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A TREATISE ON THE GOUT; In which The CAUSE is Firſt briefly aſſigned, AND Secondly an effectual and certain CURE is pointed out.

By Arentius Ferdinand Lambrechts, M. D.

Studere, verum invenire.

LONDON: Printed for J. BOUQUET, at the White-Hart in Pater-noſter-Row. 1754.

[Price Six-pence.]

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TO My much beloved and honoured Father-in-Law JOHN SCHRADER, Profeſſor of Hiſtory, Oratory, and Poetry in the Academy at Franeker.

TO The moſt renowned, learned, and expert AMOS LAMBRECHTS, M. D. BINCKE LAMBRECHTS, M. D. Practitioners at Amſterdam. DANIEL MATTHIAS LOHMAN, M. D. My beloved Kinſmen;

Alſo to My much eſteemed Friend CHRISTOPHER KENE, M. D. of Middelburgh in Zeeland.

The following conciſe Treatiſe is humbly inſcribed.

That by its Uſefulneſs and Service, it may merit your Eſteem, and obtain your kind Acceptance, is the ſincere Deſire of the Author.

A. F. LAMBRECHTS.

THE INTRODUCTION.

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THE learned Dr. Wintringham, in the Introduction to his Treatiſe on the GOUT*, very juſtly obſerves, ‘"That the Phaenomena of this Diſeaſe have been variouſly treated by Authors, and rendred intricate by the Numbers of Hypotheſes, which have wholly obſcured the true Nature of this Malady; or at leaſt have only given us a lame and uncertain Account."’ Wherefore he cloſes it in the following Manner: ‘"It is clear, that this Diſeaſe as yet remains in the Dark, which we hope, may one Day appear in its proper Light."’ I have already made ſome ſmall Mention concerning this Malady in my Compendium Anatomico-Medicum Practicum, publiſhed in Latin, Anno 1747.

[]

It is not the empty Zeal of Applauſe, that puſhes me on to make public the following Treatiſe; but the real Service of Mankind, and the Welfare of thoſe who are afflicted with this ſevere Diſorder.

Benevolent Reader,

I beſeech your Acceptance of this ſhort Eſſay with Humanity and Candour, humbly deſiring, that any Errors you may meet with, may in a humane and friendly Manner be ſet to rights.

If this ſhould prove acceptable to Mankind, I will in a ſhort Time make public all my particular Obſervations on the GOUT.

It will be to no Purpoſe to detain you any longer from the Treatiſe itſelf, therefore I cloſe this Introduction with the following Lines.

Tu, ſcio, tu fateor, noviſii rectius iſtis,
Tu, ſcio, tu, fateor, me meliora facis.
Sed, rogo, ſufficiat tibi, cum meliora nequirem Reddere, debendi ſemper habere reum.

Farewel.

A TREATISE ON THE GOUT.

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THE Gout is a tenſive and lacerating Pain about the Joints, chiefly returning in* Spring and Autumn, ariſing from an Obſtruction in the nervous Veſſels and Acrimony of the Fluids; whence Redneſs, Swelling, and chalky Concretions. In general it is called Arthritis, from the Greek Word [...], ſignifying a Joint, becauſe this Complaint chiefly ſeizes thoſe Parts. It likewiſe takes its Name from the ſeveral Parts of the Body it attacks, to wit, in the Hands, Chiragra from [...] [8]a Hand, and [...], a Prey or Seizure, thereby denoting its cruel Ravages and Injury whereſoever it comes.

The Sciatica or Hip-Gout, from [...] the Hip. In the Knees Gonogra, from [...] the Knee, and [...].

Podagra in like manner is from [...], the Foot, and [...], whence the Gout in the Feet is ſo termed.

There are various other Denominations which all take their origin from the parts affected, the Cauſe being ſtill the ſame, ſometimes ſeizing one Place ſometimes another.

Many are apt to believe the Rheumatiſm to be either Gout or Scurvy, but improperly; it has its Name from [...], to flow, hence [...], a Rheum, thereby denoting a Flowing of Humours to a Part, yet the Rheumatiſm partakes ſomewhat of theſe Diſeaſes.

