paroxysm, at which this regimen
commences.
118. In the cure of the gout, there is a
circumstance we ought ever to keep in
view, because, on the degree of attention
paid to it, our success depends. This is
the preservation of the strength of the pa-
tient, as far as is in our power, and is con-
sistent with our plan of cure, or of alle-
viating the disorder. This circumstance
should be our guide in the regulation of
the diet and exercise, which ought always
to be proportioned to the strength of the
constitution, and state of the disease.
* Medical Trans. by the College of Physicians,
London, Vol. 2. page 259. 

142 AN INQUIRY
Hence must arise a considerable diversity
in the regimen prescribed for persons af-
flicted with the gout.
119. In the young and robust, when
the disease is of a mild nature, and of no
long standing, meat may be allowed at
dinner, provided they eat only of one dish,
and abstain from strong liquors. But,
when the gout is hereditary, and evidently
prevails in the constitution, then a milk
and vegetable diet may be necessary to
produce the same good effects, by freeing
the patient of the paroxysms, or by pro-
tracting the intervals, and rendering the
disease milder. In constitutions, how-
ever, less robust, we must proceed with
more caution; for such persons seldom
bear well the sudden transition from a full
to a spare diet. For the stomach being
deprived of part of its usual stimulus, the
patient now and then complains of flatu-
lency, sickness, and sometimes of pain in
the stomach and bowels. On which ac-
count it is found, from experience, more
adviseable, to bring the patients by de-
grees to the diet suited to their particular
situation, than to make the change at once
from a full to a spare diet. By this way
of proceeding, we come gradually to know,
how far the diet may be reduced without 

143 CONCERNING THE GOUT.  
injury to the health of the patient, or the
reduction of his strength; and, when we
have arrived at this knowledge, the most
essential part of our plan of recovery is
obtained.
120. If the patient has been accustomed
to drink wine, or other strong liquors,
the same method must be observed in
weaning him from them, till water alone
comes to be his beverage. Some excep-
tions may be made to this general rule,
when vinous liquors may be given as a cor-
dial, but ought seldom to be permitted
as a necessary article at their meals. This
may be thought too strict a regimen, but
will be found more effectual in the cure or
alleviation of the gout, than when strong
liquors are drank, though moderately, at
their meals. For I am confident that strong
liquors, and indolence, have a greater
share in the production of this disease,
than a meat diet, when accompanied with
suitable exercise. For it is well known,
that the American Indians, and other sa-
vage nations who live by hunting and fish-
ing, have no such disorder; and the in-
genious Mr Smellie, in his excellent book
on the Philosophy of Natural Hisiory, re-
marks, that, 'The laplanders drink water,
'or animal oils, but never taste bread or 

144 AN INQUIRY
'salt. They live in a pure air, and have suf-
'ficient exercise. Their constitutions are
'attempered to the coldness of the cli-
'mate; and they are remarkable for vi-
'gour and longevity. The gout, the
'stone, the rheumatism, and many other
'diseases which torture the luxurious in
'milder climates, are totally unknown to
'them *.'
121. The exercise prescribed at the
commencement of the gout, should vary
according to the strength, situation, and
diet of the patient. In strong constituti-
ons, it may approach to what we would
call labour; which may be varied accord-
ing to the inclination, or habit of the per-
son, in particular exercises. Riding and
walking, in which may be enjoyed the
amusements of fishing and fowling; and,
where the neighbourhood of lakes, or na-
vigable rivers will permit, the rowing a
boat, I consider as preferable to most other
exercises. But, for the preservation of the
strength, the quantity of food should be
increased in proportion to the labour. In
persons less robust, or more advanced in
life, the gentler exercises of billiards,
bias bowls, &c. should be for some time
* Philosophy of Natural History, Philadelphia
Edit. 8vo. p. 108.

145 CONCERNING THE GOUT. 
substituted in the place of those just men-
tioned; and, as the patient gains strength,
his exercise may be increased; but ought
never to be continued to great weariness
or fatigue. The same degree of labour
cannot be prescribed for those, who, on
account of the prevalence of the gout,
are reduced to a milk and vegetable diet;
but, when the disorder appears to be di-
minished, their diet and exercise should
be increased.
122. If, from the time the gout has
continued in the habit, the number and
severity of the paroxysms, or the person's
approaching to his 50th year, there is lit-
tle probability of a complete cure; then
our endeavours should be solely confined
to render the disease as mild as it can be
done with safety, or is consistent with the
preservation of the health and strength of
the patient, during the intervals. In
such cases, meat or fresh fish, may be al-
lowed at dinner, but the patient should be
restricted to one dish; with the meat may
be taken a moderate quantity of vegeta-
bles, and with the fish, pudding. To
prevent disorders in the stomach, such ar-
ticles as are difficult of digestion, and less
perspirable than other meats, such as pork,
ham, geese, ducks, &c. should be avoided. 
G

146 AN INQUIRY
123. If the patient has been accustomed
to strong liquors, a moderate quantity at
his meals should be allowed. But as a
regularity in the use of vinous liquors, is
apt sometimes to occasion an indulgence
in them, which produces debility and in-
dolence, and increases the severity of the
disease, it is, in most cases, more advise-
able to use wine, and spirits, only as a
cordial, when particular complaints re-
quire them. From the immediate relief
that wine and spirits afford, when sick-
ness, faintness, or pain in the stomach and
bowels, take place, in gouty constituti-
ons, arises a general belief of their being
indispensible at meals. This may be the
case with those, in whom a long habit of
drinking strong liquors, or when consi-
derable debility, arising from the severity
of the disorder, has rendered the frequent
repetition of them necessary. But when
no such habit has taken place, and the
body is firm and active, wine should be
used only as a medicine, and not as an ar-
ticle of diet. I am sensible of the im-
perfection of these general rules, for the
regulation of the diet, exercise, and the
use of wine, in gouty constitutions; for,
in some instances, they cannot be applied;
but, in all such cases, it must be left to 

147 CONCERNING THE GOUT. 
the physician to accommodate the regimen
to the particular circumstances of his pa-
tient.
124. In par. 30. are mentioned the rea-
sons for supposing a diminution of perspi-
ration, to be partly the cause of the accu-
mulation of the arthritic matter; and here
it may be observed, that a free perspira-
tion, kept up by exercise, and other gen-
tle means, contributes to the cure of this
distemper. On which account, the regu-
lar friction of the whole body, and parti-
cularly of the affected limbs, every day,
conduces to the general health, and
strength of the patient. This practice is
extremely salutary; it gently exhilerates,
quickens the circulation, increases the se-
cretion by the skin, and makes up, in some
degree, for the want of exercise. Warm
cloathing is generally recommended in
gouty constitutions, and with propriety;
but it ought not to exceed much their
accustomed dress, till age, or the disor-
der renders it necessary. When flannel
waistcoats, or shirts come to be indispen-
sible, on account of a susceptability of
catching cold, which usually arises from
confinement or a sedentary life, by shift-
ing them often they feel warmer, and the
secretion by the skin is thereby increased.
G2 

148 AN INQUIRY
125. But exercise is the most natural
way of promoting this evacuation; and
as the greatest benefit is derived from it,
it ought to be continued daily, and with-
out intermission during life; for the leav-
ing off an accustomed exercise, is gene-
rally followed by an increase of the dis-
order, and sometimes by the atonic gout,
from a retension, and more speedy accu-
mulation of the arthritic matter. When
from age, or the disease advancing, and
from a stiffness in the joints, the patient
becomes incapable of his usual exercise,
then, warm bathing properly conducted,
is of great service in alleviating the dis-
order. The good effects of this practice
is well known in the city of Bath; where
the water, in the king's bath, is, at its
source, about 120° warm; but, from the
exposure of a large surface, in the bath,
it may not exceed 110° or 112° of heat;
which, however, has no advantage over
simple water, when raised to the same
temperature. For the benefit received
from heat, and moisture, must be the
same, whether from Bath, or simple wa-
ter raised to the same degree of heat;
which not only excites a free, and copious
perspiration, during the time the person
remains in the bath, but even afterwards 

149 CONCERNING THE GOUT. 
seems to increase their usual perspiration,
by the skin, being thereby cleaned and
softened. To this method of obviating
the bad effects of obstructed perspiration,
are to be ascribed the chief advantages of
warm bathing, to valetudinarians, in the
cure, or alleviation of their diseases. Be-
nefit is likewise, supposed to accrue, from
the absorption of water, by the lympha-
tics; and by a regular course of warm
bathing, in gouty constitutions, it is pro-
bable, that the arthritic acrimony, accu-
mulated in the habit, is thereby dimi-
nished.
126. The long journeys which many of
the valetudinarians are obliged to make,
before they arrive at Bath, the great tem-
perance, and regularity observed by them
while they remain there, and the drinking
the Bath water, all contribute to the estab-
lishment of their health. The heat of the
Bath water, and the quantity of fixed air,
with which it is saturated when just drawn
from its source, causes it to sit light on
the stomach, and enables the patient to
drink more of it than he can of simple
water, or of the same water after it has
lost its heat, and fixed air, by being ex-
posed in open vessels for a short time.
The medical virtues of Bath water, com-
G3

150 AN INQUIRY
pared to simple water, arise from the great-
er quantity of heat and fixed air it con-
tains; for the rest of its contents can have
very little effect in the cure of chronic
diseases *.
127. When from the long continuance
of intermittents, bilious fevers, or other
febrile disorders, caught in damp, or in
warm climates, the primae viae, and syst-
em in general are greatly debilitated, the
Bath water to such valetudinarians is of
great service. On such occasions, the be-
neficial effects must be ascribed to the heat
of the Bath water, which frees such persons
from sickness, and pains in the stomach
and bowels, to which they are subject while
they continue to drink cold water, or
other cold beverage, but leave them as
soon as they begin the use of the Bath
water. A similar delicacy in the stomach
and bowels, but from a different cause,
often takes place in gouty constitutions,
Persons long afflicted with the gout, can
seldom venture on a full draught of cold
* By an analysis I made of the Bath water, ma-
ny years ago, a pint contains three grains and a half
of Glauber salt, six grains and a hals of marine
salt, and the two and thirtieth part of a grain of
iron; which last ingredient, it holds in solution by
means of the fixed air. 

