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.]
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.
THE learned Dr.
Wintringham,
in the Introduction to his Treatise on the GOUT
Tractatus de Podagra,
in
8vo.
, 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.
T HE
Gout
is a tensive and lacerating Pain about the Joints, chiefly returning in
Hippoc.
Sect. vi. Aphorism 55.
Spring and Autumn, arising from an Obstruction in the nervous Vessels and Acrimony of the Fluids; whence Redness, Swelling, and chalky Concretions
Herm. Boerhaave
Aphoris. 1254-61,
&c.
. 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
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 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
Cap. iv. See also
De Gorter
's Commentary in his
Medicina Hippocratica
on
Hipp.
Sect. vi. Aphorism 55.
.
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.
Secondly,
From an Acrimony and Tenacity of the Fluids
H. Boerh.
Aphorism. 1262-63.
.
Hence every Fault committed in the
Non-naturals
To wit, Air, Meat and Drink, Sleep and Watching, Motion and Rest, Retention and Excretion, and the Passions of the Mind.
(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 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.
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.
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
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.
are free from it unless their natural Courses are deficient:"
And further,
"That Youth have it not before they Use Venery
Hipp.
Sect. vi. Aph. 28, 29, and 30.
H. Boerhaave
Aphorism. 1268.
H. Boerhaave
Aphorism. 1269.
."
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 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
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.
.
Now to the Method of treating this Disease.
Herm. Boerhaave
Aphorism. 1270.
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; 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
Herm. Boerhaave
Aph. 1271.
, 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 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.
Herm. Boerhaave
Aphorism 1281.
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.
Esto pius Domino, sobrius tibi, justus in omnes,
Ista tria animae causa salutis erit.
The celebrated
Dolaeus
writ well on this Head
Encyclop. Med.
p. 244.
, 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.
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
Herm. Boerh.
Aphorism 1275.
."
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.
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
Rolfinck Meth. Med. Spec. Praef. ad lect. in princip.
.
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.
Blautus Palinurus
In
Curcurl.
Act. 11. p. 167.
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 within the Pores, they putrify and inflame the whole Mass of Blood, and so produce Fevers, Inflammations, Gout,
&c.
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.
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
Croll. Basil. Chym.
p. 305.
. Sleep is Health to the Body, and a Refreshment to 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
Night the 9th. Page 373.
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.
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.
ERRATUM.
Page 16. Line 1.
for
Dops
read
Drops.