The renowned Sydenham hath well treated this Diſeaſe, yet muſt own in my Opinion, he makes uſe of bleeding too frequently. It chiefly ſhews itſelf in the ſame Places, where the Gout appears, whence in ſome meaſure the Miſtake ariſes.

The Lumbago was obſerved by the Antients; in which the Pain in the Loins is ſo great, that the Patient is obliged to ſit or ſtand upright: If he moves to either Side, or endeavours to bend forward or backward, then he ſuffers excruciating Pains, and ſometimes even Convulſions. The ſame Difficulties [9]are found in moving the Neck, if that Part is afflicted, as it often happens to be. When it ſeizes the Region of the Os ſacrum it is often termed the lower rheumatic Lumbago; by ſome alſo it is called the rheumatic Gonogra, if in the Knees: Yet this Diſeaſe may for the moſt part be diſtinguiſhed from the Gout and Scurvy; if the Perſon has not had either of theſe before, then I ſhould eſteem it the Rheumatiſm, and not the Gout.

It is not neceſſary for me here to explain the Cauſe of the regular Fit of the Gout, which invades a little before the vernal Equinox, and after the autumnal; for Wintringham has learnedly treated of this*.

The noble Willis and Heinſius alſo [who has wrote in Dutch a Tract of this Malady] deſerves to be read again and again; which makes good the old Proverb,

Lectio lecta placet, decies repetita placebit.

The Gout under its various Denominations is either hereditary or acquired. Its Cauſe is two fold,

Firſt, From a Straitneſs and Rigidity or Stiffneſs of the nervous Veſſels.

[10]

Secondly, From an Acrimony and Tenacity of the Fluids*.

Hence every Fault committed in the Non-naturals (as they are termed by Phyſicians) haſten and bring on the Fit. It principally afflicts in Parts remote from the Brain. The Defect lies in the laſt Office of Digeſtion. 1ſt. From our Food is Chyle produced, 2dly. The Serum or Whey, 3dly. The Blood, and laſtly, The nervous Spirit.

The Viſcera, or Organs of the firſt Concoctions are good, but that ultimate or laſt Effect is not properly performed. Our Maſter of the Faculty, the great Boerhaave is of the ſame Opinion; for he ſaw a Patient who had about the Joint a Swelling that broke without Pain; he forced a Needle quite through to the Bone without any Uneaſineſs, and took out this chalky Matter which was made up with the ſmalleſt Veſſels, thus deſtroyed and changed. It is alſo plain, that the Blood, Serum, &c. are not in fault, for they equally exerciſe their ſeveral Functions; the gouty Subject can reaſon properly, and feels the Power of Love as before: Hence I have often admired Hippocrates, where he ſays, the Gout cleanſes [11]the moſt minute Receſſes of the Blood in old Men; for after a Fit, they, for the moſt part remain free and well for Months; and in this Courſe, they may obtain the good old Age of Fourſcore or upwards; wherefore this Diſeaſe muſt not be in the Blood, but in the Ultimate [...], or Spirit of the Blood.

Hence it is neceſſary (as alſo Paracelſus and Helmont obſerves) that the whole Body be recruited in the Solids, and the Fluids mended, and corrected before the Cure can be accompliſhed; but this is to be done by reſtorative Medicaments, and not thoſe of a purgative Quality.

Otto Tachenius (in his Tract de Morborum Principe) ſays, that a ſubtile corroding Acid is the Cauſe of the Gout, and hence an Alcali, it being quite an Oppoſite, deſtroying and driving out the Malady, he eſteems as a Specific: which acrid Cauſe, ariſing from too great Rigidity or Straitneſs in the Veſſels, Venery, &c. deſtroys the beſt and fineſt Part of the Nerves. He got great Profit by this Invention, yet the Medicine did not anſwer. It is inſcribed on the Statue erected to the Memory of Paracelſus, that he could cure the Gout, by which, I ſuppoſe, is to be underſtood, he cured the Fit by ordering a good Diet, giving proper Anodynes, &c. But this does not root out the Seeds of the Diſeaſe; Nature left to herſelf would have performed thus much.