151 CONCERNING THE GOUT. 
water without hazard; but can drink free-
ly of the Bath water directly from the
pump, not only with safety, but with
pleasure.
128. The regular drinking of the Bath
water, has a singular effect in lessening
considerably the desire for strong liquors,
which enables the sick to bear with ease,
that temperance so necessary for their re-
covery. For persons who resort to Bath,
on account of the gout, rheumatism, or
such disorders of the stomach and bowels
as are just mentioned, have from the pre-
ternatural irritability of the system, dur-
ing the prevalence of their disorders, a
heat and thirst beyond what is natural to
a healthy state. But as simple water,
drank cold, often occasions some uneasi-
ness in the stomach for such valetudinari-
ans, they usually mix with it wine, or
some vinous spirit, to obviate that incon-
venience, which always has the effect to
keep up the febricula and thirst. As
soon, however, as they begin to drink the
Bath water, their thirst ceases; and, of
course, the desire for their former bever-
age, likewise abates. Several stomachic
persons informed me, that they had usu-
ally a return of their complaints in five,
or six weeks after their departure from
G4 

152 AN INQUIRY
Bath; which obliged them to return there
for relief. It diet not occur to them that
it was owing to the heat, and fixed air in
the Bath water, they chiefly owed their
recovery; but were convinced of this
truth when by my advice they drank,
with the same beneficial effects, Pier-
mount, Selfer, or common water saturat-
ed with fixed air, and raised to the heat of
120°, by adding to them about a third of
boiling water; which is a practice I have
recommended in similar cases, with suc-
cess, ever since the year 1756.
129. It is true, that a free perspiration,
kept up by exercise, must be considered
as preferable to that obtained by any other
means; for, while we are thereby lessen-
ing the accumulation of the arthritic mat-
ter, the general health and strength of the
patient are also obtained. But this pre-
cludes not the use of medicines that in-
crease perspiration, when their operation
is of a mild nature; for such as raise any
considerable disturbance in the primae
viae, are not admissible in gouty consti-
tutions. There are however, very few re-
medies that from their known properties
are calculated to alleviate, and not one,
that is yet known, deserves the name of a
specific in the gout. 

153 CONCERNING THE GOUT. 
130. Remedies that have been supposed
usesul in diminishing the severity of the
disease, were, simple or compound decoc-
tions, or infusions of woods, barks, and
leaves, and other parts of vegetables of a
pungent aromatic flavour and taste, taken
commonly at bed time. Gum guaiac has
been used for many years, under a variety
of forms, in arthritic disorders; but the
most usual prescription is the volatile, or
spiritous elixir, from 25 to 50 drops, in
some warm spiritous vehicle; and though
nauseous, and disagreeable to delicate sto-
machs, yet from its success, in many cases,
it is in general use among practitioners
for the anomalous complaints of the irre-
gular gout. While these medicines con-
tinue to raise a gentle perspiration, and
prove laxative, they abate the severity of
the disorder; and especially with those
who from their age, debility, and stiffness
of the joints, are incapable of much exer-
cise. But as these remedies are in general
uncertain in their operation, and often
produce little or no effect, they are soon
laid aside. For many years, a large draught
of an infusion of tansy, taken at bed time,
was a favourite remedy for the gout. In
a few instances it operated in the manner
just mentioned, and was thought to be of
G5

154 AN INQUIRY
service; but in the greatest number of
cases, it having no such effect, was at last
considered rather as an innocent than an
active medicine.
131. In ancient, as well as in modern
times, the long list of simples, known by
the name of stomachic bitters, have, in a
great variety of formulae, been recom-
mended in the cure of the gout. Their
character in this respect has been various,
but the success with them has been the
same in all ages. In cases of dyspepsia, or
want of appetite, which frequently occur,
both in the regular, and irregular gouts,
infusions of bitters and aromatics in water,
in wine, and in ardent spirits, have been
used with advantage; a spiritous men-
struum is in general preferred in gouty
constitutions; but when the patient has
not been much accustomed to strong li-
quors, infusions of them in boiling water
are equally efficacious. Those who have
been more in the practice of drinking wine,
require about a sixth part of brandy to be
added to the infusion in water, to make
it fit light on the stomach. In most cases,
where a spiritous menstruum is wanted,
a table spoonful of equal parts of tincture
of the bark, and the stomachic elixir of
the Edinburgh Dispensatory, in a glass of 

155 CONCERNING THE GOUT. 
water, twice a day, answers very well the
intention of stomachic bitters. But the
proportion of the stomachic tincture may
be varied, from the above, to one fifth of the
mixture, according to the pleasure of the
prescriber, or taste of the patient.
132. As we have supposed the gout to
arise from some defect in the powers of
digestion, it is reasonble to imagine, that
such medicines as strengthen the primae
viae, restore the appetite, and mend the
digestion, should counteract the cause of
the disorder. But, as we find not, from
experience, that stomachic bitters have
any remarkable effect in this way, we can-
not, therefore, safely depend on them for
a cure of this distemper. In debilitated
states of the primae viae, they may be ta-
ken for some time with benefit; but, when
the end is obtained for which they were
prescribed, their further use becomes un-
necessary, and perhaps hurtful. For, from
the observations of others, as well as from
my own experience, I incline to believe
that the long use of bitters and aromatics
is prejudicial to the nerves of the stomach.
Besides, it is proper to observe, that, when
a part, or the whole of the system, has re-
covered its former healthful state, no cor-
roborants, however powersul or artfully

156 AN INQUIRY
applied, can ever increase the strength be-
yond what is natural to the constitution.
But, whether the injury to the primae viae,
from the long continued use of stomachic
bitters, arises from a daily application of
an astringent to their nerves, or to what
other quality they may in common possess,
I know not; though there is little doubt
as to the fact. Notwithstanding our ig-
norance of the precise manner in which
they operate, yet we may suppose their
operation to be very powerful, when such
quantities in substance are taken, as was
formerly prescribed of Portland's powder
for the cure of the gout. This hazardous
remedy usually stops the paroxysm of this
distemper, but without acting on the cause
of the disease; for, soon aster the patients
imagine themselves to be cured, they are
either seized with the atonic gout, some
chronic disorder, become delirious, para-
lytic, or die suddenly. From all which
we may conclude, that Jesuit's bark, and
astringent bitters, may be given occasion-
ally as stomachics, but that they are inad-
missible as remedies, in the cure of the
gout.
133. This last observation is not so ap-
plicable to infusions, and tinctures, of sto-
machic bitters, which are occasionally of

157 CONCERNING THE GOUT.  
great service, in restoring the strength of
the primae viae, as to the same articles in
substance. The chief ingredients in Port-
land's powder are of this kind, and have
been praised from almost the commence-
ment of the practice of physic to this day,
for the cure of the gout. Formulae of the
antidoti antipodagraci of Galen *, and his
followers, were common among the an-
cients; they were similar to one another,
consisting chiefly of the same simples,
sometimes of four, seldom exceeding se-
ven or eight in number, of which our mo-
dern gout powder is nearly a transcript.
The principal ingredients were the herbs
germander, ground pine, and the lesser
centaury; the roots of aristolochia rotunda,
and gentian. These taken in equal parts,
were reduced to a powder, of which a
drachm was to be taken every morning,
in a little warm water, for three months;
the dose was reduced to two scruples for
three months more, and after this to half
a drachm, till the year was compleated;
then half a drachm was taken every se-
cond day, for another year; for this time
was thought necessary to complete the
cure of the gout. On account of this me-
* Galeni de antidot. lib. 2. cap. 17. 

158 AN INQUIRY
thod of giving these remedies, Caelius
Aurelianus, and others who succeeded him,
gave them the name of analia medicamina,
or medicamenta ad annum; which were often
made up in the form of an electuary with
honey.
134. The success of the ancients with
this remedy appears to have been nearly
the same with what we have experienced
in our own time; for it was considered
by them both as a useful, and a dangerous
medicine. Their greatest success was,
when the antidoti antipodagraci were ad-
ministered near the commencement of the
disorder, and accompanied with a proper
regulation of diet and exercise; which
must be the case with every plan of cure.
Principiis obsta, fero medicina paratur,
Cum mala per longas invaluere moras.
LUC.
They, from experience, had observed
them to be hazardous remedies after the
fifth, or at farthest the seventh year, from
the first attack of the disease. Caelius
Aurelianus * has told us, and Alexander
Trallianus † makes the same observation,
* Morb. chronic. lib. 5. cap. 2.
† Lib. XI. 

