DOLÆUS
Upon the CURE of the
GOUT
BY
MILK-DIET.
DOLÆUS
Upon the CURE of the
GOUT, &c.
CHAP. I.
Before I explain this Method of Cure, I would have my Reader take Notice, that he is not to expect any thing perfectly new: I only propose to confirm, by fresh Experience, what hath been long enough known. The Method of Cure here advanced consists in the proper Use of Milk for a Year and upwards. Many will perhaps wonder at my Endeavours to revive a Method so long known and exploded by Physicians, as hurtful to gouty Constitutions, and shortening the Period of Life itself: But being fully satisfied from Reason, and certain Experience, that this most excellent Remedy is the Gift of Providence, for the Relief of Persons afflicted with this cruel Distemper, I could not help drawing up and communicating my Experience and Observations for the Relief of others.
Cornelius Celsus, the celebrated Roman Physician, speaking of the Pains and Evil that gouty People suffer, tells us of some Persons who entirely avoided this Distemper by a strict Adherence to the Use of Asses Milk, and of others that by abstaining a whole Year from the Use of Wine and Women, were never afterwards troubled with it.
Among the Moderns, John George Grezzell hath wrote a very learned Treatise upon the Cure of the Gout by Milk, wherein many curious and useful Observations are delivered; that excellent Physician Dr. James Sacks hath inserted, in the German Ephemeris, a Method for the Use of Milk, communicated to him by a noble Baron, wherein many useful and elegant Observations, founded upon Experiment, are contained. The late learned Waldsmid hath published a learned Dissertation upon the Relief of gouty Persons by Milk, wherein he agrees with the Authors now mentioned as to the Cure. I have lately received a Letter from a French Gentleman my Friend, who having been for many Years afflicted in a most terrible Manner with the Gout, hath been now by the Use of Milk, free for some Years. From these Examples I had Occasion to admire the wonderful Effects of this Diet, and therefore advised it to many gouty Persons here at Cassell, who have all recovered a perfect State of Health, by a strict Adherence to the Regimen Necessary in the Use of this Remedy: Even some whose Limbs were before perfectly crippled, are now able to walk and exercise. Colonel Nicholas Dumont hath experienced the Efficacy of this Method here at Cassell, for his Limbs were so entirely contracted that he was forced to use Crutches, but having confined himself strictly to the Use of this Diet for an Year and an half, he walks very well without a Cane, and hath performed several Journies. I have been free from the Gout my self upwards of an Year, notwithstanding I had three or four Fits every Year for Sixteen foregoing. Colonel Haste hath been restored by the same Means, though he hath had some mild Returns at several Times.
I shall in the first Place communicate the Letter I just now mentioned; next I shall lay down the Rules Necessary to be observed in the Use of this Milk-Diet; I shall then demonstrate from undeniable Principles, that this Method is the most convenient to asswage and cure the Gout, and that no bad Consequences can attend the Constitution, if it be taken with the proper Regulations. The Letter is as Follows.
To Monsieur de Collet.
SIR,
Nothing can be more agreeable to me, than to satisfy the Desire of my Friends afflicted with the Gout, in communicating the Method of Diet, by which the Marquis de Bongi, Mons. Chamar, and my self were relieved from the Gout; you will please to take Notice, that the Milk we used was fresh drawn from the Cow, Morning and Evening, without other Art than that we both eat and supped it, as warm as we could well bear it; my Reason for mentioning eating and supping the Milk, is, because as soon as we arose in the Morning we supped a large Bowl of warm Milk; but the Milk which was brought us at Dinner and Supper, we eat with fine light Bread, cut thin and put therein; this is all our Secret in this Matter. Persons afflicted with the Gout may promise themselves Relief, provided that once a Month, during the Course of this Diet, or at least once in two Months, they take a gentle Purge, which we made Use of, and were so strict in our Regimen, that we neither drank Wine nor, eat other Food, than Biscuits made of very fine Flower, Eggs, and Sugar, and some sweet Fruits, as Strawberries in Summer, but we chiefly avoided Raspberries. For my own Part, I never sweetned my Milk with Sugar, though some Friends who were in the same Course did, yet without any bad Effect. The Marquis de Bongi used to mix Crabs Eyes with his Milk before Dinner, upon a Presumption, that it would prevent any Sourness in his Stomach, but neither Monsieur Chamar or I ever used that Remedy. When we had strictly adhered to this Diet for a Year, we began to hope we might eat Fish, or indulge our Appetites in some varieties of Food, which one or other of us did, more or less, occasionally, and without any bad Effects. At the End of Nine Months I apprehended my Stomach to be somewhat weakened, which made me resolve to use a Glass of Wine after my Milk, and accordingly after Dinner and Supper every Day, I drank one Glass of Wine, in which I sopped a bit of Bread; this was very delicious to me while I used it. At length as we found the State of our Healths to mend, we began to eat and drink with our Friends. This Method hath succeeded so well, that we live hitherto in our common Way upon Milk, yet not so strictly, but that we dine or sup, once, twice or thrice a Week with our Friends in their Manner, and return afterwards to our Milk without Ceremony; and by the Blessing of God we are wonderfully well. We dont here pretend to say, that none of us have been since afflicted with the Gout, for the Marquiss de Bongi hath had two or three pretty sharp Fits; but both he and I know the Difference between having two or three Fits in nine or ten Years, and of being perpetually oppressed, and confined to Bed with this cruel Distemper, which was our Case before; especially the Marquiss de Bongi, who at Six and Thirty was almost continually confined to his Bed, deprived of the Use of his Limbs, and the Joints of his Hands and Feet knotted and chalky; instead of which, he now uses his Limbs without any Marks of Infirmity, insomuch that any one who had seen him in his former bad State, and compares it with his present, would look on him as one raised from Death to Life. As for Monsieur Chamar, and my self, who are more advanced in Years, considering our Age, we are mighty well; ’tis true indeed that sometimes, as upon Changes of Weather, or of the Moon, we find (or at least we fancy so) that we have some Threatnings of Pain, especially about those Joints where the Gout used to ravage, but a little Exercise soon dissipates those Apprehensions.