[12]

A Man in Holland made Trial of all the Remedies he could pick up, among the reſt the Caryocoſtinum, but was much the worſe for it, notwithſtanding the great Praiſes given it by its Inventor Eugenius.

In England, as well as in Holland, there is a noted Powder highly recommended in this Diſeaſe; it is made with Germander, Ground-pine, the leſſer Centaury, the Roots of Birthworth and Gentian; and diſtinguiſhed by the Title of the Great and Noble Duke of Portland. It is true, this Powder will mitigate the Pains; but in my Practice, I have found it to produce Obſtructions in the ſmaller Veſſels, and cauſe the morbid Matter to attack freſh Places; hence if it ſhould retire to ſome of the more noble Viſcera, Death in a ſhort Time, muſt be the Event. I readily own, that if the gouty Perſon, having this Malady, only in a recent and ſlight manner, obſerves a good Diet, during the Uſe of this Powder, he may, for a Time, have his Pains leſſened and abated; but it is not in the Power of this Remedy to eradicate the peccant Matter.

The Gout is not only dangerous in itſelf, but likewiſe of all Diſeaſes the moſt ſevere, and obſtinate in its Continuance, tormenting poor Mortals, for the moſt part, as long as Liſe laſts; from whence the Saying,

Tollere nodoſam neſcit medicina podagram. JUVENAL.
[13]

We may further add the Words of Dr. Wintringham in the End of his Treatiſe, where he obſerves, ‘"That notwithſtanding the vain Boaſtings of Empirics, it is quite evident, that no Specific has been given, by the Help of which, this Diſeaſe has been rooted out."’

Hippocrates takes notice, ‘"That Eunuchs have not the Gout, neither are bald or bare-headed. Alſo, that Women are free from it unleſs their natural Courſes are deficient:"’ And further, ‘"That Youth have it not before they Uſe Venery*."’

Our Father Hippocrates has here declared Things worth notice, but yet he does not ſay this Diſeaſe is incurable.

The excellent Boerhaave obſerves, ‘"That this Diſeaſe cannot be cured, unleſs by Medicines, which have Power to correct and change the bad State of the Body, whence this Diſorder ariſes ‖."’

The hereditary Gout, and that attended with ſtony Concretions are of all the moſt difficult to cure ‡. For the hereditary is the Effect of the whole Compages of the human Machine, and ſhews itſelf in its own proper [14]time, in like manner, as the Secretion of the male Seed appears after Puberty, having its Origin from the Nerves ſo ingendered.

The Tophi, or Chalk-ſtones do not happen till after all the Juices of the Body have been infected; hence we may plainly learn, why they are the worſt and moſt difficult to be cured*.

Now to the Method of treating this Diſeaſe.*

During the Paroxyſm or Fit, I carefully avoid every Thing which may hinder or diſturb the Evacuation of the peccant Matter. Therefore I ſhun bleeding, for the Blood being leſſened in Quantity, the Preſſure towards the excretory Veſſels is likewiſe diminiſhed; and thus the Matter which ſhould be evacuated, is retained, whereby grievous and heavy Symptoms enſue ‡.

Dr. Wintringham directs Emetics and Purgatives to be repeated occaſionally, in order to clear the Primae Viae of their Crudities; [15]but I abſtain from ſuch Remedies, for they occaſion a Tumult in the nervous Juices, draw off the more fluid Parts, and deſtroy their expulſive Power*, whereby the natural Secretions are much hindred.

Medicines that encourage Sweat, and alſo thoſe that paſs by Urine, make the Circulation of the Blood more rapid, and of Courſe the offending Matter is determined in a larger Quantity to be ſeparated and carried off, hence the preſent Fit will be increaſed. It is beſt that the Concoction and Evacuation of the gouty Matter be left to the ſole Work of Nature.

I would refer the Reader to the 1273d Aphoriſm of the immortal Boerhaave, it deſerving a particular Regard, nay even all of them on this Subject are well worth our peruſal.

