THE body of man con­tains in it blood, phlegm, and a two-fold bile, to wit, yellow and black, of which the nature of this body is con­stituted, upon account where­of also it is sick, and enjoys health, Hipp. de Naturâ Hominis, [Page 2] Text xix, & sequ. Yet not these humours alone do affect the body, but the qualities of the humours are in a possibility to affect it; such as, a bitter, a salt, an acid, and other things both within a man, and out of a man; and these qualities in­deed through a mixtion, and mutual temperament among themselves, are neither discern­ed, nor create any man trouble: but when any one of these is divided or separated from the rest, and exists by itself, then it is clear and plainly evident, how great trouble and pain it creates a man.

The salt in our body, the salt, I say, and acrid, which was diuted with a thin insipid, [Page 3] or water, as soon as ever it is separated, and falls upon the sensible parts about the joynts, there it presently excites pain, first of all by twitching and pricking them, and not long after by pressing and distending them with its abundance. As this salt likewise is more or less sharp or vehement, the pains also do much vary, that is, do increase or abate. And this salt is lodged in the serum, which that it is acid, or that an acid adheres to it, cannot be deni­ed.

There is moreover in the se­rum of our body a certain thic­ker matter, which we may call the terrene faeculency, of which nodes are chiefly generated. [Page 4] This one thing also we do over and above maintain, that there is something of a thicker salt in the serum itself, which joyned by some of the terrene blood out of the rest of the mass, will much alter the nature of the Gout, in respect of pain, heat, and duration, as to degree, or violence, or gentleness. Be­sides, this salt serum is contain­ed about the extremities of the muscles, tendons, ligaments, periostea, and the other nervous parts of the joynts, in which places also nodes and stones are usually bred.

Moreover, as long as the use of things non natural is mo­derate, all goes well; but when the body is pampered with more [Page 5] plenty than is needful, the par­ticles of the blood are not so exactly mixt with the rest of the mass, but are blended and confounded as heterogeneous; whereupon, sanguification once vitiated, the blood is usually cor­rupted by divers humours, and the non-natural heat grows so high, that it is forced to under­go a fermentation, like new beer, and it works so much more than usual, that it seems to boyl: then it forces those sharp and foreign juyces, together with part of the serum, by what way it finds; what gets into the guts is eva­cuated by a watery looseness; what into the kidneys, by plenty of urine; what in­to the habit of the body, by the [Page 6] pores of the skin: but what falls upon the joynts, pierceth into the inmost recesses and in­terstices of the nervous parts, which being beset round with dense and cold parts, use to stop and retain the serum. This Se­rum at first is very small, but thin and sharp, producing pain only deep within, and a swel­ling without; yet the violence of the pain continuing, greater store of serum, and very often a flood of other humours with it, supervenes, so that at last the swelling appears, which in a plethorick body by its redness, heat, and throbbing pain resem­bles an angry boyl: and when this humor is spent, that fit of the Gout is at an end.

[Page 7] And the nature of this di­sease is such, that when it has once seized a man (unless by the care and industry of Physicians prevented, especially by such as are well experienced in this af­fair) scarce any one can look so well to himself, but that at certain seasons and distances of time it will return, when the matter is increased afresh, and gathered to the joynts again; which distances in the begin­ning are longer, and when the mass of blood is vitiated, and the joynts weakned, become shorter, so that they confine some people perpetually to their bed, and render the joynts stiff and knotty.

[Page 8] It remains now to enquire, what the causes of the serous matter in the blood are, and then what moves it first, and causes the fit; the first our Schools call Antecedent, the lat­ter, Procatarctick causes. Hip­pocrates in his Book de prisca Medicina teacheth, how that Salts, Acids, Sweets, and abun­dance of other such things, which are in us, have divers faculties according to their plen­ty and power; but do no way molest us, when they are mixt and mutually tempered one with another.