It is now Seven Years, that Monsieur Chamar and I have adhered to this Diet, in all which Time we have neither of us been so far oppressed by the Gout, as to be confined to our Beds, or even to our Chambers, so much as one whole Day; notwithstanding before we fell into this Method (though we were not perpetually under actual Fits of the Gout) we had a continued Weakness in our Limbs, we walked very infirmly and with difficulty, and if we chanced to make a wrong Step, or to slip in walking, we suffered Extremity of Pain; our Case is now so far altered, that we walk as firm, as if we had never had the Gout. I must confess indeed that both the Marquiss and I used the Diet for a good while, before we perceived any manifest Change, but afterwards our Pain diminished by Degrees, and the Strength of our Limbs returned. The Milk must be used a good while, that the natural Temper and Vigour of the Constitution may have Time and Leisure to come to itself; for though this Diet may be often used Six Months or even Twelve before the Patient can use his Limbs free from Pain, yet let him not despair, for if once he begins to gather Strength, it will daily increase. As to Purging, and Evacuation of the Humours, if possible it should be done once a Month, in the Decrease of the Moon: I hold purging extremely Necessary; for my own Part, it was what I did for the first Seven or Eight Months of this Diet constantly, till I grew tired of it. This is truly the Method I used, and though I afterwards remitted, I found no bad Consequence. The Marquiss and I, at present, take a Bowl of Warm Milk every Morning, but for the Rest of the Day drink and eat as usual. The Marquiss indeed, for the Space of Eight Years, hath had at Times several small Fits of the Gout, but for my self I have hardly had any, except sometimes upon Changes of the Weather, or of the Moon, I have perceived a Numbness and Weakness in my Knees and Joints, like Threatenings of the Gout; but I thank God, it never confined me, and as it came on easily, it as easily went off. The following is the Method of purging: Take of Scammony, white Turbith, Hermodactyls, Leaves of Sena, Sarsaparilla, Cinamon, and Sugar, of each one Drachm, powder them very fine, and divide the whole into Seven equal Parts, one of which is a Dose, and may be taken in white wine or a little Broth. It is necessary to purge once a Month, especially in the Decline of the Moon. If it be thought necessary to purge twice in the Month, let the first Dose be taken in the last Quarter, the second the last Day of the Quarter. The Day I took Physick, I used Milk after it as usual. When I had pursued this Course about Seven or Eight Months, I found my Stomach so much weakened from the Milk, that I was forced to take a Glass of Red Wine every Day after Dinner, which agreed mighty well with me, and I have continued it ever since; so that I am often impatient to finish my Milk, that I may have the Pleasure of regaling my self with a Glass of Wine, and a bit of Bread.
CHAP. II.
In the foregoing Letter are contained many useful Observations about the Use of Milk, and its wonderful Efficacy in the Cure of the Gout, from uncontestable Facts, in the Account of the Persons there named. I shall next lay down the Method of this Diet, by which many Persons here at Cassell were relieved. Whoever expects Benefit by this Method, must observe the following Rules. No one ought to go into this Diet without having his Body duly prepared; he must take Care by Degrees to change his Habit, and for the first Month to regulate his Diet, by strictly avoiding all Salt or smoaked Meats; Legumes, and stale, acid or feculent Liquors, and to eat white Meats sparingly, with clear small Drink, as small Beer or Barley Water, or Decoctions of the Woods: A Glass of Moselle or French Wine free from Acidity, may be allowed at Dinner, and Gruels and Broths made of white Meats. There is a necessary Caution to be used, that both in Meat and Drink, the Quantity taken be rather within the Appetite than beyond it; for from overloading the digestive Powers, arise Crudities, Flatulencies, and acid Humours, which are the Origine of many Disorders. Upon this Account it is necessary to purge the Bowels, two or three Times a Month, with Tincture of Jalap, Elixir Proprietatis, Rhubarb, some of the purging Pills, as the Arthritick or Mastich Pills; that the Viscidity arising from indigestions may be carried forth of the Bowels, and the Stomach be better disposed to receive and digest the Milk. I am of Opinion, the first Dose should be taken the first Day of the Month, preparatory to this Diet, the second after some few Weeks of this first Regimen, and the third the last Day of the Month; after this I advice the taking an Ounce of Crabs-Eyes, or prepared calcined Hartshorn, especially if there yet remains any Marks of Acidity in the first Passages. This further Caution is very absolutely Necessary, that not only in the first Month, but in all subsequent, all Passion, chiefly Anger and Grief be avoided, because of their pernicious Consequences; more especially the Use of Women during the whole Year.
SECT. 2.
All those who have other Distempers complicated with the Gout, as the Scurvy, Leprosy, bad Habit of Body, Stone or Gravel, Hystericks, the Pox, or other Distemper arising from the Impurity of the Blood, too great a viscidity or acrimony of the Juices, or a known or latent Acid in the Blood, are first to use Absorbent, Diuretick, Sweetening or other Medicines, proper to their particular Distempers, till the Acrimony or Tenacity of the Blood and Humours be corrected, the Acid expelled, and such complicated Disorders overcome, and then apply this noble Remedy of a Milk-Diet to the Cure of the Gout alone, from which they may certainly promise themselves Success: But if while the Body is ill prepared, or full of vitiated Juices, the Milk-Diet should be preposterously brought into Use, they will not only be disappointed in their hopes of Relief, but bring certain Destruction, and Increase of their Disorders; as actually happened to the Count de Perlebourgh, and a Lubech Consul in this Neighbourhood, who having a Complication of Distempers, made an improper Trial of a Milk-Diet.
SECT. 3.