During the Fit, we can only endeavour to render the Pain as mild as poſſible, by blunting the Acrimony or Sharpneſs of the morbid Matter, and gently helping forward its Expulſion out of the Body. To effect this, I endeavour to dilute and thin the Blood, that the Matter unfit for Circulation, and lodged at the Joints, may flow with more Facility and Eaſe. I order a temperating Powder, three or four Times in a Day, with a medicated Liquor to be plentifully drank. When the Pain is ſevere and ſcarce [16]ſufferable, I give fifty, ſixty or ſeventy Dops of an anodyne Elixir in a large Draught of the above Drink. I never uſe any outward Application during the Fit, unleſs the ſick Perſon ſhould be very impatient and deſirous of it; in which Caſe, I apply an anodyne Cataplaſm or Fomentation. If the gouty Matter ſhould recoil to the internal Parts; and there attack ſome of the noble Viſcera or Bowels, we muſt immediately try all in our Power to drive it out again to the Joints, with large Draughts of an aromatic Decoction, Fomentations and Bliſters too if requiſite.* By theſe Means many may be preſerved from ſudden Death.

Out of the Fit, I take Care to prevent the Encreaſe of the gouty Matter, alſo to ſhake off that which has, in ſome meaſure, begun to fix itſelf. And for that Purpoſe.

Firſt the Patient muſt carefully obſerve a good Diet, eſpecially a milky one, for Milk has been ſeparated from every groſs Part, having already paſſed through the ſeveral Digeſtions in the Animal; hence it does not beget thoſe Crudities any other Diet is liable to.

The gouty Patient, while he is under his Courſe of Medicines, ought to have the following Verſe inſcribed over his Chamberdoor.

[17]
Eſto pius Domino, ſobrius tibi, juſtus in omnes,
Iſta tria animae cauſa ſalutis erit.

The celebrated Dolaeus writ well on this Head*, learn a Leſſon (ſays he) from the rank herd of Debauchees, who, in our Tippling-houſes gorge themſelves with ſtrong Beer: What foul Savours exhale from their impure Bodies, how are they agitated by an unquiet and reſtleſs Life, how great a Dullneſs to their Wit, how benumbed their Senſes, how feeble their Limbs, how overwhelmed is that noble Part, their Brain. As when the Earth is wet by heavy Rains, Linnen and Paper grow limp and moiſt, ſtanding Waters and Sewers ſtink and are offenſive; even ſo, when too much Liquor has diffuſed itſelf through the whole Body, the Breaſt, &c. are beſet with Catarrhs, the Ears have a Tinkling Noiſe, the Eyes grow dim, a Cough invades the Lungs, the Head is ſeized with Giddineſs, the Nerves and Muſcles are tortured with Pains not unlike thoſe of the Gout; and all this is the Effect of too hard drinking.

Qui vult alterius cyathis haurire ſalutem,
Ille lucrum referet, perdat ut ipſe ſuum.
Enſe cadunt multi, perimit ſed crapula plures,
Nec facit ad multos rapula multa dies.
[18]

The great Boerhaave directs, ‘"The Uſe of aromatic, bitter and antiſcorbutic Plants; lixivial fixed Salts in a ſmall Doſe, often repeated, and continued a a long Time; nouriſhing Meats and Drink, that are light and eaſy of Digeſtion; conſtant riding on Horſe-back in a pure and clear Air, with frequent Friction and Motion of the Parts; laſtly, going to bed early, and ſleeping late in the Morning*."’

The Reader may farther compare this with the Words of Doctor Wintringham in his before-mentioned Treatiſe: He may alſo ſee my Diſſertatio Medica de ſanitate ejuſque Conſervatione, where I have expreſsly wrote on Diet, and the Preſervation of Health.

