Disease doth An. Not that the organs of motion are attacked hurt or tormented but only that the periostium is put out of its natural posture which is manifest from hence that as soon as this membrane is restored to its natural state you cannot perceive the least defect in those organs Qu. Why then doth the pain increase and grow more violent upon touching or moving the part affected An. This comes not to pass because that the organs of motion or their membranes do suffer but because that the membrane being already distended by the touch or motion thereof it comes to suffer and to stretch a new whereupon new pain must follow CHAP. X. Of the Symptoms of the Gout Qu. FOrasmuch as there are found many and different Symptoms in the Gout will it not be proper to make a distinction between them thereby to come to the true knowledg of them An. You will do very well to distinguish first the Symptoms in general from the Disease it self and then to make a distinction between the Symptoms themselves Qu. What distinction is there to be made between the Symptoms of the Gout An. This that the symptoms that arise and vanish with the Disease are to be distinguish'd from those that are bred not from the Gout but from the symptoms of the Gout Qu. Which are the Symptoms that do immediatly accompany the Gout and are born and dye with it An. Of these there are but two already spoken of viz. the Vitiated motion and the Violent pain These come and go away with the Disease following the Gout as a shadow doth a body Qu. Which of these two Symptoms is the chiefest and most grievous An. The Pain which is not the Disease it self or the cause of the Gout as hath been already said nor yet is it a simple Symptom in regard it is a cause of other symptoms especially when it is violent Qu. What Symptoms are occasioned or rather caused thereby An. Inflammations Fevers Faintings Sleepiness Loss of strength Afflux of humors Qu. Is it certain that all these six Accidents are caused by the raging Pain of the Gout An. Dr. Paul Barbette reckons them all amongst the effects of the Gouty pain when he treats of the Symptoms of Wounds in his Chirurgery p. 165. of his Dutch Edition Besides that 't is manifest that most of these do then first appear when the pain grows violent and disappear with the diminution and ceasing of the pain Qu. Whence comes it that these Symptoms that are caused by the Gout not only in divers Patients but also in the same shew themselves at one time more than another and differ so much from one another An. It comes from the greater or lesser intensness of the efficient cause the Pain which receives its degrees from the quality and quantity of the gouty matter For the more malign and abounding the damps are the more grievous also are not only the proper Symptoms but also these Accidents of the Gout Qu. Doth the raging pain excite in all Gouty persons these Symptoms all together and at once An. Not so for in bodies that have but little serosity in the blood the first five Symptoms do appear but not at all or very seldom the sixth and last which is the afflux of humors In others who abound in that serosity the afflux of moisture will be perceived first of all and often without inflammation Again when the gouty matter lurks deep as in the Sciatica and in the Gout of the shoulders you are not then to reckon upon the change of colour and the afflux Qu. That raging pains do cause inflammations is easily understood but how do they produce Fevers Faintings Sleepiness and loss of strength An. The intolerable pain drawing to the heart causeth there a Fever and Fainting and passing to the brain produces there Waking whence must necessarily follow Loss of strength CHAP. XI Of the external Serous Tumor which often manifests it self in the Gout Qu. IS it worth while to treat somewhat more largely of this Tumor than of the other Symptoms caused by the Pain An. 'T is very necessary because by this Symptom many Learned men have been so misled as to take it for the Gout-breeding matter it self or at least not to distinguish it from the Sickness it self Whence as from a fruitful soil have sprung so many errors about the Gout and especially about the proxime Cause thereof Yea this is the only cause that so many Physitians and Chirurgians are so much wedded to the Notion of Humors that they dare almost take it for granted that the Gout cannot be without this Swelling and Afflux of Humors insomuch that if they meet with any Gouty person in whom they cannot find this Swelling or change of Colour although they find great pain they will rather discard them out of the number of the Gouty than acknowledg that sometimes there are no humors at all accompanying the Gout Qu. But since the Affluxed humor which breeds the external swelling is neither in whole nor in part the Cause of the Gout what shall we make of that tumor and its matter An. It is a Symptom which is no inseparable companion of the Gout yea never begins and seldom ends with that disease Which I think I can so plainly make out as that the most ordinary capacity shall understand it to be so Qu. Does then this serous Swelling not always accompany the Gout as an inseparable Symptom An. No for besides that some Gouty persons seldom or never perceive this Tumor caused by affluxed humors as I have experienced and many Writers must witness commonly there is no affluxed Humor found in the Sciatica Qu. But does this Swelling never begin with the Gout An. 