The Milk in which the Cure of the Gout consists, ought to be excellent in its Kind; the Animal from whence it is taken, as described by Waldsmid, should be an Heifer, or Cow of a middle Age, of a good Habit, either of Red or a Black Colour, (though this need not so strictly be minded) neither fat nor lean, nor pregnant, and kept separate from the Bull: In Winter fed upon good Hay, Barley, Bran or Straw; in Summer at good Grass, and led in a Collar like an Horse. If any one can keep a Cow for their own Use, it is best, and they may more safely rely upon help from it; but if not, the Milk as the Milkmen sell it will do; taking Care however that the Cow be of a good Habit, well fed, and not too old.
SECT. 4.
As to the Quality and Quantity of the Milk, it is to be observed, that as soon as it is milked it should be warmed, but not so as to boil it. Let the Vessel full of Milk be put into boiling Water, and when it is so hot as to be conveniently supped, or at least so warm as when it came from the Cow, let it be taken after the Manner of Tea or Coffee. The Times of taking ought to be, two Pints in the Morning, some four or Five Hours before Dinner, as much about Noon, and as much about Seven in the Evening; but the Quantity cannot be exactly determined, because the Weakness or Strength of the Stomach must give a Rule in this Case; or let so much be taken as the Stomach can bear without Inconvenience, and the Patient may increase the Quantity daily till he comes to about forty Ounces. If the Stomach be weak, he may take it in a smaller Quantity, four or five Times a Day; if four Times, let two of them serve for Dinner and Supper, with some of the finest wheaten Bread; and a Draught of Milk may be repeated every four Hours; if the Milk be taken at five Times, it may be so ordered as to let three Hours intervene; those who are of more robust Constitutions, may be content with three Meals of Milk a Day; and it will not be amiss to take every Morning a Dose of Crabs-Eyes, or some other absorbent Powder: I usually take about twelve or fourteen Ounces of Milk in the Morning, Twenty four Ounces with Wheat Bread at Noon, and about Twenty Ounces at Night, half with Bread, and the other half drank as common Drink. Some allow the Use of white Meats at Dinner, lessening the Quantities by Degrees, and making up the Deficiencies by Food of Milk and Eggs, so that by Degrees the Milk and Eggs are entirely substituted in the Place of the Flesh Meat, and then by diminishing the Eggs daily, Milk becomes entirely substituted for other Food: This Method seems to me, entirely agreeable to tender Constitutions, and such as dont well bear sudden Changes. Some who have strictly adhered to Milk for fourteen Weeks, have indulged in the Use of poached Eggs without Salt, Barley boiled in Milk, fresh Butter without Salt, Custard and other Milk Foods; and in Summer, some Kinds of Fruits, as Strawberries, Peaches, &c. tho’ in my Judgment improperly, especially such Fruits as are cold, or seem to have a latent Acid, or such as weaken the Bowels. On this Head it may be observed in general, that the less whatever be used for Food differs in its Nature from Milk, it may be more freely ventured upon in the Milk-Diet; but the Prudence and Care of the Physician is to be relied on, according to the Diversity of Circumstances that may happen in different Constitutions.
SECT. 5.
This Diet ought to be so long continued, until the whole gouty Matter be discharged forth of the Body, which is to be computed by the Degree and Length of the Distemper, and Observations upon the Cure in others. The longer it is continued, the more perfect Cure is to be expected; those that are over-run with the Distemper, are always to use it, others for an Year, and others for an Year and an half; some Persons who have, upon continuing it only for half an Year, thought themselves perfectly cured, and have returned too soon to their former Method of living, have so far exceeded, as to be seized again with the Gout, but returning to the Diet, have been cured; some more prudent, have continued the Diet for an Year, and then returned to their ordinary Manner of living by Degrees, always taking about sixteen Ounces or a Pint of Milk every Morning, and have thus for many Years been free. The best Time of Beginning the Diet is in the Spring, and that from the Beginning of May, to the End of April in the succeeding Year.
SECT. 6.
Some have in the Continuance of this Diet been seized with Oppressions and Difficulty of Breathing, Weakness in their Limbs, Coughs and Phlegm; but these Symptoms either vanish of themselves, or quickly give way to Elixir Proprietatis without an Acid, Spirit of Hartshorn succinated, Sal volatile oleosum, or any of the more fixed absorbent alkaline Medicines.
SECT. 7.
For those who are oppressed with an abundance of Humours, whose Bowels are full of Flatulencies, or are constipated, let them once in every Month or Six Weeks take a gentle Purge of Rhubarb, or of the Arthritick Pills, or half a Scruple of Pill Ruffi, or of Sylvius his Gum Pills: But if the Body be open, and the Milk passes too quickly through, it may suffice to take twenty Grains of Rhubarb; or if the Body be bound, take twenty Grains of Rhubarb in the first Draught of Milk, drinking the rest of the Quantity after it, or else in the Evening take twenty Drops of the Essence of Rhubarb with the Milk, and repeat it as often as there may be Occasion; but for the general, if it can be conveniently done, the purging Medicines should be used in the Decrease of the Moon.
SECT. 8.
If the Milk should occasion a Looseness, let it boil before it is used, adding a Grain of Salt and so supping it hot; if it do not succeed the first Time, try it a second Time, and a third; but if it doth not do then, take a Dose of Crabs-Eyes, Unicornu fossile, or Terra sigillata.
SECT. 9.
If the Milk should heat the Body, let a third Part of Barley Water, made with Raisins, be added to it; or if it occasion Thirst at any Time, Barley Water with Raisins; or in case of a Cough, the pectoral Decoction may be used between the Intervals of using the Milk.
SECT. 10.
If the Stomach be weakened by the Use of the Milk, the Patient may be allowed Sugar Biscuits, sopped in Spanish, Italian or Burgundy Wine, or any other that is neither Acid nor Foul; and if necessary, even a Glass of those Wines: Thus the Stomach will be fortified, and more easily perform its Office; if there should be a Necessity for it, some of the warm aromatic Powders may be brought into Use.