Conſtant Exerciſe is directed by the noble Boerhaave, and very juſtly too; for Sloth is Sepulchre of the Living; to ſtand ſtill and be unactive is pernicious; if the Air ſtagnates it becomes peſtilential; if Water is without Motion, it ſoon is putrid and corrupt; if the Land is not cultivated it becomes Deſert and waſte; in like manner the Warrior laying aſide his Arms, Ruſt and Canker prey upon them; the Muſician too neglecting his Inſtrument, the Chords of Harmony decay and are uſeleſs; the Moth alſo makes his Inroads on our horded Garments: Thus ſings the Poet Ovid.

[19]
Cernis ut ignavium corrumpunt otia corpus;
Ut vitium capiunt, ni moveantur aquae.
Lib. ii. ELEG. vi.

What ſays the old Divine Hippocrates? Indolence moiſtens and renders the Body weak and flaccid; Labour and Induſtry throws off the ſuperfluous Juices, and makes it firm and robuſt.

The Diſeaſe of Drowſineſs and unſtable Judgment is the Offspring of Negligence and want of Care.

Always to ſit is bad, for the pancreatic Juice and Bile, which is a Balſam neceſſary to be mixed with the Chyle, is by this Inactivity precipitated in the ſmaller Inteſtines, hence ariſes a Cacochylia or bad State of Chyle; wherefore inſtead of a ſweet nutritious Chyle, an acid aquoſe Fluid enters the Lacteals.

Alſo the Ferment in the Stomach becomes acid, which afterwards changes whatever it receives into the ſame Acidity, after the manner of the Fermentation in making Bread (for a little Yeaſt being mingled with the Flour, &c. ſoon communicates the ſame Ferment to the whole Maſs.) Hence varirious Diſeaſes ariſe.

[20]

Blautus Palinurus * directs a Cappadocian (whoſe Blood had not a free Circulation) to walk, it being the beſt Remedy for the Spleen.

Agreeable to Boerhaave, every gouty Perſon ought to ride in a clear, but not a cold Air: As Chillineſs or Cold is the Forerunner of Mortality, thus a due Warmth ſhews the vital inteſtine Motion, that is ſo neceſſary to Life; for as long as we live, we muſt enjoy a more or leſs Degree of Heat: Cold is injurious to the Nerves as Euripides bears Teſtimony, where he ſays, [...], that is, Cold is very hurtful to a thin or lean habit of Body.

Hippocrates alſo takes notice, that thoſe who travel through Snow, or in extreme cold Weather, ſo as to have their Feet, Hands, &c. benumbed thereby, are much afflicted by their Approach to any ſudden Heat, and have intolerable Itchings, and that in ſome even Bliſters ariſe, like thoſe from a Burn, but this happens not till after they begin to grow warm.

Cold Bathing is prejudicial, for it produces a ſudden Hurry and Tumult to Nature, becauſe of the immediate Change from the warm Air into cold Water; thus the Perſpiration is in a Moment checked, and all the moiſt impure and ſaline Effluvia remaining [21]within the Pores, they putrify and inflame the whole Maſs of Blood, and ſo produce Fevers, Inflammations, Gout, &c. *

The Reaſon is that the Body undergoes a greater Alteration by Air from [...], (Tranſpiration) or Breathing of Vapours through the Pores, than from [...] (Inſpiration) or taking Air into the Lungs; hence an [...], or Obſtruction of the natural Perſpiration is the Mother of many Diſeaſes.

It is obſerved that many who labour under Fevers, &c. in the Spring, if they do not guard themſelves well againſt the Air, though they may eſcape Death, yet are ſubject to Relapſes.

Moreover, the ſick Man ſhould be early in Bed in the Evening, and late in the Morning, as Boerhaave obſerves; for Sleep is the beſt Specific in all Diſeaſes, it is a Secret in Medicine more valuable than Gems or precious Stones; and that Phyſician ought to be much eſteemed who can aſſiſt the Wants of Nature in this Reſpect, with Security and Advantage to the Sick. Sleep is Health to the Body, and a Refreſhment to [22]Nature, as neceſſary as our Meat and Drink: It is beautifully deſcribed in the following Lines of the Poet, viz.

Somne, quies rerum, placidiſſime ſomne Deorum,
Pax animi, quem cara fugit, tu pectora duris
Feſſa miniſteriis mulces reparaſque labori.
Quod caret alternâ requie durabile non eſt;
Hic reparat vires feſſaque membra levat.