'T is never perceived in the beginning of the Gout for though in many Patients this Tumor very soon follows upon the Gout yet if it be well observed it is never of the same age with the Gouty tumor which in order of time always precedes it Yea if care be had its birth may sometimes be altogether prevented by being timely ready to evaporate this dolorifick damp by a speedy application of my matchless discharging Remedy as I have often experimented on my self and shall further teach in the second part treating of the Cure of the Gout Qu. But as this Symptom never begins with the disease does it neither end always with it as other Symptoms do An. No This Symptom alone survives the Gout yea the cause whence it rises ends not with it For as for the most part it first appears when the sickness is at its height and the pain rageth so it is often seen a good while after the Gouty pain and then by good means and some patience dispelled Qu. It seems then that the pain which is the cause of this Symptom ceasing the outward tumor doth not vanish at the same time An. No for very often the limbs remain swelled as before and it requires some days
imply that the Gout is a Disease wherein violence is done to nature in some part or other of the Body But this is a novelty to me that you add viz. that it is an inward deep-lurking and for the most part invisible little swelling and that that swelling is caused by a damp c. intreating you that you would vouchsafe to express this more plain and to render reasons thereof And first why you call it an internal and deep-lurking tumor An. The better to distinguish it from other windy swellings in respect of its seat For whereas those other lye between the flesh and skin this lies deep underneath the membrane that covers the bone as hereafter shall be more largely proved Qu. But why do you add that it is a little and mostly invisible swelling An. Because it is so indeed Qu. But pray Sir take care that you run not against sense out of a blind zeal of producing a novelty For is not the tumor which manifests it self in the Gout big and conspicuous enough An. You do not distinguish between the Disease it self and the Symtom which is the stumbling stone of many even learn'd men And the want of this very distinction seems to me to have been the main if not the only obstacle why they have not lighted upon the true cause of the Gout and why they have taken quid pro quo Qu. What then is to be done not to mistake herein An. You must ever make a difference between the swelling which is caused by the morbific gouty matter and that which is consequent to the Gout and this is to be laid as a fundamental Truth never to be remov'd viz. That the humour which makes the external palpable and visible swelling in the Gout is not the Gout or dolorifique matter Which are not so much my words as the words of that famous Physitian of Dort called John Van Beverwyck deliver'd by him in his Book of the Gout and which he hath borrow'd out of the description of that disease which that learned and experienced Professor of Physick at Wittenberg Daniel Sennertus left behind him Which also is the reason that I shall place that aqueous and serous tumor amongst the symptoms of the Gout where also it is to be handled and not here where we speak of the Disease it self Qu. What is not the humor that causes the outward and visible swelling the Gout or dolorific matter A. No they differ very much from one another and may be sufficiently distinguisht by those that will attentively consider Qu. Wherein consists this difference Ans In this that the one is the cause of the Disease the other a symptom which will be made very clear when we shall come to treat of this symptom But in part to satisfie your curiosity pray mark the ratiocination of the lately named Beverwyck saying in the quoted Book That the humour which makes the swelling is not properly the peccant matter is from hence evident because that in the beginning before the part swells the greatest pain is felt and the same grows less when the swelling appears 'T is true that that learned man adhereth still to the opinion of the saltish Serum affirming that it is a serous humor pervaded by a salin acrimony that causes the Gout But herein he as well as the great Sennertus hath mistaken Mean time t is certain that the external tumor is not the morbid matter it self for the reason given and which is more some podagrical persons endure great pain without the appearance of any visible swelling CHAP. II. Of the inward Tumour of the Gout and how it is mostly invisible Qu. I Shall for the present rest contented with the proof alledged until we come to the symptoms But when this symptomatical or accidental swelling of the Gout is present do you then observe two sorts of swelling in this Disease one inward the other outward An. I do so of which two the first is that which I say in the description to be a swelling that is little and for the most part invisible Qu. Why do you say so An. Because it is indeed small and for the most part cannot be seen by the sharpest eye of the body though it be seen by the eye of reason For although you outwardly perceive no swelling you may not thence infer that there lurks none within forasmuch as the contrary is true in these and other swellings See the proof hereof in a couple of observations of the skilful Physitian and Chirurgian Hildanus in his second Part the 37th and 38th concerning dangerous and desperate tumors in the muscles of the stomach in which nothing preternatural of swelling or other disorder could be seen outwardly Qu. If this tumor cannot be perceived by the eye whence do you then know that there is an inward one An. From the violent pungent beating distending and continual pain to be easily perceived by ones finger Qu. But it seems by what you intimate in the description of the Gout that sometimes this tumor may be seen An. Yes it may for at times it appears plainly enough though few Artists take it for a gouty swelling misled by the