SECT. 11.
After this Diet hath been used twelve or fourteen Months, the Patient may begin to use Flesh Meats of easy Digestion, avoiding sharp, acid or salt Meats, but using such as we mentioned before, drinking Milk still, or small Beer well wrought, neither stale nor turbid.
SECT. 12.
The Cure being thus absolutely finished, it will be still necessary to take every Morning a Pint of warm Milk, and to be constantly cautious about your Diet, avoiding every thing acid or sharp.
SECT. 13.
To prevent the Milk from cruddling, some Sugar may be mixed with it, or even a little Salt, thus the Acid is prevented from gathering; but this should be done but seldom, and upon the most urgent Necessity.
SECT. 14.
Though there should not follow an immediate or sensible Change upon the Use of the Milk for some Time, yet the Patient ought not to be disheartned; for if these Rules be strictly observed, and the Patient be otherwise in a good Habit, the Pains will vanish by Degrees, and a due Strength and Tone return to the Limbs.
CHAP. III.
I Have now delivered the Directions I proposed, partly from the Authors before-mentioned, and partly from my own Experience; by a due Observation of which many Persons have been perfectly relieved from this grievous Distemper; of which I shall give some Examples. D. Sorbait, p. 741, tells us, that he knew several Persons, by the Use of the Milk-Diet, either perfectly cured, or their Gout so much overcome, that their Pains were dwindled to nothing. John Pilus, the Emperour’s Surgeon told me, that tho’ he frequently had Fits of the Gout, and almost lost the Use of his Limbs, so that he was in a very miserable Condition, yet for these three Years past, by the Help of this Diet, he hath been perfectly free from Pain, his Countenance is now become fresh and healthy, he hath had several Children, and appears as if he were born a-new. Count Coningseck, his Imperial Majesty’s Counsellour, found the same Benefit by this Diet; and Count S. Hillario of the Emperour’s Bed-Chamber; several others, who were almost worn out with the Gout, grown pale and wan, have in a manner become young and florid again by this Diet. The Bishop of Wallendorf, tho’ quite impotent by the Gout, was cured by Milk. Three noble French Refugees, the Marquess de Bongi, Monsieur de Chamar, and the Counsellour de Talo, have been now many Years free from the Gout, as appears by the Letter before inserted. I am told that a Consul, and several others at Hambourgh, are now using this Diet with Success. A Counsellour of Oldenbourgh, the Sieur Van Velden, hath used this Diet this last Winter with very wonderful Success; for tho’ he could neither use his Hands nor Feet, he uses both now readily and perfectly well. A Miner here in the Neighbourhood hath used Milk for these six Months past with great Benefit; he was almost a cripple, but now walks very well to the Mines. All the World knows that the famous Prince of Conde was cured of the Gout in France by Milk-Diet. There are two Citizens of Hambourgh, one of which, tho’ he hath had the Gout fifteen Years, is well recovered by the Use of Milk, and the Knots in his Joints are quite wore away. Colonel Haste hath used Milk for six Months, and been free from the Gout; and tho’ he hath left off the Use of it, the Fits are much easier than before. There is no Occasion to multiply Examples; many more may be found in Sorbait, Sacks, Greizel, Waldsmid, Authors already named. I have experienced the great Benefit of this Diet in myself; I was so cruelly handled by this Distemper, that I almost lost the Use of my Limbs, and at last had a Fit every Month or Six Weeks; I was at the same Time violently afflicted with the Stone, and difficulty of Urine; but now that I have confined myself to this Diet for an Year and upwards, I have not only been free from any Fit in that Time, but the Strength of my Limbs is returned, the Dysury is abated; and what is wonderful, the Stone in my Bladder is lessened and dissolving, so that I now hope I shall get the better of the Gout, having been in a manner free from it an Year and an half; I have had some Fits indeed, but very mild ones. I take Milk to be a Medicine beyond any yet discovered for the Stone, since within the Space of one Year, the Stone in my Bladder diminished an Ounce, as I judge from the Bits I have voided and collected in that Time; and since I have left off the Cure, I have not voided one Bit. I am of Opinion, contrary to most Physicians, that Milk doth not breed the Stone in the Bladder, but only a viscid kind of Phlegm in that or any other Part.
SECT. 2.
These Things premised, I shall next examine how it comes to pass that Milk is endued with this mighty Power; but it is necessary first to enquire concerning the genuine Cause of the Gout. All the Symptoms testify the first and nearest Cause to be some viscid, sharp Liquor, endued with some acid or lixivial corrosive Salt, more or less fixed; this Salt indeed occasions such a singular smart Pain, that it seems to be specifick. I think it not only acid, but also somewhat austere, from the different earthy, cheesy Particles it contains. Hence it fixes its sharp stiff Points in the Membranes, Tendons and Nerves, and more readily thickens and coagulates the lymphatick Juices. Where and how this Liquor that causes the Gout is generated, I shall explain in a few Words. First then the Stomach and Bowels, whether from too great an use of Wine or Women, or from too sedentary a Life, and want of due Exercise, or from the particular Disposition of the stomachick Juices, or from bad Diet, become so affected, that by Degrees the Digestion or Dissolution of the Food is lessened; the Chyle thence produced, becomes more thick and viscid than formerly; so that this Chyle, thus delivered into the Blood, renders its Mass thicker, and of Consequence the several Secretions of the Humours, as the Lymph, animal Spirits, the mucilaginous Juices about the Joints are more slowly performed; thus the Stomach and Bowels become more tainted, the stomachick Juices and those separated by the Glands of the Intestines become more viscid, and the Difficulty of Digestion is increased; Part of the Food turns to Flatulency, and viscid sharp Slime in the Bowels; Part of the Chyle becomes infected with a corrosive acid Salt thence produced, and being again thrown into the Blood, the Lymph and other Juices become infected with the same acid Salt, which gives Birth to many Distempers. It is observable these viscid Juices, thus stopped in their Progress, and infected with this noxious Salt, so as to be more liable to an intestine than a progressive Motion, are the most subject to Corruption of any in the Body, and to contract a Thickness, and Inaptitude to Motion. Such an Humour is the Lymph, and more especially the mucilaginous Juice separated in the Glands of the Joints, in order to keep them moist and smooth for Motion. If therefore a sufficient Quantity of these acid Salts be brought into the Mass of the Blood, or the Humours impregnated with them, be lodged about the nervous or tendinous Membranes, and there acquire so extraordinary a Tenacity or Sharpness, as to be coagulated, the Gout thence arises, as is evident both from Reason and Experience. That this may more evidently appear, I shall next explain the Figure, Situation and Structure of these Glands.