Doctor Young, in his Night Thoughts, ſpeaking of Sleep, calls it*

Man's rich Reſtorative; his balmy Bath,
That ſupples, lubricates, and keps in play,
The various Movements of this nice Machine,
Which asks ſuch frequent Periods of Repair.
When tir'd with vain Rotations of the Day;
Sleep winds us up for the ſucceding Dawn;
Freſh we ſpin on, till Sickneſs clogs our Wheels,
Or Death quite breaks the Spring, and Motion ends.
[23]

Secondly, He muſt every Morning rub well the gouty Parts, eſpecially about the Joints, with a Flannel full of the Smoak from a Suffimugation, which is made by a Powder ſprinkled on live Coals for that Uſe; and take one Drachm of an Arcanum antipodagricum reformatum, three Times a Day (when the Stomach is moſt empty) drinking after it a Draught or two of medicated Drink.

The gouty Subject muſt regularly continue this Courſe of Medicine for a ſhort Time, carefully keeping to a good Regimen of Diet, and duly obſerving the enſuing Verſe.

Si vis incolumen, ſi vis te reddere ſanum,
Curas tolle graves, iraſci crede profanum,
Parce Mero, caenato parum, non ſit tibi vanum,
Surge poſt epulas, ſomnum fuge meridianum,
Nec mictum retine, nec comprime fortiter anum
Haec bene ſi ſerves, in longo tempore vives.

If he will indulge me thus far; then I dare promiſe a compleat and certain Cure.

FINIS.

Appendix A ERRATUM.

Page 16. Line 1. for Dops read Drops.

Notes
*
Tractatus de Podagra, in 8vo.
*
Hippoc. Sect. vi. Aphoriſm 55.
Herm. Boerhaave Aphoriſ. 1254-61, &c.
*
Cap. iv. See alſo De Gorter's Commentary in his Medicina Hippocratica on Hipp. Sect. vi. Aphoriſm 55.
*
H. Boerh. Aphoriſm. 1262-63.
To wit, Air, Meat and Drink, Sleep and Watching, Motion and Reſt, Retention and Excretion, and the Paſſions of the Mind.
In our Days this holds not good. But pray, can we find no Reaſon for this?

Creſcentibus delictis creſcunt paenae.

Frigora, Vina, Venus podagrant corpora noſtra.

*
Hipp. Sect. vi. Aph. 28, 29, and 30.

H. Boerhaave Aphoriſm. 1268.

H. Boerhaave Aphoriſm. 1269.

*
The celebrated John De Gorter (late Profeſſor at Harderwych, but at preſent of Peterſburg) obſerves in his Chirurgia Repurgata (Lib. ii. Cap. ii. Par. 205.) That the Tophi or Nodes, in the Lues venerea, are to be treated in the ſame manner, as a Caries or Rottenneſs of the Bones; but that no Remedy has been given for the gouty Tophi: There is good Reaſon in what this worthy Man mentions, for Ointments, Emplaſters, &c. externally applyed, do nothing; it being neceſſary, firſt to remove the Cauſe, and then the Tophi will ſpontaneouſly diſappear.
*
Herm. Boerhaave Aphoriſm. 1270.
*
Herm. Boerhaave Aph. 1271.
*
Herm. Boerhaave Aphoriſm 1281.
*
Encyclop. Med. p. 244.
*
Herm. Boerh. Aphoriſm 1275.
Rolfinck Meth. Med. Spec. Praef. ad lect. in princip.
*
In Curcurl. Act. 11. p. 167.
*
Concerning the Diſadvantages of Cold Bathing. See Oration. D. Weſſerhauſen de Diaeta ſtud. ſ. 8. p. 5. it. Zeil. Handb. p. 11. p. 404. Zacut. Lucit. H. Ephem. Germ. An. 1. Obſ. 84. Dol. d. 1. p. 190.
Croll. Baſil. Chym. p. 305.
*
Night the 9th. Page 373.
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