external appearance of it which is in the form of a small hard pimple on the place of the part affected of which you have a manifest proof in Pareus the French Chirurgian treating of a distemper in a young woman at Bourdeaux that had such a tumor on her thigh though Pareus doth not record it for such Qu. When may this tumor be perceived by the eye An. Then chiefly when the gouty cause attacks the Patient not about the joints of the limbs but in or about the middle of those places with a boyling pain wherein nature labours as much as she can though she be not strong enough to expel the peccant matter At which time if you observe it carefully some tumor appears as was said above This I have found not only in my self but very notably in another that was a young man employed here in the Foundery of Batavia called Martyn Smith of Breslaw who having the Gout in his right foot without a considerable afflux of humors the evil setled on the midst of his foot in the form of a protuberant hard pimple or button Which I also by the help of God did presently cure so that he the same hour without any pain went out of the house to his Work-house which can be attested by the Physitian Thomas Flory and the chief Chirurgian Warner Leuretius as eye-witnesses that saw it with great admiration CHAP. III Of the next and always concomitant Cause of the Gout Qu. A After you have sufficiently made out that the gouty matter causes a swelling for the most part invisible be pleased to explain to us what is the next and always accompanying cause of this tumour which to know I think to be of great importance An. You judg aright forasmuch as the Cure hath always a respect to the
Cause of the disease and since 't is in vain to hope for a recovery as long as there is an error or mistake about the peccant or gouty matter Qu. Have Physitians been of one opinion herein An. No For some have assigned the cause to be a slimy and cold humor some a mixture of gall and slime some a crude indigested and impure blood others a serous humidity mix'd with an acrimonious saltness others winds with a mixture of the four known humours others ill-conditioned winds alone Qu. Whence I pray ariseth this great diversity of opinions An. From thence only that as hath been already intimated they have not distinguish'd the Gout from its symptoms which hath so abused them with the notion of the humors that they have put those out of the list of gouty persons who in their Gout perceived no afflux of humors absolutely requiring the same in this disease notwithstanding that such as find no serous swelling in their gouty distemper do feel full as much pain as others that are wont to find that afflux whose grievous pains also are considerably abated upon the swelling Qu. Which then is in your judgment the next and immediat Cause An. We have expressed it in our above-recited description of the Gout to wit that it is a Vapor or Damp dry and cold and mixed with malignity Qu. But many will look upon this as an airy and windy fancy and no solid truth An. If men shall devest themselves of prejudice and maturely consider all what hath been said and is yet to follow I shall then expect a more favourable judgment and an unanimous consent to my doctrine Qu. According to your theory the Gout is to be reckoned among Windy swellings An. So it must be because grounded upon experience the Mistress of Fools Qu. But is not this a quite new opinion or hath there ever been any learned man that hath delivered the same An. When I lately enumerated unto you the various opinions concerning the cause of the Gout you may remember that the last of them was that which placeth it in meer winds Now among those Doctors Sennertus reckons Guainerius and Matthaeus de Gradibus two eminent Physitians and as far as I can find the Chinese Doctors are all of that mind Besides that ancient Physitian Guido de Culiaca though in the Gout he follows the Humorists relates that he had read in some prescriptions of health given to the Popes of Rome that this disease did arise from winds and the Royal Chirurgian Pareus p. 534. assigns for the certain cause of the running Gout a very thin fuliginous matter which is nothing else but a subtile smoaky damp or spirituous substance Qu. But Pareus doth not speak so of the other kind of Gout Ans 'T is true that he affirms it of the running Gout but then I must say that that kind doth not at all in its essence or next cause differ from the other Gout but only in some qualities relating to the thinness and thickness of damps those from whence proceeds the running Gout thinner and subtler and those which cause the other Gout courser and thicker And 't is notorious that almost all intelligent Physitians assign damps for the next cause of Tooth-aches Head-aches Pleurisies at least bastard Pleurisies Colicks and Epilepsies Diseases which in name indeed place and some symptoms differ from the Gout but not in their true essence they being so near a-kin to one another that they acknowledg but one and same cause Qu. 