SECT. 3.
These Glands, as described by Dr. Havers in his new Osteology, and as they discover themselves upon Dissection, are of two Kinds; some are small and thickly interspersed in the Membranes of the Joints, and with very few Exceptions of an equal Bigness, so as to render the Membrane perfectly Glandulous: In some Parts of the Membrane, in the Joints, and in the Furrows of the Bone, these Glands are so united as to form very remarkable and large conglomerate Glands. In some of the large Joints there is but one, as in the Hip Joint; in others, as in the Knee, four or five; they are of a red Colour, which is communicated from the blood Vessels; as to their Substance, soft and papillary, tho’ not tender and friable; they are in their Structure Conglomerate, consisting of divers Membranes, wove one within another, interspersed with small round Vesicles, which are not only contiguous, but adhere closely one to another, as the Membranes also do. By the Pores of these little Vesicles a mucilaginous Liquor is strained and secerned from the general Mass of the arterial Blood, and thence by the excretory Duct, with which all these Glands are furnished, is shed into the Interstices of all the Joints.
SECT. 4.
These Glands have a sufficient Number of blood Vessels, they dont come out of them in right Lines, but are observed to have many Convolutions, Windings, and Insertions; there seems to be a very particular Reason, from the Nature of the Liquor to be separated, for this Obliquity of the blood Vessels; for since that Liquor is to be viscid and mucilaginous, its Parts should proceed slowly, and not without Difficulty, through the glandulary Pores; and therefore the Vessels are contorted in the Manner we see, that the Motion of the Blood may be retarded, and more Time and Leizure given, both for the separating Particles of such a Nature, and for their Admission through the Pores of the Glands.
SECT. 5.
These Glands are of different Shapes, so as to fit the Furrows and Cavities where they are placed; some are long, others conical, broad at their Base and grow narrow towards the Top, so as to terminate in an Edge; some have a broad Base, and rise into a sort of Cone; some are like little Ridges; some like Fringe; some are broad and pretty flat.
SECT. 6.
As to their Situation, they are differently seated in the several Joints; in some they stand over-against the very Interstice of the Bones, and run in a little way between them, where the Ends of the Bones towards that Side are not contiguous, but so formed as in their Conjunction to make an Interstice, and these are commonly in the Manner of a Fringe; some are seated in some Sinus or Cavity, others planted upon the Membrane, which immediately covers the Articulation: In general they are so seated, that they cannot be injured by a Compression from the Bones; and yet there is this Contrivance, that the Bone does, either in the Inflexion or Extension of the Joint, lightly press upon them, so as to promote the Excretion of the Humour, which they separate into the Joints, when they are moved and stand most in need of it; and by this Means it seems to be most plentifully supplied, when there is occasion for the greatest Quantity of it, and to be proportioned to the present Exigence, according to the State of Rest, or the several Degrees of Motion in the Part when it is moved. And it is no small Security to these Glands, against the Obstructions which the mucilaginous Quality of the Liquor that they separate does naturally dispose them to, that they are solicited, and the Liquor expressed out of them by the Motion of the Parts where they are seated: The same sort of Glands are placed about the common Membrane of the Muscles, and about the Tendons.
SECT. 7.
The Liquor that is separated from these Glands is a Mucilage, not unlike the White of an Egg, tho’ not always so clear and pellucid; when pure it is very like it. In some Animals it is of a Colour inclining to Yellow, and is composed of watry, saline and slimy Particles; it is supposed that the earthy Particles may be about a two and thirtieth Part. The Nature of this Mucilage seems nearly to approach to that of the Serum of the Blood, separated from the grumous Part upon being exposed to the Air, and exhibit much the same Appearances upon Trials by Mixture with other Bodies, only the Serum is not so mucilaginous. The Serum is coagulated upon being mixed with Spirit or Oyl of Vitriol, Spirit of Salt, Oyl of Sulphur, and other acid Spirits. The Serum, upon being held in a Spoon over the Fire, becomes a thick Jelly, and at length a sort of friable Glew; on the contrary, the Mucilage grows thinner, upon the same Application, throws up a slight thin Film at Top, and produces but a slight Coagulum. After the aqueous Parts are evaporated, there remains scarce a thirtieth Part of the whole Mass.
SECT. 8.
The principal Use of this Mucilage is to lubricate the Joints, and to render and preserve the Extremities of the Bones, at their Articulations, smooth and supple, for the easy Performance of animal Motion. Besides this mucilaginous Liquor from these Glands, there is an oily medullary kind of Substance transmitted through the very Bone into the Cavity of the Joints: These two Liquors are mixed by the Motion of the Joints, the Mucilage contributes to make the Oyl more slimy, and the Oyl preserves the Mucilage from stiffening into a Jelly. This Mucilage further serves to prevent the Extremities of the Joints from being burnt up in the Gout. In the same Manner the Muscles and Tendons are lubricated and kept in Vigour by the Liquor supplied from the same kind of Glands placed on their Membranes.
SECT. 9.