159 CONCERNING THE GOUT. 
that a long uninterrupted use of those
compositions, was by many condemned as
dangerous, and often fatal.
135. These remarks are similar to those
that were made by physicians, and the
public, a few years ago, after the gene-
ral use of Portland's powder for the cure
of the gout. But their bad effects in all
times must, perhaps, be rather ascribed to
the injudicious, and indiscriminate use of
these powders, than to their want of effi-
cacy, in restoring the strength of the sto-
mach and bowels, which must be consi-
dered as a principal circumstance in the
cure of the gout. It is an excellent cau-
tion given us by the ancients, not to use
these powders after the fifth or seventh
year from the first attack of the disease,
and ought constantly to be observed. For
is the disease has made such advancement
on the constitution as has induced debi-
lity, or such a degree of stiffness in the
joints, as to disable them from taking
that degree of exercise so necessary for
their cure, and preferable to every reme-
dy, then the free use of such a medicine
is much to be suspected.
136. In some of our receipts, particu-
larly of our modern gout powder, there
are introduced wormwood, bugbane, car- 

160 AN INQUIRY
duus-benedictus, flowers of chamomile,
the root of columba, orange peel, and
Jesuit's bark. This last was unknown to
the ancients; nor have I any great favour
for it in such a composition, on account
of the bad, and sometimes fatal effects, I
have known it to produce in several in-
stances, when taken as a remedy for the
gout; perhaps from its superior and per-
manent astringency, which from long use
may injure the nerves of the primae viae.
But is, from the knowledge we presume
to have acquired of the true nature of
this distemper, the advantage to be de-
rived from such remedies, is the strength-
ening of the nerves of these viscera,
then I should apprehend it unnecessary to
keep strictly either to the ancient or mo-
dern formulae of these medicines. I
would incline to follow the ancient sim-
plicity with regard to the number of in-
gredients; but, these might be selected
in such a manner, as to suit particular
constitutions better than by keeping to a
fixed and invariable formula. For, as
physicians of experience seldom keep to
the same formula in all cases, even when
the intention to be answered by the pres-
cription is the same, the powder may be
varied according to circumstances. Some 

161 CONCERNING THE GOUT. 
of the ingredients, thought to be less
powerful than the rest, and others disa-
greeable to the palate, or stomach, of
certain patients, may be left out, and
some aromatic may be added, to render
the composition more agreeable to the
taste, and lighter on the stomach.
137. Such a remedy, I am persuaded,
might be given occasionally, to strength-
en the primae viae with advantage; for
it is only with this view it can be admitted
in the cure of the gout. The dose of this
medicine should be small; two scruples
at most once a day, or one scruple twice a
day, nor should its use be continued
above two or three weeks at a time. For
the large doses of the annalia medicamina,
and of Portland's powder, and their long
continued use, was perhaps the principal
cause of their falling into discredit and
neglect; for I imagine, that the reputa-
tion of those medicines, is now, as much
below their real merit, as their first prais-
es were above it. For the mischiefs im-
puted to these medicines must be consi-
dered as a proof of their powers, and that
their disgrace was more owing to their
having done too much, than their having
done too little.
138. These remedies (par. 130.—37.)
some years since gave way to flowers of

162 AN INQUIRY
brimstone, which is certainly more pow-
erful and permanent in its effects as a dia-
phoretic, and laxative, and of course,
promises to be of greater utility in this
disorder. The infusion of sulphur in sim-
ple water, as was at first recommended,
can have very little effect, unless a due
proportion of fixed salt is added, to assist
the solution of the sulphur. Even this
succeeds not so well as a solution of he-
par sulphuris, made in the common way,
in the proportion of thirty grains to a
quart of water; which when saturated
with fixed air, will be somewhat similar
to the water of Aix la Chapelle, and may
have nearly the same effects. But the
general practice at present, is to give the
flowers of brimstone in substance, from
half a drachm to a drachm, or more, at
bed time, in any form most agreeable to
the patient. Though this mineral is not
dissolvable in simple water, yet it is acted
on by the gastric fluids in the primae vi-
ae; by them, and our digestive powers,
some part of the inflammable principle
comes to be volatilized, or adheres more
loosely to the vitriolic acid, than before
it was taken into the stomach. This ap-
pears from  the increased foetor of the
faecis alvinae, and the sulphureous smell 

163 CONCERNING THE GOUT.
of the perspiration of those who have tak-
en it for some time.
139. The action of this medicine is
most apparent by these two emunctories,
and as it is mild, though permanent and
uniform in its operation, it may be con-
tinued for some time with advantage.
But as I apprehend the constant use of sul-
phur to heat the body, more than is con-
sistent with safety, in gouty constitutions,
so it is, perhaps, more adviseable to re-
strict the time of taking it to two, or three
weeks, than to intermit a fortnight, when
its use may be again reassumed; and to
proceed this way alternately, so long as
as the patient perceives that he receives
advantage from this medicine. During
the interval, care should be taken to keep
the body open with gentle laxatives, and
that which gives the least disturbance to
the bowels, should be preserred. Sulphur
acts not as specific, by counteracting, or
destroying the cause of the disorder, as
mercury in the venereal disorder, or sul-
phur in the itch; but by assisting the ex-
pulsion of the arthritic matter, by the skin
and intestines. For those who continue
to subject themselves to the action of the
remote causes, receive little or no advan-
tage from it; while others who persevere 

164 AN INQUIRY
in temperance, and exercise, are benefited
by its use.
140. It has frequently happened, that
persons subject to the gout, have also been
afflicted with the gravel, or stone; and,
on account of these last disorders, have
been induced to take soap less, or mild
fixed alkali, and sometimes lime-water
and soap, for a considerable time, with
such an alleviation of symptoms, as gave
hopes of their solvent power; though for
the most part no such effect took place.
But in most of these cases, it being observ-
ed, that the intervals between the parox-
ysms of the gout, were protracted, an o-
pinion has arisen, that these medicines are
likewise useful in moderating the severity
of this disease. This opinion, being found-
ed on experience, cannot well be disput-
ed; but as their action in producing these
good effects, will be better understood,
after considering their manner of opera-
ting, in alleviating the complaints of cal-
culous patients, I shall subjoin the follow-
ing observations on that subject.
141. Independent of the general sym-
pathy of the stomach with the rest of the
body, there is a particular sympathy which
subsists between it and the urinary pas-
sages. This is most remarkable, when 

165 CONCERNING THE GOUT.  
these parts are diseased, or when there is
a stone in the kidney, ureter, or bladder.
In fits of the stone, the stomach often suf-
fers by consent with the seat of the disease,
as appears from a great uneasiness in that
viscus, sickness, and vomitting. But,
when these sympathetic affections are often
repeated, they seldom fail to weaken the
stomach, and lessen the powers of digest-
ion. This subjects such patients to col-
lections of phlegm, crudities, and acidity
in the primae viae, and, from their action
on the nerves of these parts, render the
whole system more irritable than usual.
In this increased irritability of the body,
the seat of the stone, from its diseased
state, suffers most remarkably, which sub-
jects such persons to fits of the stone, from
very slight causes. Catching cold seldom
fails to bring on a fit of the stone, in those
who are subject to that disorder; but a
more frequent cause of such fits is indi-
gestion, or acidity in the primae viae.
142. By whatever means, therefore, the
nerves of the stomach and bowels are
strengthened, and the system is rendered
less irritable, the fits of the stone will
thereby become proportionably less fre-
quent and severe. But, in debilitated
states of the stomach and bowels, nothing 

l66 AN INQUIRY
contributes more to their recovery, and
the restoration of health, than a regular
spare diet, neither so low as to induce de-
bility, nor so high as to hazard indigestion.
Such is the diet usually prescribed during
the use of alkaline solutions, and the other
supposed solvents for the stone; but it is
not always, of itself, sufficient to prevent
indigestion and acidity in the stomachs of
calculous patients. This arises chiefly
from a weakness in the digestive organs,
but partly from such persons being pre-
cluded from exercise, which so often ex-
asperates their disorder.
143. In a few days, however, after the
commencement of the alkaline remedy,
the acid in the stomach is neutralized, the
quantity of phlegm lessened, and by the
continued use of that medicine the farther
generation of it is prevented. This soon
produces a remarkable change in the state
of the primae viae; for being freed from
those hurtful slimuli, which kept up a
constant debility, and retarded digestion,
the nerves of these parts gradually recover
their natural strength. Besides, the mor-
bid irritability of the urinary passages, in
so sar as it depended on sympathy with
the stomach and bowels, oppressed with
acidity and phlegm, is considerably les- 

167 CONCERNING THE GOUT.  
sened, or entirely removed. By persever-
ing in eating moderately of one dish at
dinner, especially of boiled meat, avoiding
acids, and acescent articles of diet, and
continuing the regular use of the lixivium
twice a-day, the nephritic symptoms les-
sen by degrees, till they at last, in some
cases, almost totally disappear. For it is
not for some weeks, that these happy ef-
fects are distinctly perceived, because it
requires that time, and often a longer
period of freedom from irritation, before
the primae viae, and urinary passages,
can recover from their former state of dis-
eased irritability.
144. But the nephritic complaints no
sooner abate, than the patient begins to
conceive hopes of the solvent power of
the lixivium, or other alkaline remedies,
used by him, and recommended as infal-
lible in the cure of the stone. This de-
lusion seems perfectly natural, since pati-
ents have been brought from the misera-
ble state of not being able to walk for a
quarter of an hour, without suffering
greatly from the motion of the stone, to
ride on horseback, to bear the motion of
a carriage, and other exercises, for a
much longer time, with little or no in-
convenience. Yet it has been found, that 


168 AN INQUIRY
these very patients, deceived into a belief
of their cure, have in a month or two,
after having left off their remedy, and
strict regimen of diet, fallen into the
same wretched situation they were in be-
fore the use of their famous specific. For,
when those persons have had the courage
to submit to the operation for the stone,
or have died of the disease, and the stones
were extracted, they have always been
found entire, and untouched by the me-
dicine, which was once thought to have
dissolved them.
145. I cannot refuse the authority of
Dr. Whyte, and some others of reputati-
on and credit in their profession, for the
solvent power of lime-water on the stone.
But these instances are exceedingly rare,
depending much on the nature of the
calculi themselves; for in this, as in some
natural productions, the mode of con-
cretion, or chrystallization, as it may be
called, is varied in different specimens of
the same substance, where their chemi-
cal principles are the same. Indeed,
most of the human calculi are so com-
pacted, and defended with a quantity of
animal glue, or by some other cause, as
not to be affected by the powers of lime
water, soap, or soap lees; because they 

169 CONCERNING THE GOUT.
are so altered, and in so diluted a state,
by the time they arrive at the ureter, as
to have little or no effect on the calculi.
We must, therefore, look for the relief
afforded to calculous patients using these
remedies, rather srom the above circum-
stances, than from any solvent powers
possessed by them.
146. From these observations, on the
manner in which alkaline remedies act,
in alleviating the complaints os persons
afflicted with the gravel, or stone, it is
easy to perceive, that their beneficial ef-
fects, in mitigating the severity of the
gout, must be derived from the same
source. For, as this last disorder arises
chiefly from a defect in the functions of
the primae viae, it is always accompanied
with a proportionable debility of these
parts. This subjects persons afflicted
with the gout, to indigestion, collections
of phlegm, acidity in the stomach and
bowels, which produce, in different per-
sons, a variety of complaints. These are
generally removed by a gentle emetic, or
by draughts of warm water alone, to sa-
vour their expulsion. As the debility in
the primae viae, however, still subsists,
they are liable to returns of the same com-
H