'T is true that some learned men have affirmed winds or damps to be the next cause of the Gout but others have rejected that opinion and for their ground of doing so I shall produce but one argument for all which M. Beverwyck alledgeth out of Sennertus in his Treatise of the Gout saying All sicknesses which arise from winds do not last so long as the Gout and making use of this reason for his denying the flatus or winds to be the true Cause of the Gout And further in his Medicina p. 62. treating of Tumors in general he declares That the windy swellings do vanish easiest of all What you can say to this objection I long to hear Ans Those great men speak here only in general of windy tumors and what they say is only true of such windy swellings as lurk under the skin or in fleshy parts not in those that lie in deep parts and under firm and thick membranes as in the Gout and other hidden or manifest swellings raised from latent winds See the proof hereof in Hildanus p. 6. obs 40. in a Tympanites that was refractory to all remedies Qu. What then is the true cause why the Gout is so long a curing Is the gouty cause the damp so difficult to be with speed removed and evaporated Ans The gouty damp is easy enough to be evacuated and 't is even forward to be exhaled but there is a notable obstacle which hinders the speedy performance of it And that is this The impacted and inclosed damp which causeth the windy tumor in the Gout seeks a passage to issue out at but finds none partly because of the grosness of the damp partly and chiefly by reason of the close and firm membrane of the bone under which it lurks especially since the place in which this cold damp lodgeth enjoys but little warmth for the attenuating of this gross damp and expelling it through the small pores of that membrane Qu. But I pray Sir let me know what is the chief motive that hath induced you to make Damps the only next cause of the Gout Ans First This remedy which I here offer as that which suddenly cures this disease For if it be true that the Medicine declares the Disease as Physitians afirm with their Master Hippocrates I must then conclude that no humors but only a Spirituous thing is the cause of this Disease Secondly observing the sudden motion of the gouty matter sometimes dislodging in a very short time from one limb to another from the hand to the foot from one foot to the other c. flying as 't were with swift wings from above to beneath and back again I find my self obliged to judg that these are not Humors but some Spirituous matter able to do such things CHAP. IV. Of the Qualities of the damps that cause the Gout Qu. OF what quality I pray are these gouty Damps Ans The above-recited description saith that they are dry cold and ill-conditioned Qu. Why do you say they are dry Ans The better to distinguish these Damps from windy Humors Qu. Why cold Is there not a hot as well as a cold Gout Ans As there is but one next cause which for quality is always cold so is the distinction of a hot and cold Gout vain My opinion agreeing with that of Fernelius that all Gout arises from a cold cause Qu. But with what reasons can you maintain this opinion Ans Irrefragably by the
parts of these humors may be caused by the natural and innate warmth of the suffering part assisted by the adjacent parts as also by the preternatural heat of the inflammation of the same without any other external cause Whereupon the gross thick saltish and carthy parts as the sediment and relicks remaining in the limb are coagulated and concreted Qu. I. understand you very well but I pray tell me also how may this come to pass by the Unskilfulness of Practitioners An. When they apply too strongly repelling or drying or too much cooling remedies which drive the thinner parts inward or dispel them and so harden and render incurable the thicker stuff whereas they should use moderately warm mollifying remedies thereby to expel and consume the whole matter Qu. Do these Nodes when they are caused without the application of perverse remedies grow on leisurely An. They do so when they are bred of themselves For the foundation of this chalky matter being once laid 't is raised and encreased more and more upon every new afflux and from time to time scaled over until it comes to that bigness that it only hinders the motion of the limb and renders it crooked but can also stay or have room no longer under the skin but making it first protuberant bursts it at length in pieces Qu. Surely an ignorant Practitioner can bring this to pass much sooner An. So he can and to such a degree that the poor Patient in the very first fit of the Gout is for ever deprived of the motion of the suffering limb of which we have in Banda an Example of a Lieutenant of ours now lying here in Garrison called Jan van Haerlem Qu. But may not this growing of Tophes or Nodes be prevented and hindred An. Very well as shall be taught in the Cure of the Symptoms of the Gout Qu. Will you proceed now to the second principal you intended viz the Cure of the Gout An. I will after you have heard what I had to say of the Nature and Cause of the Gout its Seat and Part affected its Diagnosticks Symptoms and the necessity of distinguishing these latter not only from the disease it self but also from one another All which have made way to judg the better of a fit Remedy to cure the same seeing we cannot hope for Cure before the Malady be throughly understood THE SECOND PART Of the CURE of the GOUT CHAP. I. Treating of the Cure of the Gout in general Qu. HAve there not been at all times men that have pretended to the skill of Curing the Gout Ans Yes indeed but Experience hath put them to shame For whereas they have promised cheap and sure remedies against this painful disease their promise hath notoriously failed and their Patients have been at last abandoned remediless See hereof amongst others Fabritius Hildanus his second Part p. 174. where he speaks of one whom he calls a Monster that highly bragged he could conquer that great Enemy of Mankind the Arthritis or Gout but was confuted by very sad Experience Qu. Why doth he call him a Monster Ans Because of that monstrous and mischievous means by him used whereby he killed his Gouty Patients See in the same Hildanus his second part p. 87 that unhappy preparation of Quicksilver for the Gout Qu. But have none of the best Physitians of Europe in so many Ages found any sure Remedy against this Disease Ans None