This Mucilage is formed from the purer Part of the Lymph and the serous Parts of the Blood, and separated in these Glands from the Mass of the Blood. In order to have a more distinct Notion of its constituent Parts, and to know how it comes to occasion the Gout, the following Experiments of Dr. Havers may be very properly repeated in this Place. He made most of the Trials both when it was hot and when it was cold. Vinegar dropt into it, when it was hot, made a considerable Coagulation with a Serum; it must be observed that those Mixtures that were made with it cold, did produce the same Effect when it was warmed, namely a Coagulation with Acids and Stypticks, only in an higher Degree: And whereas the Coagulations, which were made when it was in one State, did only change it into a thick Jelly without any Serum, after the Manner of a Cheese when it is newly set, as they term it, which over the Fire afterwards exhibited two distinct Parts, a Coagulum and a Whey; in the other, that is, when the Mucilage was hot, the Mixtures which coagulated it produced an harder Curd, and a Serum distinct from it. By dropping in some of the Decoction of Galls into it, the whole turned into a gelatinous Mass, and it was all a Sort of Coagulum like a Skin, of a whitish Colour, and so tough as to hang all together when it was taken up with a Needle. This Coagulum or Jelly being laid in the Sun, and dried, the Parts of it stuck all together in one Piece, but was very friable and easily rubbed to a Powder, which was very much like fine Flower. The same Effect had the strong Infusion of Balaustia, red Roses, Pomegranate Bark, and the Peruvian Bark, although there was some Difference in the Coagulation, according to the different Degrees of their Astringency. With a few Drops of Aqua Fortis distilled upon it, the Mucilage was immediately coagulated, though the Coagulum, which was white, was so tender, that it would by Agitation be dissolved in fair Water, and make it of the same Colour almost like Milk; Spirit of Nitre made exactly the same Alteration in it as Aqua Fortis did, a Coagulum which was of a white Colour. Vinegar, Spirit of Salt of Vitriol, Oyl of Vitriol, and of Sulphur in some Mucilage which I tried it with, did not make any considerable Alteration when it was cold, but in some other it did more; when Aqua Fortis and Spirit of Nitre did produce in all the same Effects in the same Degree. It was mighty observable, that so strong an Acid as Oyl of Vitriol should have no greater Effect upon it to alter it not, so considerable as that of Vinegar, which would incline one to think that it is not always the high Degree of Acidity that works this Change. But there seems to be something particular in Wines, which disposes them to coagulate this Liquor, when any of them are made Use of; and those Parts of them, which are apt to act thus upon it, are cast into those Interstices where they have the Mucilage singly to work upon. And therefore we find how readily any Wines do procure the Paroxysms of the Gout, where the Tone of the Glands is weakned, and the Patient hath a Disposition to this Distemper; which agrees with those Trials I have made with some of them: For Claret, white Wine, and even Sack, but the Claret especially, did make a Coagulum like a Jelly; and it was not strange that Claret, which hath both an Acid and a Stypticity in it, should produce the greatest Coagulation. A mercurial Water made of Sublimate and Aqua Calcis, made a very considerable whitish Coagulation, and rendred it all a thick Jelly, which being held over the Fire, turned to a Curd and a Serum. A Solution of Roman Vitriol produced a Coagulation likewise; so did Allum dissolved in Water, but it made a greater Alteration in some than it did in others, though the Mucilages were taken from subjects of the same Species. Saccharum Saturni did inspissate it, which appeared to be a true Coagulation, because with the Fire they would turn to a distinct Coagulum and Serum. Salt of Wormwood made no sensible Alteration, only it seemed a little thicker, to which I put some of the Decoction of Galls, which immediately produced a Coagulation. Upon dropping in some Spirit of Vitriol, to see what would be the Effect of the Colluctation of the Salt and Spirit, and I found, after it was over, that the Coagulum and the serous Part were distinguished, and the Serum limpid like Water. I took some of the Decoction of Galls, and added to it Spirit of Vitriol, intending to make a strong Acid austere, where I observed that these two by themselves produced a strong Coagulation; and stirring of them together, to see if the whole might not be brought to mix by that Means, I found the Coagulum turned into a viscous Body, and a perfect soft Gum. Then I took out the Gum, and poured some Mucilage to the residuous Liquor, by which it was changed so as to assume a whitish Colour, but was not considerably coagulated; which it was the less, because the austere Parts were most of them, with some of the Acid, precipitated into the Gum which had been separated from the serous Part. But if the Spirit of Vitriol and the Mucilage are first mixed, and the austere Liquor be afterwards added, they make a very considerable and plentiful Coagulum, which will only be broken into smaller Parts, and not be dissolved in Water. Aqua Fortis, and the Decoction of Galls being both dropt into some of the Mucilage, made a white Coagulum, which likewise was not dissolved in Water, altho’ with oleum Tartari per Deliquium, and so with Spirit of Sal Ammoniac dropt into it, I presently dissolved it. I found likewise, that the Coagulum made with the Infusion of Pomegranate Peel, red Roses and Balaustia, being mixed with some of the Mucilage, to which an Acid had been put, made the Coagulum more firm, so that it would not dissolve in fair Water; but yet the Oyl of Tartar by Deliquium, and the Spirit of Sal Ammoniac, did the Business in all of them. The Coagulum of the Mucilage made with an Acid, and the Infusion of the Peruvian Bark and several other Astringents, I kept and dried, which when they were first put to the Teeth, seemed a little gritty, though after they were moist they were of a softer Nature. All the Mixtures made of the Mucilage with an Acid and an Austere, produced not only a plentiful Coagulation of a white Colour, but such a one as was of a thicker Consistence, and not Soluble in fair Water, as that was which was made with an Acid only.
CHAP. IV.