170 AN INQUIRY
plaints. But, soon after the patient com-
mences the use of an alkaline remedy,
for the cure of the gout, the morbid
symptoms, arising from a collection of
phlegm, acid, or other crudities in the
alimentary canal, gradually disappear.
By persevering in the use of this medi-
cine and diet, as prescribed for calculous
patients, their effects will be nearly the
same. For a freedom from indigestion,
and complaints in the stomach, for a con-
siderable time has a wonderful effect in
restoring, not only the health and strength
of the primae viae, but of the whole
body. The digestion being more com-
plete than formerly, the quantity of
arthritic matter generated will be there-
by diminished; but the additional strength
acquired by the patient is sufficient of
itself to protract the intervals, and to mo-
derate the severity of the paroxysms.
147. Although lixivial salts, lime
water, &c. act not as a specific on the
cause of the gout; and it rarely happens
that we meet with a stone so soft, and of
so loose a texture, as to yield to their
solvent powers; yet, from the relief they
afford, we must, consider them as useful
remedies, in both diseases. Amongst the
alkaline remedies used in calculous cases 

171 CONCERNING THE GOUT. 
soap-lees is possessed of the strongest solv-
ent power; and although, for the reasons
mentioned, it has very little effect on the
stone, yet its efficacy as a solvent is not
only evident on tough phlegm in the pri-
mae viae, but on the coagulable lymph
of the blood. This is the reason why
persons, who have been long in the use of
taking the above medicine, become thin,
emaciated, and sometimes hectic, from
the prevalence of an alkali in the habit *.
On which account, when necessary to give
the lixivium for a considerable time, it is
more adviseable to give a solution of the
mild alkali in water, saturated with fixed
air, as prescribed by the late ingenious
Doctor Dobson. This is perhaps less
powerful as a solvent, but more salutary
* A quack medicine, sold under the name of
Adams's Solvent, appears to be composed of equal
parts of soap lees, of the ordinary strength, and
simple water; to every ounce measure of this mix-
ture is added about fifty drops of laudanum, of
which an adult is directed to take two tea-spoonfuls
twice a-day, in a tumbler of water. The opiate
will no doubt have its proper effect in alleviating, or
removing slight Nephritic symptoms; but, when no
such complaint exists, the habitual use of lauda-
num is improper; for it ought not to be given con-
stantly with a view to prevent pain, but only occa-
tionly to remove it.
H2 

171 AN INQUIRY
in its effects, not only from the antiscep-
tic power of the fixed air, but from the
agreeable stimulus it affords to the sto-
mach. As it is considerably milder than
the caustic lixivium, so it may be taken
much longer with advantage; but, when
its use is protracted beyond a month, the
quantity of alkali should perhaps be les-
sened.
148. But the advantages derived from
the use of lixivial salts, are not confined
to that morbid condition of the alimen-
tary canal, which so often attends persons
affected with the gout, or stone, but are
extended to similarly diseased states of
the primae viae, from whatever source
they originate. These may be occasioned
by intemperance, improper diet, the or-
dinary causes of hypochondriac and nerv-
ous disorders, and by the remote causes
of the gout, though that disease is not
apparent in the habit. They are often
the consequence of certain fevers, espe-
cially those wherein the stomach and
bowels have been particularly affected.
In all such cases of debility in the primae
viae, there are large secretions of phlegm,
the powers of digestion are diminished,
and an acetous fermentation, from the
digestion of their food, subjects the pa- 

173 CONCERNING THE GOUT. 
tients to acidity in the stomach. While
these symptoms continue, with their usu-
al effects, general debility, and disorder
of the system, a recovery is not to be ex-
pected. This may be effected by gentle
emetics, laxatives, stomachic bitters,
Jesuits' bark, preparations of iron, &c.
But in obstinate cases, from a scruple to
half a drachm of fixed salt in five or six
ounces of water, and saturated with fixed
air, taken twice or thrice a-day, will in
general be found an efficacious remedy.
149. Issues have been recommended
in the cure of the gout, and, although
their salutary effects, in some cases, have
been evident, yet their success has not
been so effectual as to bring them into
general use. It happens, not unfrequent-
ly, that scorbutic sores or ulcers make
their appearance, commonly in the legs,
in persons towards their fiftieth year, sub-
ject to regular attacks of the gout.
When the discharge from them is large,
it has been observed that the intervals be-
tween the fits have been considerably pro-
tracted, and in some instances the gout
has been almost entirely removed. If,
in a gouty habit, a sore is occasioned by a
bruise, or other accident, and heals rea-
dily by the usual means, soon aster its 
H3

174 AN INQUIRY
commencement, no bad consequence is
to be suspected; but, if the sore proves
obstinate, puts on the appearance of a
scorbutic ulcer, and is of long standing,
the cure is attended with hazard to the
constitution, unless issues are put in both
legs, to supply the discharge from the ul-
cer. If this precaution is neglected, and
the gout returns not as formerly, the usu-
al consequences are dropsy, asthma, some
other chronic disorder, or the atonic gout,
under its various forms. For, when na-
ture has been interrupted in her operati-
ons for a considerable time, these are sel-
dom renewed with the same salutary ef-
fects. Those swellings in the joints which
usually take place in persons who have
had annual, or more srequent returns of
fits of the gout, (par. 35.) often suppu-
rate, and discharge a quantity of matter.
If the discharge is large, and the sore
keeps open for a considerable time, or is
succeeded by the suppuration of another
tumour, the interval is rendered thereby
more complete, and the succeeding pa-
roxysm less severe. When these suppur-
ations succeed one another in different
parts of the feet, hands, &c. as, in some
inveterate cases, I have known them to
do for many years, they contribute 

175 CONCERNING THE GOUT.
considerably in preventing the approach
of the atonic gout even to extreme old
age.
150. These observations prove the
utility of natural drains of morbid hu-
mours, in gouty constitutions. From
them we may conclude similar advantag-
es to be derived from artificial issues, and
proportioned to the discharge occasioned
by them. The necessity, however, of
continuing issues for life, is a circum-
stance extremely disagreeable to most pa-
tients; and, as they are rather calculated
to alleviate symptoms, than to cure the
disease, they are seldom advised by the
physician with this last intention. Be-
sides, issues, which are usually placed
below the knee, become sometimes so
painful as to prevent the walking, or rid-
ing, with that freedom and perseverance
so necessary for the attainment and pre-
servation of health. Notwithstanding
these objections, issues must be consider-
ed, in certain situations, as extremely
useful in removing particular complaints
of distress and danger.
151. It would be tiresome and unprofit-
able to the reader, and unpleasant to my-
self, were I to proceed further with obser-
vations on as variety of other medicines,
H4 

176 AN INQUIRY
which have been, at different times re-
commended to the public for the cure of
the gout. For the nature of the disorder,
and the qualities of the remedy, being
known, it cannot be difficult to deter-
mine on the propriety or impropriety of
its use in this disease. Notwithstanding
the obligations we lie under to the empi-
rics of eminence in their profession, the
high encomiums bestowed on the efficacy
of many of their medicines, in the cure
of particular diseases, has at all times
been a great obstruction to our advance-
ment in the medical art. The indiscreet
zeal with which they endeavour to raise,
and support the character of their famous
specific often carries them, in their ac-
count of its virtues, greatly beyond its
real merit. When such medicines are
recommended by men of reputation in
their profession, and the proofs given of
their powers in the cure of certain diseas-
es are narrated with apparent fidelity and
candour, we are scarcely allowed to
doubt of their salutary effects. But,
when these medicines come to be used,
under the more discerning eye of dispassi-
onate men, in the same disorders for
which they were recommended, and the
success being greatly inferior to their ex- 

177 CONCERNING THE GOUT.
pectations, they often, from disappoint-
ment, throw them aside as useless. As
this is the usual effect of extravagant
commendations, it is reasonable to sup-
pose, that useful remedies have been ne-
glected, because they did not answer
the exaggerated accounts given of their
efficacy.
152. The principal object in the stu-
dy of medicine is to expiscate, as far as
can be done, the causes of diseases. But,
from the great difficulty of tracing na-
ture, we, in this respect, remain ex-
tremely ignorant with regard to the ori-
gin of certain disorders. In all such cas-
es, we are obliged to proceed on the em-
pirical plan of cure, by depending on
our own, or the experience of others, for
the recovery of our patients; sometimes
using with success medicines whose opera-
tion on the system in the cure of the dis-
ease we do not fully comprehend. But
when, from the history of the disease, a
sedulous attention to the symptoms, and
the effects of medicines which either alle-
viate, or exasperate the disorder, we are so
fortunate as to perceive the nature of the
cause, we can then proceed in the cure
more rationally and consistently. It is by
this manner of conducting my inquiries,
H5

178 AN INQUIRY
I have endeavoured to throw such lights,
as were in my power, on the nature and
cause of the gout. The operation and
effects of those medicines, mentioned in
the preceding pars, and which, when pro-
perly administered, prolong the intervals,
and alleviate the symptoms of the gout,
are the best proofs that can be brought in
favour of the foregoing doctrine, and
which shall be farther illustrated in the
sequel.
153. It is much to be regretted, that
the credulity of some patients should lead
them, from the unmerited high character
of certain medicines, to such sanguine
expectations of their efficacy, in the cure
of this distemper. Their impatience un-
der repeated attacks of the gout, with a
a strong desire to get free from so severe
a disorder, is some apology for their easy
saith, and confidence in their specific.
Too great a reliance, even on such me-
dicines as have been mentioned, always
gives me concern, because the patient is
often thereby apt to neglect temperance
and exercise, the most efficacious means
of cure, or of lessening the severity of
the disease. For, notwithstanding the
benefit that may be derived from the use
of medicines, yet, in so obstinate a dis- 