This mixture and temper is often dissolved in the mass of blood, when the humors are augmented in plenty or power, [Page 9] or in both. Omitting other humors, in the foregoing di­scourse, we have only mention­ed the serum, to which in the further disquisition hereof we will confine our selves, and do say, that sometimes the evacu­ation of this serum is hindred, and sometimes too great plenty of serum is bred. The neces­sary evacuation of the serum is hindred, when some vitious matter is impacted in the very glands, whence it comes to pass, that either the sensible or insen­sible transpiration of our body is insufficient, as it happens in idleness, melancholy, stopping of sweat, and over-cooling the body.

[Page 10] Moreover the necessary eva­caution of this serum is hindred, when people are costive, and make but a little urine and thin, such as contains not in itself e­nough of salt and sediment.

For the alimentary and sweet portion of what we eat and drink, cannot be wholly con­verted into the substance of our body, but even this has some excrements: So that the Suc­cus [...], the imper­fect and violent juice, which is the other part of our aliment, (according to Hippocrates) ought not to be wholly mixt with the blood, but the greatest share of it should be purged out by stool and urine (whence it may be drawn by destillation). [Page 11] Now if for the causes aforesaid the evacuation of the sharp se­rum be checked, as it increases first in plenty, and then in power, it is separated from the other parts; and so it affords matter for the Gout.

Now we proceed to the se­cond, that is, to the more plen­tiful generation of serum; here we do not mean the supply of the watry part, but of the acrid and salt, or a certain hereditary inclination to the Gout, (deri­ved from the seed and maternal blood) which seems to consist in a weakness of the joynts, and especially in some innate fault of the blood. Then there is an adscititious disposition of the body, induced partly by the [Page 12] frequent invasion of the fit part­ly by the manner of living, such as is in them, who though they use their utmost diligence, can­not guard themselves from the return of this grief.

Which indeed happens for divers causes, hereafter to be mentioned, namely, through the weakness of the parts about the joynts; through pains, where­by many fibres of the nervous parts are broke; from a fre­quent influx of humors, where­by the parts are relaxed and softned; through unreasonable heat or cold; from violent mo­tion, as it happens in Venery; and finally, when a vitious san­guification is contracted, where­by the acrid matter is continu­ally [Page 13] bred in the blood.

Such meats and drink should be taken notice of, as have in them a sharp matter in such plenty and power, as not being to be conquered with the other juices in our body, it can nei­ther be sufficiently separated nor discharged, nor can it be exactly mixt or tempered with the other juyces.

Such as are generous Wines, which have much Tartar in them; for not only that Tar­tar, but the spirit also breeds the Gout, which consists of an oyl, an acid and a volatil salt, from whence the Wine receives all its strength.

Moreover, gluttony and drun­kenness contribute much to the [Page 14] breeding of this humor; all in­temperance likewise in dainty meat and drink, over hard stu­dy, especially in the night, which in this case is the most dangerous; and afflicting cares; all these hinder sanguification, so that the sharp part in the ali­ment is either not well mixt, or not well separated; and above all immoderate Venus is the most dangerous and hurtful.

But if any doubt arise, and the question be, what way it hurts, it may properly be repli­ed, that Hippocrates his assertion is of undoubted truth; there is in us a salt and a sharp: Now I think this is rendred more effi­cacious by the use of Venery, so that at first it is augmented [Page 15] not so much in plenty as in power; for what is sweet or fat in the blood, is consumed partly with the spirits, partly with the seed, and what re­mains is more and more exaspe­rated, and so existing more a­part, it acquires strength and does harm.

This matter being augment­ed and gathered by the foresaid causes, is moved, not always by the proper impulse of nature, but often as it is stimulated by several evident causes; such as are able either to impress an impulse on the blood, or to quicken its internal motion or fermentation, violent passions of the mind, especially anger and fear, sudden cold and heat, [Page 16] retention of accustomed sweat, some seasons of the year, espe­cially Spring and Autumn, and as we said before, gluttony and Venery.

The causes of this disease be­ing now explained, we lay down this definition of the Gout:

The Gout is a violent pain of the parts about the joynts, caused by a serous and sharp humor, sud­denly coming out of the Vessels.