that I know of they rather call the Gout Ludibrium Medicorum and the Disease of Rich-men though it seizes also on the Poor who if they could be helped would soon lose that name Hence 't is become a Proverbial saying viz. that he who undertakes to perform something extraordinary is like him that pretends to Cure the Gout Which pretenders are usually sent to the Courts of Kings and Princes to practise their skill on them who will not sail to make such men rich as shall perform such undertakings Qu. What 's the matter then that the true Remedy hath not been found hitherto is the fault in the Physitians or in the Gouty Patients Ans In both but most in the former as not knowing the true nature of this Disease notwithstanding all their Disputes and Discourses about it Qu. What do you think of Cardanus his saying in the praise of the Gout viz. That whosoever will stop the source of the Gout stops withall the source of life Doth not this imply that the Gout is incurable Ans He will say that the Root of the Gout cannot be totally pulled out though you may strip off the Leaves that is remove the outward Accidents thereof CHAP. II. That the Gout is curable by Burning with Moxa Q. BUT pray let me know your opinion in this matter Is the Gout an incurable Evil and Cardanus his saying true A. I or the comfort of all the Gouty I here openly and joyfully declare that 't is Curable Q. But is not this a presumptuous Arrogance A. No for the good God in compassion to mankind hath been pleased not only to bring me to the true knowledg of the nature and condition of this Disease but also to direct me to a specifick and proper remedy thereof which removes this sore Evil it being now through the divine goodness in our power to quell and tame this Gyant without making our selves guilty of any vanity Q. What means is this I pray A. 'T is the harmless Burning with Moxa which being three or four or more times repeated according to the condition of the place which the Gout hath seized on pulls the Enemy out of his fastnesses Mark it the raging Gout in the height of its rage is first stopp'd in its carrier and soon after forced to pack away Q. Is this possible A. It is for I have succesfully experienced it on my self and many others CHAP. III. How and for what this Remedy is used Q. BUT to speak with order of the Cure of the Gout what is above all to be considered in this Disease A. The suffering part and labouring nature is to be succour'd without delay and the part affected to be delivered of the inclosed damp the Cure principally consisting herein viz. in giving an out-let to the Gout-breeding or peccant matter and even in forcing it to evaporate Q. Which then is the remedy that performs so great an effect Is it not known in Europe Where hath it been found out A. 'T is Moxa best known amongst those of China and Japan so celebrated valued and commended there that no other remedies are to be compared therewith upon the account of its excellent performances considering that there are few pains in the body for which they do not use it with great benefit CHAP. IV. What Moxa is and where to be had Q. BUT what is this Moxa Ans 'T is a very soft and woolly substance made by a very skilful preparation out of a certain dried Herb. Q. What name hath that Herb out of which
here delivered be embraced and this small work encouraged and the remedy here recommended put in practice which I heartily wish may be done according to my prescript before it be prejudged and rejected The Table of the First Part Treating of the Description of the GOVT CHap. 1. Of the Gout and its Nature Ch. 2. Of the internal swelling of the Gout and that for the most part invisible Ch. 3. Of the next and always accompanying cause of the Gout Ch. 4. Of the qualities of the Damps which cause the Gout Ch. 5. Of the part affected and the seat of the Gout-making matter Ch. 6. That the Gout is a common disease of the limbs taking its denomination from the limb it seizeth on together with the place in which the peccant matter of the Gout is bred Ch. 7. How and by what ways the peccant matter of the Gout comes to the several limbs Ch. 8. Of the expelling part Ch. 9. Of the marks or signs of the Gout Ch. 10. Of the symptoms of the Gout Ch. 11. Of the external Serous swelling which often manifests it self in the Gout Ch. 12. Of the dislocation caused by the Gout Ch. 13. Of Schirrus's and Nodes The TABLE of the Second Part Treating of the Cure of the Gout CHap. 1. Of the Cure of the Gout in general Ch. 2. That the Gout is curable by burning with Moxa Ch. 3. How this Remedy is to be used Ch. 4. What Moxa is and where to be had Ch. 5. More particularly of the manner of the application of this Remedy Ch. 6. What is to be done after the burning is over Ch. 7. Of the admirable effects of this burning Ch. 8. That this way of burning goes beyond all Remedies of Europe against the Gout Ch. 9. That this kind of bruning is very tolerable Ch. 10. Of the qualifications requisite in the person that shall perform this operation Ch. 11. Of the Aromatick sticks to be used in this operation Ch. 12. Of the place where this burning is to be made Ch. 13. Of the inconveniences and dangers attending a faultive operation Ch. 14. Of the Serous swellings of the Gout and their Cure Ch. 15. Of the Nodes and stony Tumors and their Cure Ch. 16. Whether there be divers sorts of the Gout and whether there be an essential difference betwixt them Ch. 17. Of the means conducive to prevent the Gout Ch. 18. Of the Gout of the Teeth and its Cure An Appendix Of three very remarkable Cases THE GOUT More narrowly SEARCHT and FOUND out Together with The certain CURE thereof CHAP. I. Of the Gout and what it is Theoph. I Have understood with joy Theodidactus