179 CONCERNING THE GOUT.  
order as the gout, we cannot dispense
with the proper regulation of diet and
exercise in a plan of cure, or of consider-
able alleviation of the disorder. But our
views can seldom rise so high, as is just
mentioned, with probability of success,
unless in the first years of the disorder.
For, after the joints becomes stiff and
are increased in size, from the long con-
tinuance of the disease, perhaps no com-
plete cure should be attempted of expect-
ed. Having carefully attended to the
operation and effects of those medicines
and means, used during the intervals,
for the cure of the gout, or alleviation
of its symptoms, and which in many cas-
es, have been attended with success; we
shall next proceed to the consideration of
some of those remedies, and applications,
employed by practitioners, for mitigating
the severity of a paroxysm.
154. From what has been advanced
in the preceding pages, a fit of the gout
must be considered as an exekement of
the system, to discharge the arthritic mat-
ter, generated in the body during the
preceding interval. The more complete-
ly, therefore, this is effected, the longer
and more perfect will be the succeeding
interval. To assist nature in this saluta- 

180 AN INQUIRY
ry process by keeping up the strength of
the system, patients are advised during
the paroxysm to a light diet of meat,
with a moderate quantity of wine, or
other strong liquors, twice a day. But
our surest guide is the patient's ordinary
way of living, in respect to diet and
wine, which admits not of much altera-
tion during a fit of the gout. When the
secretion of the arthritic matter on the
joints is considerable, it is sometimes at-
tended with a small degree of fever,
which afterwards, for a day or two, be-
comes symptomatic from the severity of
the pain. In such situations there is a
general disorder through the body, an
impatience of the mind, with want of
appetite. On account of this last circum-
stance, and to guard against the stomach
being oppressed with food, no meat
should be allowed; pudding or panada
should constitute the principal part of
their diet, though their usual quantity of
wine may be continued.
155. But the advice of the physician
is seldom wanted during the progress of a
fit of the gout; for the critical discharge
of the arthritic matter, with the conse-
quent inflammation and pain, having tak-
en place, warmth and ease are the most 

181 CONCERNING THE GOUT.
approved means to promote the comple-
tion of the fit. The great point here is
to procure a plentiful perspiration in the
feet, the parts which nature seems to have
chosen for conveying off the gouty mat-
ter, accumulated in the habit during the
preceding interval. This is commonly
attempted by several folds of flannel;
but a practice introduced in London, some
years since, and which I have followed
with success, is greatly preferable to the
usual method of wrapping up the feet in
flannel alone.
156. As soon as a fit, or the symptoms
of an approaching fit appear, the patient
is directed to draw on each foot three or
four socks, made of the finest and softest
wool, commonly fold under the name of
Welsh flannel; over them a pair of short
hose or bootikens of oiled silk, neatly la-
ced up, and drawn as close as possible
round the ancle, to prevent the escape
of the moisture, arising from the copious
perspiration of the feet. After the booti-
kens have been neatly applied, one, or
two more socks are to be drawn over each,
and, to cover the whole, a pair of soft
woolly Shetland stockings.
157. By this means, the feet are con-
stantly exposed to the fomentation of a 

182 AN INQUIRY
warm moisture, retained by the bootikens,
which increases the perspiration propor-
tionably. This is so considerable, as to
oblige the patient to remove the whole
coverings twice a day, on account of the
great quantity of moisture in the socks,
under the oiled silk hose. For, when
this is not the case, and the socks are
found dry, we must suppose the bootikens
to have cracked, and leaked, or that they
have not been applied sufficiently close at
the ancle. As both feet are wrapped up
in the same way, it is proper to observe,
that the transpiration of the sound foot,
is thought to contribute as much to the
recovery of the patient, as that of the
foot affected. When, by the proper use
of these flannels and bootikens, the pa-
tient has kept his feet in a constant per-
spiration night and day, it has been re-
marked, that the fit is not only thereby
shortened, but that the disease becomes
afterwards milder. This probably arises
from a more complete discharge of the
arthritic matter, than from the ordinary
method of treating this disease. They
have sometimes been of great service,
even when there were no gouty pains in
the feet, or other joints, by relieving the
patient from pain and flatulency in the

183 CONCERNING THE GOUT.
stomach and bowels, low spirits, and
other complaints proceeding from the
arthritic matter in the habit *; of which
the following, amongst many instances
that might be given, may serve as aa
example.
158. An unmarried lady, about 56
years of age, healthy, and of a good
constitution, became subject to a lumba-
go about the year 1787.  In the begin-
ning of winter 1788, this complaint be-
came more severe than before, and it was
observed to alternate with pains in her
bowels, so that she never suffered much
in both places at the same time. As she
had, from time to time, sharp shoot-
ing pains in the ball of the great toe,
and in other parts of her feet, though
of no long continuance, her friends had
little hesitation in pronouncing her disor-
der to be an irregular gout; knowing her
father to have been afflicted with regular
paroxysms of that distemper. An inter-
* In some hysterical and hypochondriac patients,
who have sometimes complained of a great coldness
in their feet, at other times of a burning heat in
these parts, the use of socks and bootikens has been
of great service, not only in removing these par-
ticular complaints, but in restoring the general
health of the patient. 

184 AN INQUIRY
val of ease succeeded to these complaints,
but they returned now and then with
more or less severity, till May 1790,
when she was seized with a fixed pain in
her left side, above the false ribs, and
soon afterwards with a cough. This
was rather a dull, than an acute pain,
unless in violent fits of coughing, but
it continued without intermission, though
with different degrees of severity. She
could lie in the night with tolerable ease
on the left, but not on the right side.
This last position disturbed her respirati-
on a little, and increased the frequency
of her cough, as is usual in similar
disorders.
159. Under an aggravation of these
complaints, I was called to visit her on
the 12th of December. She gave me
the history of her disorder, when I found
her pulse to be about 90 beats in a mi-
nute. At night a blistering plaster was
applied over the seat of the pain, and
she was directed to take a pectoral pill
twice a day for her cough. This was com-
pounded of a drachm of the pilulae stoma-
chicae of the Edinburgh Dispensatory, and
eight grains of the extractum thebaicum
divided into sixteen pills, which is a com-
mon prescription of mine for one in simi- 

185 CONCERNING THE GOUT.
lar complaints, or for a cough from a
catarrh. I prefer this formula to the ex-
tract alone, as it keeps the body open,
which is a material circumstance on such
occasions. By the fifteenth, her com-
plaints were alleviated, but not remov-
ed; for the pain in her side continued,
though less severe; but the cough was
nearly as troublesome as before. That
evening the socks and bootikens were
applied; but, as she was one of those
persons whose feet are brought to per-
spire with difficulty, the moisture in the
socks, on the mornings of the 16th and
17th, was found to be only moderate;
but she was sensible of relief from their
use. By a more careful application of
of the bootikens on the evening of the
17th, on unlacing the bootikens next
morning, the socks were found quite
wet. This was the only night on which
the perspiration appeared to have been
very considerable; but I allege that
the quantity of moisture in the socks, in
the subsequent application of them, was
in proportion to the degree of attention
paid to the lacing of the bootikens, and
shutting them at the ancle. Though the
perspiration in the feet, from the 18th,
was less than usually accompanies these 

186 AN INQUIRY
applications, yet, from the warm mois-
ture in which they were involved, the
heat was rather pleasant than disagree-
able. The benefit derived from this
practise was every day so evident, that
it was continued to the third or fourth
of January, by which time the pain in
the left side was scarcely felt, the cough
was considerably alleviated, and she
could sleep on both sides with great ease.
Before the end of the month, the cough
had left her entirely; and though, for
some time, she felt a slight dull pain in
the original seat of the disorder, yet it
gradually decreased, and went off with
the warm weather in the spring. The
same complaints, but in a less degree,
returned in November last, and were re-
moved by a similar practise.
160. These good effects are certainly
owing to the copious perspiration in the
feet, and are often experienced in a few
hours after the foot-socks and booitkens
are applied. In the irregular gout, when
the patient is not prevented by pain, the
walking about the house in large cloth
shoes over the socks and booitkens is
of service; and this covering to the feet
should be kept up, while the symptoms
continue for which they were employed.

187 CONCERNING THE GOUT. 
Even when the fit of the gout is appa-
rently gone, if the socks and bootikens,
are used during the night, till the patient
is able to walk abroad in his usual way,
it is of great service in lessening and car-
rying off the irregular symptoms of this
disease. This may have the appearance
of nursing the gout, which I by no means
recommend; for, from observation, I am
confident, that, as soon as the pain will
permit the patient to put his foot on the
ground, the more he walks in the house,
or abroad in good weather, provided his
feet are kept sufficiently warm, the soon-
er he gets free from his complaints. Of
the great number of proofs that might
be brought in confirmation of the saluta-
ry effects of this practise, I shall recite
only one from Van Swieten, who says,
'Vidi hominem, saltatoriae artis magis-
'trum, qui bis in anno podagra satis
'acriter infestabatur, et per viginti ac
'ultra annos nullam in articulis rigidita-
'tern expertus suit: Numerosae enim
'familiae ut victum compararet, simul
'ac aliquam saltem dolorum remissionem
'sentiebat, mox lecto exibat, et, quan-
'tum poterat, incedebat, dumque hoc
'quotidie tentabat, citius liberabatur.
'Generosa autem haec molimina diffici-

188 AN INQUIRY
'lius impetrantur ab illis, qui laute et
'molliter vivere consueverunt. Vol 4.
'4 to. p. 323.' It is unecessary to men-
tion the necessity of easy shoes for per-
sons afflicted with the gout; though I
wish to observe that the soles of most of
those which I have seen in the possession of
gouty persons, are too thick, stiff, and
heavy. But the best I ever met with
were from Sweden, made of seal skin,
the sole soft and pliable to the foot, and
were lined with sheep skin with the wool
on; they, of course, were light and very
warm.
161. When extreme pain, or want of
rest, calls for the aid of an opiate, the
patient, from experience, commonly re-
gulates his dose. This, however, ought
seldom to be permitted; for, from an
eager desire to be released from pain, the
patient is too apt to increase the quantity
of this inestimable remedy, beyond what
is consistent with the nature of the disor-
der, or to continue its use too long.
The most frequent occasion for medical
assistance is on account of some sympathe-
tic affection of the stomach and bowels,
urinary passages, lungs, &c. and as the
attack is commonly sudden and alarming
in its appearance, the advice of the phy- 