It is now proper to apply what hath been hitherto delivered, to the Distemper we are treating of, that from thence the Powers of Milk in the Cure may more clearly appear. We have shewed before how the Mass of the Blood becomes impregnated with a saline Acrimony, more or less Acid, from a sharp and indigested Chyle, and the Powers of Digestion weakned and impaired; whence is easily explained how the Lymph and acrid Serum is communicated to the mucilaginous Glands, and the smallest Branches of the Arteries, so as to infect and coagulate the Mucilage, in Proportion to the Quantity of Salts they contain. The Fibres of the Membranes and Tendons are vellicated by the Acrimony of those Salts, so as to occasion intolerable Pain, and affect the Nerves to a very great Degree.
SECT. 2.
From the Diversity of Pains and other Symptoms in the Gout, it appears that these saline Particles are sometimes salt and pungent, sometimes more volatile, sharp and burning. That the mucilaginous Humour is frequently acid and corrosive in the Gout, appears from hence, that this Liquor is neither so easily coagulated, nor acquires so great a Degree of Viscidity by any other Mixture as with austere Acids, and from the Obstinacy and Duration of the Pain. It is frequently observed, that upon the Approach of a Fit, People complain of sowre Belchings, Wind, and vomit acid Humours, so that hypochondriac People, and such as are subject to the Gravel, are most apt to be seized with this Distemper; this may afford a good Reason why not only the drinking of acid Wines bring on a Fit in gouty Persons, but originally occasion the Gout in such Persons as frequently drink them. The Mixture of Wine with the Mucilage plainly evinces, that the acid Particles of the Wine give a Disposition to the Distemper, for it caused a greater Coagulation of the Mucilage than Oyl of Vitriol, whence easily appears what Mischief it may do to gouty Persons.
SECT. 3.
How this sharp acid Humour comes to be secerned in the Glands, seems to want Explanation, and this I judge to be in the following Manner. The Blood being first imbued with a sufficient Quantity of these saline heterogeneous Particles, which it receives from the corrupted Chyle, is by Degrees disturbed in its Motion, and the Fibres of the Nerves begin to be sensibly irritated, so as to cause irregular Motions of the animal Spirits. The Blood itself is thickned, because these saline and viscid Particles get into the small Ramifications of the Arteries, and occasion Obstructions there; by this Means the natural Functions and Secretions of the Humours, especially in the Glands, are disturbed, and proceed slower; and accordingly for some Time before the Fit, we find Complaints of Crudities in the Stomach, a swelling and Heaviness of Body, and Weakness and Numbness of the Limbs, which increase daily till the Fit is formed. At length the Blood, by continued Irritations, being put into more violent Motions, drives these saline heterogeneous viscid Particles through the obstructed Capillaries into the glandular Vesicles, whence without doubt the Juices there secerned, especially that of which we are speaking, viz. the Mucilage in the Glands in and about the Joints, is not only plentifully stored with these acid corrosive Salts, becomes more viscid and ropy, but also very corrosive and poignant; and while it irritates and corrodes the adjoining Membranes and Tendons, not only causes violent Pains, but also since by the Contraction of the Nerves the Blood cannot move so freely through the smallest Vessels, the Fibres are distended, and an inflammatory Tumor frequently succeeds.
SECT. 4.
The Reason why the Gout affects particularly the Hands and Feet, and not all the Joints together, where Glands of the same Nature are placed, seems to be this: The Blood vitiated in the Manner before explained, propelling these saline Parts into the Pores of the Glands, from the inequality of its Motion in the Time of a Fit, does not impel those Salts with an equable Force, but chiefly into such Parts (especially the Feet and other pendulous Members) where the Pressure and Impulse lies heaviest; so dilates the Cavities of the smallest Canals, till at length it deposits Part of such Salts, with other viscid Humours, upon those Glands. Thus being partly freed from those Salts, the Gout does not seize other Parts with the same Violence; for frequently a large Quantity of such vitiated Humours are secerned by Urine, Sweat, and other more open Passages; and it even often happens, that Persons whose Juices are much corrupted, have avoided the Distemper by the Laxity and Openness of their Vessels; yet these very Persons, when the Blood becomes oppressed by these saline Particles in so great Degree, as not to be readily discharged by the larger Passages, they affect the Mucilage in the Glands and occasion the Gout.
SECT. 5.
That this Distemper comes by Fits, appears owing to this, that upon the Approach of a Fit much of the morbifick Matter is thrown upon the Glands by the Blood, so that the Blood thus freed from sharp and viscid Particles, moves easier and freer, till such Time as a sufficient Quantity of morbifick Matter is again generated in the Blood; which by separating again, a viscid and sharp Mucilage, the Symptoms of the Gout, are repeated in another Fit. The feverish Chilliness and Shivering that attends the Gout, is to be accounted for from the irregular Motion of the Blood, occasioned by the Salt and viscid Particles; and it is very likely that those very Salts themselves, irritating the Nerves, and occasioning inordinate and violent Motions of the animal Spirits, contribute to such a Fever; this Sharpness of the Blood, while the Salts are thrown forth by Urine or Sweat, remits till the Blood be again infected. We observe that the Gout often prevents other Distempers; for by this Expulsion of the corrupted Parts from the Blood, Distempers which might have arisen from them are prevented.
SECT. 6.
Because there is a great Difference made between the fixed and wandering Gout, I shall observe a few Things thereon. As to the wandering Gout, it is observable that the Mucilage of the Glands is often very differently affected from the viscid and saline Particles of the Blood; sometimes these Particles are mixed in different Quantities with the Mucilage, neither have the Salts at all Times the same Degree of Volatility or Fixity; so that the Mucilage may at some Times be only lightly infected, and the Infection be more Volatile, and consequently it may easily move from one Joint to another, or attack many Joints at a Time. The Points of the Salts are in a Manner lixiviated, become more volatilized, and of Consequence are with more ease protruded from the Blood into the Glands, and render the mucilaginous Juices sharper; whence the nervous Membranes are irritated and distended, and the gouty Pain generated.
SECT. 7.