Sometimes wandring pains foretell the Gout to be coming, especially in the joynts of the feet or hands: that it is at hand, stretching, yawning, painful weariness, catarrhs, wandring [Page 17] pains in the limbs and joynts, and sometimes a heaviness in the head do shew: a kind of feve­rish heat, a pricking pain in the joynt, with inability to move, and after that a swelling usual­ly red, which are attended by divers other things, as watching, loss of strength, and several o­ther complaints familiar to gou­ty persons, shew it to be pre­sent.

The Gout ends either in the translation of the matter to a more ignoble part, or in the discussion of it, or when, being changed into corruption, it breaks through the skin, or when, tarrying long there, it turns knotty: All which come to pass, sometimes by the assist­ance [Page 18] of nature, sometimes of art.

For there is a twofold de­sign in the artificial cure; First, to remove that which aggra­vates the paroxysm; Secondly, to preserve the patient from the return of it. In the fit three things are urgent, pain, the swelling and inability to move; of all which since an humor is the cause, partly still coming in, partly got in already; so the whole method of cure con­sists in two things; first in hin­dring the influx of the humor; secondly in expelling the hu­mor that is got in.

Which method of cure is often interrupted by some grie­vous pain or by some other ur­gent symptome.

[Page 19] The influx may be checked by repelling the humor from the joynt, or by stopping its motion, or by expelling it out of the Body.

Repulsion, whereby the hu­mor is driven from the part af­fected, may be made either by strong ligatures, or by applicati­on of coolers and astringents.

The Repulsion of this hu­mor in the beginning is very dangerous, because the repul­sed humor may run either into another joynt, or into some more noble part, or being im­pacted into the inner recesses of the parts about the joynt, it may increase the pain.

The motion of the humor, which depends upon a certain [Page 20] inevitable agitation of the he­terogenous humors, cannot of itself be stopt; yet it may be abated by evacuating some part of the mass of blood (if no­thing hinder) by venaesection; whereupon the quantity of the humors being lessened, the heat of the blood, and the violence of the peccant matter, may both be stopt in some measure.

The evacuation of the hu­mor, which does offend, (if this humor could altogether be eva­cuated,) would prove a most effectual remedy against its run­ning into the joynts.

Now this evacuation is made by vomits and sweats. Vomits and purges may either follow blood-letting, or they may [Page 21] serve instead of it, without a­ny previous preparatives or al­terations. Diureticks and su­dorificks do very often give much relief; the reason is, be­cause nothing in a manner be­sides are so able to extirpate the very root of the disease, that is, the salt and tartar: for we have known several, who have been recovered by virtue of these, taken either separately or together: such as are anti­monial medicines, antimonium diaphoreticum, Cinnabar of An­timony, &c. Volatil Salts, as volatil Salt of harts-horn, greater burdock-root, a deco­ction of germander, and se­veral things called antipoda­gricks.

[Page 22] To remove the humor, when it is fallen upon the joynt, there is a necessity for discuti­ents, wherewith sometimes som­thing of a repellent is to be mixt. Fat and oily things are carefully to be avoided, where­by the pores are shut up. Re­medies composed of salts, ei­ther fixt or volatil, are the sa­fest of all; the reason is, be­cause they vehemently discuss the impacted humors, and cor­roborate the weakned parts. There are some also, who use to apply spirit of salt, mixt or allay'd with some other Liquor.

In the mean time we must attend with our utmost dili­gence and caution, to things which either relieve or do pre­judice; [Page 23] because the salt hu­mors may be various, and may be mixt with various ichors. If the matter, when the thinner parts are discussed, do congele, and degenerate into chalky knots, stronger emollients, to­gether with discutients, are con­venient; such as gum Ammo­niack, and several sorts of gums, to which if the node gives not way, the skin must be broke, and the chalky stones taken out.

As to the diet, in the fit it must be altogether spare and thin, small wine may be drunk moderately, sharp and salt food must wholly be avoided, the cold air is to be kept off, and sweating must be indulged.