189 CONCERNING THE GOUT.
sician is at such times speedily required.
These complaints may be excited by in-
digestion, the ceasing of the pain in the
joint, the general mobility of the system,
or preternatural irritability of the part af-
fected.
162. When it appears that acidity,
bile, phlegm, or indigestion is the cause
of the disorder, the speediest relief is pro-
cured by draughts of warm water, to
which a small quantity of spirits of harts-
horn, or mustard flower, may be added,
to assist the expulsion of them by vomit-
ing. If this method is found insufficient,
a proper quantity of tincture of ipicacu-
han should be given to obtain the effect
proposed; which is preferable on such oc-
casions to tartar emetic, or other antimo-
nial vomits. But, after their operation,
an opiate is in general of great service,
and commonly secures the patient from a
return of the complaint.
163. The ceasing of the pain indi-
cates some impediment to the secretion
of the arthritic matter, and that the fit
of the gout is rendered thereby incom-
plete. At such times, to procure imme-
diate relief, warm wine, or brandy and
water, with spices, amongst which gin-
ger in powder to the quantity of a tea 

190 AN INQUIRY
spoonful or two, is not the least effectual,
are usually given with benefit. In such
cases, I have never permitted my patients
to drink such large quantities of wine, or
ardent spirits, as I understand has been
given to others. Some practitioners seem
even to vaunt in the number of bottles of
strong wine, and in the quantity of ar-
dent spirits, they permitted their patients
to take in the course of 24 hours, for
such complaints as are mentioned in
par. 161. But I have always considered
the giving of strong liquors to inebriation
as a bad practice, as it induces debility
and languor, soon after their effects begin
to cease. In all obstinate cases, opium
properly administered is the most effectual
means of relief. But as this is only palli-
ating till nature throws out part of the
arthritic matter by the skin, kidneys, or
otherwise, but more particularly by re-
newing the pain in the joint, our endea-
vours should be chiefly directed to this last
circumstance. This is often obtained by
bathing the feet in warm water, and the
application of sinapisms till they raise con-
siderable pain in the part to which they
were applied, and afterwards wrapping up
the feet in warm flannel, or in the man-
ner mentioned in par. 156. 

191 CONCERNING THE GOUT.
164. If we succeed not by these means,
and the complaint still continues, blis-
tering plasters must be applied to the
ancles; in some cases, they are after-
wards applied to the thighs, even to the
arms, and sometimes to the part affect-
ed, with success. The inflammation
and pain excited by the Spanish flies
appears to solicit the arthritic matter
to the parts inflamed, (par. 105.) for
the relief in some cases is obtained with the
rising of the blisters, though in general it
gradually takes place, with the discharge
previous to the healing of the blisters.
Such sympathetic affections as arise mere-
ly from mobility of the system, or of some
particular part, are more readily subdued
by warm wine, or by an opiate; but, when
they prove obstinate, a blistering plaster
near the part affected, in general, removes
the complaint. These are the principal
remedies and applications occasionally
used during a fit of the gout, either to
procure the expulsion of the arthritic mat-
ter, or to remove such painful and alarm-
ing symptoms, as sometimes occur during
a paroxysm. There are other means em-
ployed with the same intention of remov-
ing or alleviating a fit of the gout, but
more on the empirical plan, and not in 

192 AN INQUIRY
such general use. Most of them are un-
worthy of our notice, but there are several
which merit our attention.
165. To abate the severity of the pain
in the joint, which, from the sudden in-
flammation and distention of the vessels,
often rises to a very great height, leeches
have been applied with success. Those
who have experienced the application of
leeches to gouty inflammations, have as-
sured me, that their effect in mitigating
the pain was considerable, and that the
lameness, and even the fit, was of shorter
duration than in former paroxysms. For
it is reasonable to suppose, that topical
bleeding will lessen the distention of the
small arteries, and may even have some
effect in soliciting the inflammation to the
more external, and less sensible parts.
This is in general an application of the
patients themselves, from an ardent desire
of relies from a deep seated excruciating
pain in the joint, and as it is usually suc-
ceeded by an abatement of the pain, it is
afterwards repeated on similar occasions.
The only objection against this practice, is,
that, in the awkward application of the
leeches, the part affected may be too long,
or too much exposed to the cold air;
however, this is easily prevented by a skill- 

193 CONCERNING THE GOUT. 
ful and experienced hand in the use of
them. But, to illustrate the utility of this
practise, it may not be improper to subjoin
the following case.
166. A gentleman 30 years of age,
with an hereditary disposition to the gout,
having in other respects a good constituti-
on, was in the beginning of the year 1768,
about three days after he had taken a long
walk from the country in hard frost, with
tight or new shoes, seized with his first fit
of the gout. The inflammation which
spread over the ancle and outside of the
left foot, extended likewise up the leg,
near to the calf, resembling in its appear-
ance an erysipelatous inflammation. The
pain was considerable, and the redness
and swelling more extensive than is com-
monly observed in fits of the gout. Dur-
ing a painful illness of three weeks, a small
suppuration took place on the outside of
the foot, which healed up as the disease
declined; but this severe paroxysm left
a considerable weakness in that limb for
several weeks. This patient was bred a
surgeon; as such he practised abroad for
several years with reputation. Being a
person of observation and of a clear under-
standing, some credit was given by a phy-
sician who attended with me, to the pa-
I 

194 AN INQUIRY
tient's opinion, that his disorder was not
the gout, but an ardent erysipelatous in-
flammation; nor was this doubt of theirs
removed, till a similar fit seized the right
foot, after an interval of about two years.
Our patient had this last paroxysm in Lon-
don, where, in discharging the duty of a
civil employment, he has since resided.
By a letter from this gentleman, some
weeks ago, he informs me, that, from the
year 1770 to the year 1779, he had a re-
gular fit of the gout every twelve months,
and sometimes oftener, first in one foot
and ancle, then in the other; but it never
went higher. During every fit, the pain
and inflammation frequently moved from
one part to another of the foot. It usual-
ly fixed in the heel for two or three days,
then moved to the great toe and ancle, for
nearly the same time, and afterwards to
the other foot, shifting from place to place
until the fit was completed. These pa-
roxysms commonly confined him for a
month, and the subsequent weakness in his
feet and ancles usually continued for an
equal space of time.
167. About the year 1779, Mr. Robert-
son, surgeon at Richmond, recommended
to him the application of leeches on the
first appearance of pain and inflammation, 

195 CONCERNING THE GOUT. 
as a practise in which he had been success-
ful in a great number of arthritic patients.
From the too general opinion, that all ap-
plications to gouty inflammations were
dangerous, the leeches were applied with
great reluctance, three to the ball of the
great toe, and the same number to the an-
cle; by the application of warm cloths
they bled freely, and the relief was consi-
derable. This encouraged him to repeat
the application of the leeches, as often as a
new pain arose in the heel, or other parts
of the foot, and always with the same suc-
cess. By this treatment of the disease, the
duration of the paroxysm was shortened,
and the subsequent weakness of the limbs
was less than in former fits of this disor-
der; for, in a week from the commence-
ment of the paroxysm, the patient was
able to walk about his house, and in eight
days more to go abroad. This plan of re-
covery was not followed by any bad con-
sequences, and being in every respect great-
ly preferable, to his former method of flan-
nel and patience, he resolved, in all future
fits of the gout, to employ the same means
for the speedy mitigation of the pain and
inflammation, and shortening the time of
the paroxysm. He has continued the same
practise in every fit of the gout since the 
I2

196 AN INQUIRY
year 1779, and always with the same good
effects. He has likewise observed, that
the intervals, since he began the use of the
leeches, have gradually lengthened, and
that he has not had a fit of the gout for
these four years past. He besides informs
me, that such arthritic patients of his ac-
quaintance, as were prevailed on to apply
the leeches, in the manner mentioned, re-
ceived equal benefit from them. But
there were others, who from applying the
leeches too sparingly, received little advan-
tage from them; though he never knew
that they did any harm. These persons
generally took fright on the ceasing of the
pain and inflammation, in the part to which
the leeches were applied, especially is soon
after another part of the foot was afflicted
in the same manner, which is a common
circumstance in the progress of a fit of the
gout, whether leeches are applied or not.
168. This account of the benefit derived
from the application of leeches, in abating
the inflammation and pain in a fit of the
gout, is so favourable, that it is to be re-
gretted this practise has not become more
general. A dislike to the use of leeches
sometimes arises from an aversion to the
sight of these usesul reptiles; but is oftener
owing to a dread of their obstructing the 

197 CONCERNING THE GOUT. 
natural course of the disorder: For even
the sudden relief patients receive from their
application, gives an alarm, as if they had
that effect, which is not the case. It is
owing to these prejudices, that we have so
few instances of a complete trial of the
utility of leeches in the cure of the gout.
For I know no person who has prosecuted
this plan of recovery with so steady a per-
severance, or with so much success as the
above gentleman, who had thereby his fits
of the gout rendered much milder and
shorter, the intervals were protracted,
and he has been free from the gout for
these four years. These happy effects
ought to remove every objection to the use
of leeches, especially as I have further to
observe, that though this gentleman, from
choice, leads a temperate life, yet he in-
forms me, that, on particular occasions, he
has no great stricture on himself, either in
regard to his diet or quantity of wine.
169. Warm poultices have likewise been
proposed to abate the inflammation and se-
verity of the pain, in a fit of the gout;
and were it possible to keep them in an
equal degree of heat, they might, perhaps,
answer the intention. But as this is scarce-
ly practicable, and as the application of a
I3 

198 AN INQUIRY
cold poultice would have a dangerous ten-
dency, they ought, on that account, to be
rejected. A physician in considerable prac-
tice here some years ago, recommended a
particular cataplasm, for alleviating the in-
flammation and pain, in a fit of the gout.
It was composed of a pound or a quart of
rye meal, two ounces of salt, four ounces
of yest, and as much warm water as to
make it into a paste or dough, of a con-
sistence similar to what is sent to the
oven *. This is then rolled out to the
thickness of half an inch, large enough to
cover the sole, toes, and half of the up-
per part of the foot, to be applied as warm
as it can be borne, and renewed every ten
or twelve hours, or as often as it becomes
dry.
170. My experience in this application
goes no farther than one instance, in which
it proved successsul. This was in the case
of a cook in a nobleman's family, who
was suddenly seized with the gout, in the
night preceding an entertainment, of which
he had the chief management. When the
above cataplasm was first applied, he was
scarcely able to stand at his dresser; in an
hour or two he moved about with difficul-
* The water, yest, and salt, should be mixed
before they are added to the meal.