that you have a singular opinion of the Gout its Cause Seat Passages and Ways as also that you know the true and genuine Remedy against this cruel Disease which is also come to your door no less than it had assaulted your Father and Father-in-Law who were so grievously tormented therewith that they became altogether helpless and were so spent and consumed thereby that before they arrived to any considerable old age they fell into their graves Whereas I see you to admiration advanced to so great an age and in so much vigour as if you had never known or had any Podagrical person in your Family or among your Relations or had never been subject your self to that merciless disease Hence it is that I most heartily intreat you that you would be pleased to explain this matter to me according to the good inclinations which I have always perceived in you of doing good to your Neighbour Theodid My dear Theophilus although in doing this I step somewhat out of my Vocation yet Christian charity constrains me to comply with your desires herein and 10 to confine this knowledg of mine to my particular Friends and Relations on condition only that at this time you do ask me no more questions than what shall be pertinent to make us come to the knowledg of the Gout and the Remedy thereof Theoph. I most kindly thank you for your goodness and promise you to contain my self within the bounds prescribed Theodid Very well be pleased therefore to propose your questions in that order and I shall answer you to the best of my knowledg Theoph. To recover gouty persons and to free them from their pains without which all the blessings of this life are insignificant what is above all things necessary Answ To have a thorow knowledg of the Disease and of the true Remedy thereof both which are equally necessary insomuch that the one without the other is not valuable Quest Why is it that for accomplishing a happy Cure there is first of all required a well-grounded knowledg of the Disease An. Because 't is impossible to cure a disease according to Art if the nature thereof be hid from the Artist And the want of this is the chief reason why the care and pains taken by so many learned Physitians hath proved so ineffectual in the Gout Qu. What then are the Requisites to attain to the true knowledg of this Disease An. There is required a solid knowledg of these following particulars 1. Of the next and ever-concomitant Cause of the Gout 2. Of the Seat of this Evil. 3. Of the Part affected 4. Of the Ways and Passages through which this Evil takes its course 5. What are the inseparable signs thereof 6. What Symptoms commonly accompany it 7. That the Symptoms of this Disease be rightly distinguished If you err not in these main points you are in the right way of arriving to a happy cure of this Malady Qu. Do you understand by the name of Gout all pain in the Limbs An. No but that pain which in sharpness and fierceness exceeds all other and that which I mean to describe Qu. To let pass the name of the Gout pray give me a full and plain description of the Disease it self An. The Gout is a preternatural inward deep-lurking and for the most part invisible little swelling within in the periostium that is the membrane that enwraps all Bones caused from a dry and cold ill-natured damp or vapor which out of the arteries by the expelling vertue of the heart is driven out into the place that is between the bone and the periostium for the most part into such Limbs of the Body as are about the Joints in which this vapor being and remaining impacted and inclosed and distending that most sensible membrane produces those violent and intolerable pains whereby the motion of those Limbs is incumbred and dispoiled and many other grievous accidents occasioned Qu. Doth this description differ much from that which hath been hitherto delivered of this Disease An. It doth Whence it is that I exceedingly apprehend I shall incur sharp censures from many Qu. But let this pass let us weigh rather your description in its principal parts And First I do remember that you make the Gout to be a preternatural swelling whereby you doubtless
remedy it self as also by the pruriency and shivering which gouty persons upon the motion of this cold damp do commonly feel especially in those parts through which it takes its course as also happens in Epilepsies Pleurisies Colick and the like that come from cold damps Qu. But soft and fair Your last proof taken from shivering doth not hold as Beverwyck objects for then should the matter of hot Fevers be also cold which passing through parts endowed with the sense of feeling not only cause shivering but also clashing of teeth Ans This is not said from well-grounded knowledg since it hath never yet that I know been satisfactorily proved that Hot Fevers as they are called must needs procced from an hot cause and upon a thorough disquisition it might perhaps be found that they have been produced from some cold matter or other which I think at least to be half proved because sometimes an hot Fever ends in the Gout as I have found not to go far in my self when I was in the 50 th year of my age It sometimes also comes to pass that the Gout determines in an hot Fever as appears from what Beverwyck saith in his Book of the Gout p. 110. speaking of the ways through which the gouty matter takes its course The damp saith he turns back into the veins and ascends up again to the noble part meaning the heart where it raises hot Fevers Anguish and the like evils or shoots suddenly into some other limb whereby the pain that is in the hand is soon after felt in the foot Qu. But is not that notable inflammation which is often seen and felt in the Gout sufficient proof that there is a sort of