The Reason why this morbid Matter is not long fixed in a Place, but is apt to wander from one Joint to another, I take to be this: These saline volatile Particles, when their intestine Motions are increased, are very easily dissipated, either through the Pores of the Skin in sensible Transpiration and Sweat, or by insensible Perspiration, and so the Pain ceases; other Glands, whose Pores are more open to receive this acrid volatile Matter, are for the like Reasons infected, the same Tragedy repeated, and the Particles in like manner dissipated. This is the Reason why the Pains in the Gout are not fixed and permanent, but rather wandring and uncertain, the morbid Particles being attenuated, and pushing to get forth by the Methods now mentioned, vellicate the Nerves in various Directions. It may be further considered, that when by the smallness of the Pores or glandulous Vessels, or any other Disposition, the morbifick Matter cannot be separated from them in sufficient Quantity, and the Secretion once begun is stopped, it recurs to other Glands of the same kind, and thus the morbid Matter is suddenly translated from one Joint to another, and from one Sett of Glands to others, so as to produce this Effect.
SECT. 8.
As to the fixed Gout, where the morbid Matter remains long in a Place, I take it that many acid Salts and viscid Humours contained in the Blood, occasion a greater Coagulation and Viscidity in the Mucilage about the Joints and the Tendons, than can be easily dispersed and evacuated; and on the contrary growing more viscid and sharp, it distends and vellicates the small Fibres of the Tendons and nervous Membranes, and occasions a Pain proportional to the Degree of Acrimony and Viscidity in the Mucilage about the Joints and Tendons, generally pretty sharp. The Mucilage is affected in the same Manner as it would be from the Affusion of Aqua Fortis, Spirit of Vitriol, or any other corrosive acid or austere Substance, whence it is manifestly thickned and coagulated. This affords a Reason why such a Gout is not only fixed in a particular Limb, but also why it long remains there. The ingenious Dr. Havers explains this Matter very well; he tells us that when the Matter happens to be thick and gelatinous, it is not to be expected that it should be easily and presently discharged out of the Interstices of the Joints, either by being resorbed or evaporated, when the Consistence of it renders it uncapable of insinuating itself into the minute Pores, and penetrating those narrow Avenues through which it is to pass. And according to the Degree and Nature of the Acid in the morbific Humour, it doth more or less coagulate the Mucilage, and the Part affected is sooner or later, with more or less Difficulty, freed from it, either by the Translation of it to another, or by the more happy Exclusion of it out of the Body. The same Author very elegantly explains the Cause of the Knots in the Joints, where he says that it seems to be no difficult Thing to account for that tophaceous Matter, which is sometimes found concreted in those Parts that have been afflicted with this Distemper. It hath been observed, that an Acid and an Austere, being both mixed with the Mucilage, did produce a plain, a notable and white Coagulation, where the Coagulum, though it was made when the Mucilage was cold, was not so soft and tender, nor dissolvable in Water like that which was made with Acids only; but though it would break, remained distinct in it, and being dried, was easily reducible to a fine Powder like Flower, or the fine Powder of Chalk. Whence he humbly conceives, that where-ever the Gout comes to be nodose, there is not only an Acidity in the preternatural Humour, which is separated by the mucilaginous Glands, and mixed with the Mucilage; but it is an Acid austere, which is no sooner thrown into the Interstices of the Joints and the Sinuses of the Tendons which are thereabout, but it produces a Coagulum in the Mucilage, and that such a one as is not easily attenuated and dissolved, so that it lies fixed and imprisoned there, and in Time, as the aqueous and moist Particles are by the Heat and Spirits carried off, the terrestrial and saline Parts concentrated come nearer together, and coming to be immediately contiguous, do mutually adhere, and are concreted so as to produce that Chalk or tophaceous Matter which is in some arthritick Cases to be observed. And as the Coagulum, which may be made by an Acid austere, seems apt to make a Concretion of that nature, so the Colour of the tophaceous Matter doth answer to that of this Coagulation, so as to seem generated in this Manner.
SECT. 9.
The same Author explains the Reason why the Hands and Feet are most subject to this Disorder. In the Hands, as was shewn before, there not only are considerable Glands in all their Joints, but the Tendons which are there inserted, especially those of the Musculi perforantes, have their mucilaginous Glands, so that Nature hath a convenience in these Parts to depurate the Mass of Blood, and they must receive the morbifick Matter, when the Blood in its Circulation obtrudes it upon them, and the Glands are disposed to separate it. The same Thing may be observed of the Shoulder and of the Knees. But of all the Parts none are so frequently afflicted with this Disease as the Feet, and it is plain why they are so. For besides, that they have many mucilaginous Glands in their Joints, and others about the Tendons which are inserted into their Bones, as the great Chord or Tendon of the Muscles which extend the Foot, and those of the Perforantes; I say besides this, they are the inferior and pendulous Parts, so that as their Glands make them capable of entertaining, so their Situation does conspire with the Effort of Nature, to bring down the morbifick Matter into them. Thus far Dr. Havers, whom I have chosen to quote, because he hath exceeded all Authors in treating of the Nature of this Distemper. It is not necessary to add any more upon this Head. What I have omitted for Brevity’s Sake, the Reader may find in my Encyclopædia Medica, where I have treated of the Cause of this Distemper, and evidently shewed how from the Glands and Lymphatick Ducts about the Membranes and nervous Parts of the Joints, a large Quantity of sharp Serum and other lixivial and acid Particles or other morbid Matter thickning and corrupting the Lymph, is secreted and deposited upon the Joints, where they corrode and vellicate the nervous Fibres. Upon the Addition of Particles more than ordinary acid, the Pains become more durable and fixed; insomuch as Salts of different Natures become jumbled together, and from the Agitation and Conflict of the Particles, the Membranes are vellicated and distended in a very painful Manner; neither doth the Pain abate till the Particles get forth of the Glands, or their Conflict being over, leave the Spirits at rest.