199 CONCERNING THE GOUT.
ty, and at last with great ease; and two or
three of these applications freed him of
the gout for that time. I considered this
patient as in a particular situation favoura-
ble for such an experiment; for the flag
stones in the kitchen being kept warm by
the large fires and stoves, there was little
danger to be apprehended from the cata-
plasms becoming cold. Notwithstanding
the successful treatment of this patient,
which appears to have arisen from a warm
fomentation to the feet, I have not conti-
nued this practice, being always afraid of
such applications becoming cold, and of
course dangerous. Besides, as the same
good effects are more readily and safely ob-
tained by the foot-socks and bootikins
(par. 156.) I have always preferred them
to cataplasms, or any other wet application.
171. The access of cold air to gouty in-
flammations, produces a soothing and plea-
sant sensation, from an abatement of the
heat and pain. The application of cold
water is still more powerful in stopping the 
progress of the inflammation, and when
long continued, for the most part carries it
off entirely, or renders the fit incomplete.
This is a most dangerous practice, because
it puts a stop to the critical discharge of the
arthritic matter, which is of course retain-
I4

200 AN INQUIRY
ed in the habit. As this practice, is not al-
ways followed immediately by any bad
consequence, the patient seeming to escape
the painful duration of a fit with impuni-
ty, he is encouraged to repeat it in succeed-
ing paroxysms, till it at last becomes
fatal. This fact is so generally known, that
it is unnecessary to give examples. The
bad effects of this method of stopping the
natural progress of a fit, is sometimes felt
immediately after the bathing of the feet
in cold water; but at other times, two or
three weeks, or months elapse, before a de-
lirium, palsy, or sudden death, shows the
bad consequences of this noxious practice.
The distance of time from the cold bath-
ing at which these dismal effects take place,
often leads to a false opinion with regard
to the cause of them. But as often as such
cases will admit of a clear explanation, it
should be given, to prevent others from
falling into the same fatal mistake.
172. Cold water, the solution of cer-
tain metallic salts, and other cooling as-
tringents, that are known to lessen or ob-
struct the advancement of inflammations,
are usually denominated repellants. This
appellation of these substances, gives the
idea as if they had the power of produ-
cing a retrograde motion in the fluids, and 

201 CONCERNING THE GOUT.
particularly of the morbid matter exciting
the inflammation. When small vessels,
conveying in their natural state pellucid
fluids, are so distended, in inflamed parts,
as to be filled with red blood, they, on the
cause of the inflammation being removed,
will return to their former size. In this re-
covery to their natural diameters, in which
they may be assisted by astringents, the red
blood will be pushed back into larger
branches, and so far a retrograde motion
must be admitted, but no farther, to my
knowledge or observation. But this con-
cerns not the acrid matter exciting the in-
flammation, which appears to be secreted
from the blood, by the exhalent arteries
opening on surfaces, and when once se-
creted, cannot be thrown back into the
same vessels. It may indeed be absorbed,
as it certainly is in a greater or less quan-
tity, in every inflammation; for the lym-
phatics are the most powerful agents in
terminating inflammations by resolution *.
These considerations have induced me,
* It is easy to imagine, that the office of the lym-
phatics may sometimes be suspended by compressure,
in inflammations tending to suppuration, or from the
acrid quality of the matter to be absorbed.
I5

202 AN INQUIRY
for many years, to reject every idea of a
retrograde motion in the morbid matter
exciting inflammation. For the same rea-
son I have difused the term repellant, ap-
plied to the remedies used in the cure of
inflammation, as improper, on account of
its leading to a false notion of the man-
ner in which these remedies act in produ-
cing their effects.
173. The operation, therefore, of those
remedies that are known to assist in the di-
minution or cure of inflammation, remains
to be explained. This most probably de-
pends on the astringent and cooling qua-
lities they in common possess, which, from
their peculiar stimulus, lessens or puts a
stop to the morbid secretion, and increases
the power of the absorbents. From the
view I have taken of the origin of inflam-
mation, this is the only explanation I can
suggest, of the manner in which metallic,
and other neutral salts, dissolved in water,
act, in producing their effects. As these
solutions are generally applied cold, it is
perhaps to this circumstance chiefly that
their virtues are to be attributed. For we
know that cold water alone removes slight
inflammations in the eyes, and other parts,
and that bathing the feet in cold water,
carries of an incipient gouty inflammation
in these parts. 

203 CONCERNING THE GOUT. 
174. There are some circumstances rela-
tive to the secretion and absorption of mor-
bid fluids, that at first sight seem to con-
tradict each other, but from experience
and observation, are reconcilable. For
many are the chronic, and sometimes dan-
gerous disorders, which result from the re-
tention of acrid fluids in the habit, which,
on a complete critical discharge of them,
disappear. But, as the lymphatics are al-
ways active, it may be asked, why the dis-
orders which arose from the acrid fluids,
before they were secreted, return not, in
some degree, on part of the same morbid
matter being absorbed and again carried
into the circulation? This question is not
so applicable to critical discharges, by the
excretories of the skin, kidneys, or intes-
tines; though, in this last case, some part
of the morbid fluids may be absorbed, be-
fore the whole can be thrown out of
the body. But, when such morbid flu-
ids are thrown on the surfaces of mus-
cular fibres, small vessels, cellular sub-
stance, or other soft parts of the body,
a greater or less portion of these flu-
ids must be absorbed. The quantity of the
acrid matter taken up by the lymphatics
will correspond with the manner in which
the inflammations, thereby excited, termi-
nate, and according to the greater or less
depth of the seat of the inflammation. For, 

204 AN INQUIRY
when the inflammation terminates by reso-
lution, a greater quantity will be absorbed
than when it ends in suppuration, or mor-
tification. When superficial, some part of
the morbid matter may be carried off by
the excretories of the skin, or by those ter-
minating on the surface of the viscus in-
flamed; but, is the inflammation is deep
seated, and ends by resolution, then the
whole of the morbid matter is carried off
by absorption.
175. But it is a surprising circumstance,
that, in every inflammation, more or less
of a morbid matter, after it has been se-
creted, is carried again into the circulati-
on, seemingly with impunity. For those
disorders are not reproduced, that were ex-
cited by it before it was secreted, or during
the existence of that salutary effort of na-
ture to throw it out of the circulation. It
is true, that in some diseases, when the
quantity taken up by the lymphatics is
considerable, it has alarming consequen-
ces, as in the small-pox and measles, of a
malignant kind, it produces what we call
the secondary fever, which is sometimes fa-
tal. But, when these disorders are of a
mild sort, even when convulsions and other
alarming symptoms have preceded the
eruption, and the number of pustules is 

205 CONCERNING THE GOUT.
considerable, the absorption goes on with-
out any apparent bad consequence. These
observations, however, are not so applica-
ble to inflammations accompanied with
proper fever, as to those accompanied with
symptomatic fever only. Neither do I as-
sert, in this last case, that, when the quan-
tity of matter absorbed is considerable, or
remarkably acrid, it is harmless, because,
in such instances, we frequently experience
its deleterious and sometimes fatal effects.
All I wish here to represent is, that, when
the quantity of matter absorbed is not
great, or very acrid, the disturbance it oc-
casions in the habit is much less than might
be expected. For, in ordinary inflamma-
tions ending in resolution, or even in sup-
purations of a moderate size, where the
absorption must in some cases be consider-
able, no remarkably bad consequence is
observed. But in erysipelatous inflamma-
tions, and that of the gout, where the mor-
bid matter is more acrid, some symptoms,
similar to those which preceded the in-
flammation, sometimes recur during the
recovery of the patient.
176. To these observations it may be
objested, that the minutest portion of the
matter of the small pox, measles, or other
febrile, infectious disorders, are capable of 

206 AN INQUIRY
communicating the same diseases to others,
that existed in the person from whom they
were taken, and of course that they retain
their original acrimony. But this must be
understood to concern their infectious
power only, and not the acrimony they in
common possess with other noxious fluids,
not of a febrile origin. For we ascribe the
secondary fever, after an unfavourable sort
of the small-pox, to the quantity of puru-
lent matter absorbed, and not to its infec-
tious quality; because, in general, no such
fever succeeds to the milder kinds. In a
subject so obscure, perhaps, no complete
explanation can be given; but till such is
presented to us, I shall offer, with dissi-
dence, what at present occurs to me on
that head.
177. In every critical inflammation, we
are not to suppose that the whole of the
morbid matter generated in the body is
thrown on the inflamed part, some portion
of it escapes by the skin, kidneys, and
other excretories. This is evident from the
perspiration, and turbid urine towards the
end of rheumatic, and gouty inflammati-
ons. These evacuations are in common
with other critical discharges, and lessen
the quantity proportionably of the morbid
matter in the habit. The matter absorbed 

207 CONCERNING THE GOUT. 
probably undergoes some alteration, in its
course through the lymphatics and lym-
phatic glands, in its passage to the subcla-
vion vein. But it most likely suffers a still
greater change in the course of the circu-
lation, which may fit it more effectually
to be thrown out of the body by the usual
emunctories. Besides, the custom of nature
to a particular stimulus, may go a great
way to its being borne for some time, with-
out any apparent inconvenience.
178. The number of uncommon cases,
and some of them rather of a marvellous
kind, that are in our medical records, and
from which we can draw no useful conclu-
sion, is very great. This may arise from-
our ignorance of the manner in which na-
ture acts, on being particularly affected,
our not knowing the cause of the disease,
and sometimes from a false representation
of facts. In general, the cases of marvel,
more calculated to astonish than instruct,
may be placed with these last, to be for-
gotten, because no useful inference can be
drawn from them. I mean not to draw any
disbelief on those cases, however uncom-
mon in their appearance, that are given to
us with fidelity and candour; this would
be to oppose truth, which must always be
attended with discredit. For cases of an ex- 