Gout which comes from heat Ans This is a Symptom or accident in the Gout which is not caused by the next and always accompanying cause of it but by the violent pain as I shall more clearly make out when I come to speak of this Symptom But 't is a Symptom not to pass that by in this place which hath strangely misled those who have mistaken it for a mark of the Gout as Sennertus and others do ackuowledg Qu. Is this damp also ill-conditioned and malignant Ans So 't is judged by considerable and experienced men as well as by my self and that from the intolerable pain and other accidents So doth that old Master Guido de Culiaco and Pareus in his 7th Book ch 2. proves it by two Examples and our new Medicine confirms the same Besides the foetid damps of the Gout do plainly speak this malignity which is perceived both at the time of the act of burning and after it that being such that sometimes both the Patient and the Person that administers the Caustick and dresses the part are ready to fall away And this is most of all found at the dressing of the little wounds when they begin to omit good store of moisture For as soon as you shall in a morning open the little Plaisters you will be so struck with a strange stinking smell that it will almost cast you into a swound 'T is very probable that this stuff is already malign before it be cast out from the heart into the limbs yet remaining for a while wedged in the limbs from the evaporation obstructed its malignity is heightned Hence it is not advisable to serve this burning or dressing upon any one that is fasting but 't is best that both the Patient and the Agent should first breakfast and take a cordial Qu. But is it possible for Winds to occasion so much mischief Ans Very possible and then especially when they are more peccant by their quality than quantity So Hippocrates in his golden Tract of Flatus's doth not without cause judg of winds that most of all the grievous and dangerous Diseases owe their original to them Qu. But can Winds breed such viclent pain Ans They can chiefly when the membranes the main instrument of the sense of Feeling are by them attacked and distended CHAP. V. Of the Part affected and Seat of the Gouty matter Qu. WHich then in this painful Disease is the part that is attacked and offended by these Winds Ans Principally if not only that sensible membrane called the periostium that is that membrane which immediatly covers the bones Qu. Do you not think that the membranous ligaments do also suffer here or rather the membranes of the ligaments Ans No but I agree herein with Galen that they have no feeling the which is also confirm'd by the learned Barbette in his Praxis chap. 5. p. 30. Qu. What do you understand by the Peri-ostium Ans That single membrane or film whereby the Author of Nature hath outwardly invested and covered all the bones of our body and which is a close and firm substance extendible and very sensible Qu. Doth the gouty matter fall from without upon this sensible periostium fretting and biting it by its acrimony Ans Not so for then it could not cause so intolerable a pain or the right Gout Qu. Where then are we to look for the true seat of the gouty matter Ans No-where else but between the membrane and the bone Qu. Wherein then consists the genuine essence of this Disease Ans In the violent distension or stretching of this sensible membrane by the Winds whereby this membrane being forced out of its due and natural form and situation excites so violent a pain Qu. Whence do you infer that the gouty matter lies so deep and particularly between the membrane and the bone it self Ans Not only from the distending pain which is to me proof sufficient but also from the contumaciousness of the Gout which made Hippocrates say in his 6th Book aph 49. That the Gouty fit doth not cease before the fortieth day And truly whereas all other windy tumors that are not lodged so deep are in a short time made to evaporte this windy swelling of the Gout lying so deep and lurking under so firm and close a membrane and besides in a place of little warmth and it self coming from a cold cause cannot be easily brought to a quick evaporation but by such a kind of remedy as ours is Qu. Have not the old and new Masters mistaken the Part affected and the true Seat of the Gout Ans Certainly they have For to speak of the part affected and the seat together I must first alledge the opinion of Galen as 't is cited by Beverwyck he affirming that the gouty moisture doth flow into the hollow of the joynts and there forces asunder the bones whereby the ligaments and membranes that fasten them together are so violently expanded that they cause that excessive pain Qu. Hath this sentiment of the great Galen been generally judged and received to be conform to truth Ans It hath been rejected by many as by Beverwyck and others and by others maintained Qu. Where do those that contradict Galen find the Part affected and the Seat Ans In the
then think you to be most advisable in this case A. To open as often is done and must be done the skin and to take out the matter of the Schirrus as far as is possible and that done to heal up with my Coridons or Leaf-plaisters the skin as well as you can Q. But then if this should succeed well can you preserve the place thus weakned from a new afflux of humors A. I think I can and that after this manner If the Schirrus were for example upon the knuckle of the fore-finger I would then duly burn the limb under it on the hand and thereby intercept all ill humors and so keep them from flowing to the weak part Q. But what if that should fail you and the Gout surprise the limb with a new afflux of humors A. Then should I resolve to hinder those humors from coagulation and induration by the advantage of our Bruning remedy by which means you may at least take away the disfigurements which these nodes cause in the limbs if you cannot restore the use of the limbs Q. It seems you have some hopes even of the last A. I have because I know that the nodes do lodg not in the very Joynts but about them and being discharged one way or another 't is found that the Joynts are free provided only that the veins and arteries yea the nerves too be not so obstructed by the bigness hardness and diuturnity of this stony tumor that the pervasion of the Blood and Animal spirits cannot by fit means be restored in which case the limb must needs remain stiff CHAP. XVI Whether there be different sorts of the Gout and an Essential difference betwixt them Q. ARE not almost all Physitians of opinion that there are different kinds of the Gout essentially dissering from one another or at least that there is the Cold and the Hot Gout A. They are but they mistake being misled by the external Symptoms For all Gout ariseth from cold dry and malign damps Q. But yet the Gout may be distinguished A. It may in divers respects and principally First in respect of the Limb it seizes on whence are the names of Chiragra Sciatica Podagra c. Secondly in respect of the quantity and quality grossness or subtilty of the Gouty matter more or less malignity whence proceed the denominations of the Running and Fixed Young and Old Adventitious and Hereditary Gout Thirdly in respect of the greater or less afflux of humors Fourthly the Gout is either with nodes or without nodes Fifthly there is a Gout which is seated in or about the Joynts and another though that be rarely perceived which lodges it self in the midst of the limbs And this is to be noted against all those who will not acknowledg such a Gout for any Gout which is a great mistake and no longer tolerable because Experience teacheth us otherwise CHAP. XVII Means useful to prevent the Gout Q. WHat general means do you think to be good to prevent the Gout A. These following First you must beware of windy meat and drink Secondly you must avoid great and violent commotions of the mind especially the passion of anger Thirdly neither must you put your body into too violent motions and exercises nor afflict it with night-wakes Fourthly you must take continual care to keep your body soluble and to prevent costiveness nor to remove the same too suddenly Fifthly 't is beneficial to take a gentle Vomitive after your meal once a week Sixthly as soon as you perceive any signs of a Fever the mother of the Gout then is it proper to take a sudorifick by the advice of some experienced Physitian to open the pores and to promote evaporation Eighthly since that many of the chief Physitians forbid wine to Gouty persons as if it were poison to them though Sennertus is not so peremptory therein but that he allows even to those that actually are in a gouty fit a cup of good and sincere Rhinish wine especially if the Patient cannot forbear it I see no reason in the World why these Patients should be so quite debarr'd this strengthning and cordial liquor wine as in and after the fit especially if it be a good condition'd wine And my opinion is that such a wine is so far from being noxious that it is beneficial to them for many reasons which Van Helmont alledgeth at large in his Book of Fevers whose judgment I cannot but subscribe to in this matter CHAP. XVIII Of the Tooth-ach or the Gout of the Teeth and the Cure thereof Q. IS there also a Gout of the teeth for I have been inform'd by Dr. Wilhelmus de Ryne who lately is arriv'd here that there is publisht a treatise in Europe entituled of the Gout of the Teeth A. Thus is very properly exprest that kind of tooth-ach which hath the same proximate Cause with the Gout and ariseth from cold Damps as the Gout doth which otherwise according to the common opinion is bred from Desluxions Q. But seriously do you think that the Gout and Tooth-ach come from the same Cause A. Ti 's certain to me whatever some may alledg to the contrary that the next cause the part afflected the seat the ways the signes and symptoms are the same in these distempers and do agree together Q. Is then the Cure of the Tooth-ach to be perform'd after the same manner as of the Gout A. By no means the Tooth-ach is to be cured in another place because that the place where the pain hath its seat here is within the mouth and the teeth where you cannot come to burn with our Moxa Q. Would you then have the Temporal Artery open'd with a lancet this seeming to be the way by which the evil damp may be expelled out of the teeth as some hath ventur'd to do to the great ease of the pain A. This means is too dangerous because it is very subject to occasion an Aneurisma and spends too much of the vital spirits Q. What do you say then of scarification in the neck or upon the shoulders or of purging or of blood-letting A. These and the like remedies seldom give ease Q. Would you have then the aching Tooth pulled out A. Not at all that way being a desperate one and not only accompanied with great pain mischief to the poor Patient but also occasioning many evils and even death it self But take me right I pray for I here only speak of that kind of Tooth-ach which is above described not of that which comes from the Rottenness of teeth Q. What then may we follow Spigelius whole manual operation Scultetus mentions in the 18th of his Chirurgical Observations who with his knife heated red-hot did cut off that little branch of the temporal artery which runs through the Ear to the teeth by which means the pain presently vanished and never return'd A. T is true that Scultetus speaks with great commendation of this device calling it a