208 AN INQUIRY
traordinary nature, and accompanied with
singular circumstances, will sometimes oc-
cur, which, on account of our ignorance
of certain operations in the animal body,
admit not of any satisfactory explanation.
In conducting the cure on such occasions,
we are obliged to become empirics, hav-
ing nothing but experience for our guide.
But, when we are so fortunate as to acquire
some knowledge of the cause, then several
circumstances in the history of the disease,
that were involved in obscurity, become
more intelligible. After this we become
more regular, can account for our prac-
tice, explain the operations of medicines,
and can give some satisfactory reasons for
the success of certain remedies used by em-
pirics in the cure of the disorder. In con-
firmation of this last observation, there is
a remarkable case, and quackish cure, of
the gout, given us by the late Dr. David
Clerk, in his ingenious treatise on the ar-
thritis anomala and true gout. Although
the method observed by the Doctor's patient
to free himself from a fit of the gout, can-
not in general be practised, or recommend-
ed; yet, as it will serve to illustrate some
part of the foregoing doctrine, concerning
the cause and cure of the gout, I shall tran-
scribe it in the Doctor's own words. 

209 CONCERNING THE GOUT.
179. 'William Richardson, footman to
'a lady of quality, naturally a strong
'man, and now aged fifty five, was seized
'with the gout about twenty years ago.
'For the first eight or nine years, he had
'a fit once every year in the spring, which
'used to last above a month. After that,
'he was told by somebody, that he might
'free himself of the gout, if he would, at
'its first appearance, eat one, or more salt
'herrings at bed time by way of supper,
'and taste no other food, or drink, that
'night: That one herring would cure a
'slight fit; but that, is the fit was very se-
'vere, it would require two or three; that
'this should be continued for three nights
'successively, if the gout should not be
'entirely gone before that time: And
'that it was necessary to take the herrings
'straight from the pickle, without wash-
'ing them, and to roast them. He ac-
'cordingly followed the prescription, and
'the first time he was seized with the
'gout, that he might make sure of suc-
'cess, he eat three whole herrings at bed-
'time, after the manner prescribed, and
'next morning was so well, as to be able
'to go abroad about his business; nor did
'he stand in need of a second night of the
'cure at that time. Every year since, he 

210 AN INQUIRY
'has followed the same method, eating
'three herrings at bed time, when the fit
'attacked him; and, when he did it at
'the beginning of the fit, he was always
'well next day; but, is he allowed the fit
'to go on for some days, it obliged him
'to have recourse to the herrings, for three
'nights running; however, he was sure
'of being well in three days at most.
'The nights on which he took the reme-
'dy, he wrapped his feet in flannel, and
'they sweated. As the distress for want
'of drink was excessive during the night,
'he used to chew some hay or straw, with
'a view to lessen the violence of his thirst.
'Ever since he began this method of cure,
'he has had very good health through the
'rest of the year, except the first year.
'For, having been much hurt by a fall
'from a tree that year, viz. in summer
'1750, he lost much of his strength, of
'his sight, and of his memory; but, by
'the use of some medicines and a seton in
'his neck, he was perfectly recovered be-
'fore the time of the gout's returning
'upon him next spring. This present year,
'his health has been very good, though
'he had no fit of the gout last spring as
'usual, which is the first time he has miss-
'ed it these twenty years. I never knew 

211 CONCERNING THE GOUT.
'above one, or two other people who tri-
'ed this method of cure; but, as they
'had not fortitude enough to withstand
'the violence of the thirst, and were
'obliged to quench it with drink in the
'night, it did not answer.*'
180. Neither Dr. Clerk, nor Dr. Whyte,
who made a report on Dr. Clerk's paper
to the Philosophical Society, both men of
learning, genius, observation, and in con-
siderable practice, attempted to account
for the remarkable effects of the salt her-
rings in the above case. Nor could an ex-
planation be given, on any theory of the
gout I have yet seen; but, from the na-
ture and cause of this distemper, as stated
in this and the preceding section, I appre-
hend it will be clearly understood.
181. The wrapping up the feet in flan-
nel, is no more than experience has taught,
to defend the tender inflamed parts from
the friction of the bed cloaths, and to in-
crease the perspiration, which assists in
shortening the duration of the paroxysm.
But a fit of the gout, which formerly con-
tinued for a month, being carried off in
ten or twelve hours, must be ascribed sole-
* Essays and observations phys. and lit. of Edin
vol. 3. page 462. 

212 AN INQUIRY
ly to the herrings, or rather to the salt
they contained. The thirst which this pa-
tient suffered in the night, must have been
very great. For no condiment used in
diet, is so powerful in exciting that disa-
greeable sensation as sea salt, as shall be
shown more particularly in a future treatise
on Absorption. But it must be remarked,
that thirst is the criterion of the increased
action of the lymphatics, and the exertion
of their powers must be measured, by the
degree of thirst which attends their action.
Hence we may safely conclude, that, after
a supper of three salt herrings from the
pickle, unwashed, and broiled, without be-
ing permitted to drink till next day, the
absorption of secreted fluids must have
been considerable. It was during that pe-
riod of suffering from excessive thirst, that
I suppose the arthritic matter secreted,
and about to produce a painful gouty in-
flammation, was greedily absorbed by the
lymphatics, to be mixed again with the
circulating fluids. The consequence of
this absorption of the arthritic matter,
was a freedom from the gout next day,
provided this extraordinary method of cure
was practised at the commencement of
the fit.  But, if it was delayed to the se-
cond or third day after the attack of the 

213 CONCERNING THE GOUT. 
disorder, then the repetition of this sin-
gular remedy was necessary, even to the
third night. For the increased action of
the lymphatics for one night, was not suf-
ficient for the complete absorption of the
arthritic matter, increased in quantity by
time, and pain. This supposition appears
to be proved by another experiment; for
for those men who eat broiled herrings
with the same view, but quenched their
thirst with drink during the night, were
not cured, because the powers of the lym-
phatics were chiefly exerted in the absorp-
tion of a large quantity of drink, taken
into the stomach.
182. From the representation given of
the Atonic Gout, in paragraphs 62, 63,
73, 74, and in other parts of this treatise,
it appears unnecessay to enlarge on the
management of those who labour under
this afflicting state of the disease. In this
last period of the gout, accompanied with
great debility and languor of mind and bo-
dy, with all the effects of an accumulated
acrimony in the habit, we must consider
the disorder as incurable. In such cases,
the skill of the physician reaches no fur-
ther than to alleviate pain, and the anoma-
lous complaints incident to this stage of
the disease, and by such means as are men- 

214 AN INQUIRY
tioned in paragraph 62. The intervals of
freedom from complaint are protracted,
and the disorder in general mitigated, by a
proper regulation of diet, with their ac-
customed quantity of wine, or other strong
liquors, and by prompting them to as
much exercise as their debilitated state will
permit them to take. With the same view,
issues, and in some cases, setons, are used
with advantage; but on a sudden and se-
vere attack of some disorder, threatening
danger, more immediate relief is obtained
by blisters. As such persons are more sub-
ject to indigestion, flatulency, and costive-
ness, than formerly, some stomachic laxa-
tive medicine, of a gentle operation, should
be at hand to obviate these complaints.
When acidity, or phlegm, are prevalent in
the primae viae, the aqua mephitica alca-
lina of Dobson, as formerly mentioned, is
of service. The rubbing the whole body
every day, and particularly the stiff joints,
with a flannel, or flesh brush, supplies in
some degree the want of proper exercise,
and it is on that account of great use (par.
124). If debility does not preclude the
patient from the use of the warm bath, it
is of benefit in some cases, though it ought
not to be repeated above once a week.
This is to promote the perspiration; and, 

215 CONCERNING THE GOUT.  
for the same reason, warm cloathing, par-
ticularly to the feet and legs, ought to be
recommended.
183. In the preceding paragraphs on
the cure of the gout, I have endeavoured
to point out the manner in which the se-
veral remedies, used with success in this
disease, produce their salutary effects. In
treating of this part of my subject, it ap-
pears, that the operation of the several
means and medicines mentioned, assist us,
almost in every instance, in explaining the
nature and cause of this distemper. If this
observation is well founded, it is the strong-
est proof that can be given of the truth of
the preceding doctrine. But, as the view
that is taken of this disorder in general, and
the explanations that are given of the
symptoms that precede, and succeed a pa-
roxysm; of the immediate cause of a fit,
the inflammation that accompanies it, and
the operation of particular remedies, are
new, I offer them to the public, as I ought,
with distrust and dissidence. Some obser-
vations made, in the first part of this trea-
tise, on other diseases, were carried no fur-
ther than to elucidate the doctrine I have
endeavoured to establish on the nature and
cause of the gout, the principal point I
had in view. For the same reason, in treat-

216 AN INQUIRY, &c.
ing of the operation of certain medicines,
found to be usesul in the cure, or allevia-
tion of this disease, I have carried my ex-
amination of their beneficial effects to
other disorders. This was done in consi-
dering the contents and virtues of Bath wa-
ters; in examining the properties of lixi-
vial salts, and in pointing out the manner
by which they produce their salutary ef-
fects, not only in the gout, but in the stone.
If I have attempted to give reasons for the
morbid effects that follow the retention of
acrid fluids, and their less noxious qualities
when secreted and afterwards absorbed, it
was with the same design of elucidating my
subject. This will likewise appear in a
variety of other explanations I have been
obliged to attempt, before I could proceed
with any satisfaction to myself. But these
seeming digressions give the appearance of
an irregularity to this treatise, scarcely to
be avoided, and which I hope will be ex-
cused, on account of the difficulties that
attended the inquiries in which I have been
engaged.
FINIS.