of greife is incident to men of middle age and such as are of a sanguine complexion and do use a full diet with little exercise and much rest Thirdly the Gout is a greife in some by way of distemperature and this doth fall out as occasion is offered as some by standing long in cold water may have the Gout by reason of a cold distemperature which is wrought into the part by the cold water And some by much travell on foot in hot weather may have the Gout by reason of a hot distemperature procured unto the feet by overmuch travell and heat Lastly in some the Gout is a greife by way of corrosion not that it eateth the flesh but in that it gnaweth and fretteth that the patient somtimes thinketh that dogs do gnaw his bones This kinde befalleth cholerick persons and such as use an ill diet breeding in them store of ill humors So is it evident that the Gout is a greife and what kinde of greife which is profitable to him that will give help thereunto for by the manner of the greife wee come unto the cause thereof and so accordingly apply the remedy It followeth that it is a greife of the feet There are foure reasons why the feet are more afflicted with these greifes than other parts are First in respect of their place for that they are the lowest parts in the body the upper put downe their superfluities to them where they remayning procure in some one manner or other as is before specified a paine The second cause is for that the feet are not of so compact or solid substance as some other parts are of but have a thinne composition with many void and empty receptacles and therefore in more abundant sort do receive and reteine the superfluities of other parts The third cause is for that the feet are more in motion than other parts and the nature of motion is to make attraction of humors unto the moved part and consequently a paine The fourth is a debility naturally incident more to the feet than unto other parts for that they are situate farthest from the fountaine of heat which is the heart They also consist of such substance as is of a cold complexion so that both for lack of the comfort they should have from the heat of the heart as also in respect of their owne composition the feet are weaker than the other parts and the weaker goeth still to the wall for they receive the annoyances of the stronger because they are not of strenght to resist and therefore must of necessity yeeld to their paine Now why in the Gout the feet should feele such greevous paine this is the reason for that they consist of many joynts and have for their motion and sense many nerves which are the instruments of motion and sense whatsoever part is most neruous is also most sensible and therefore the feet upon any little offence are pained or greeved the more Another reason is this that about every joynt is wrapped a skinne and when as a humor hath insinuated it selfe betweene that and the joynt in distending of that untill it bee resolved it worketh an intolerable greife and it is so hard to resolve it as that sometimes it doth indurate or grow into an hard substance which is called nodosa Podagra the knotted Gout And these two causes of the dolorous state of the feet are accidentally growing from the part it selfe affected In respect of other causes I have given other reasons before in the fourefold distinction of greifes Now it doth follow that this greife in the feet is occasioned by some distemperature There are eight sorts of distemperatures foure simple and foure compound The foure simple are too hot too cold too moist too dry The foure compound too hot and dry withall too moist and cold withall too hot and moist too dry and cold with all And these inequalities come by reason of some unequall mixture of the foure elements in us and the dominion of some one or other above the rest The foure elements whereof wee are compounded are the fire the ayre the water the earth the element of fire is hot and dry the ayre hot and moist the water cold and moist the earth cold and dry Of these foure mixed together come the foure temperaments or complexions The cholerick hot and dry where the fire hath the dominion the sanguine hot and moist wherein wherein the ayre hath the dominion the phlegmatick cold and moist wherein the water hath the dominion the melancholick wherein the element of earth is predominant and of these foure temperaments come the foure humors to wit choler hot and dry blood hot and moist phlegm cold and moist melancholy cold and dry Of these foure humors are framed and maintained all the parts of mans body so that if they offend either in the first composition in any inequality or after by disorder of diet be made unequall then do they breed either in the whole or in some part the like inequality And hence it commeth that we have hot and dry diseases as Fevers and we have cold and moist diseases as the Palsey Apoplexie the falling sicknesse and divers moe also we have diseases of the blood as inflammations and likewise of melancholy Which all diseases as some in some one part and some in some other may come of the distemperature of the same part so the Gout may also come of a distemperature in the feet either bred therein originally or by some disorder procured unto them as hereafter in the causes which procure the Gout shall appeare It followeth that it is occasioned eyther by some distemperature or irregular humor The humors of the body are either good and naturall and then nature rejoyceth in them for that they nourish the body and maintaine it in good health and long life Or else they are naught and contrary to nature for that they procure diseases and destruction unto it as when they are possessed with putrifaction Or else they are neither good altogether neither bad but semimali halfe naught and this state of the humors I call irregular because they are not altogether over-ruled by nature and that in three respects for either they offend in quantity in being in greater abundance than the nature of the body requireth or they offend in quality being too hot or too cold or too sharp and rodent or else they offend in substance when as they are declining some what from a good and naturall state unto an unnaturall There are three sorts of bodies considered in physick the body healthfull the body diseased and thirdly the body neither perfectly whole neither diseased but in a neutrality between both which is after two sorts either when a sick body recovereth and groweth toward health then it is neither whole nor sick or when a whole body is declining from a healthfull state and groweth to bee sick
in time of hunger and hard fare it is by better concoction converted into a profitable blood for the maintenance of the body And therefore next unto blood it is of all humors in greatest abundance in the body and hath no proper place allotted unto it but doth converse with the blood in the veines and that for three causes The first is to make the blood more current in the veines which of it selfe otherwise would be too thick The second is for that with the blood it should passe to such phlegmatick parts as are to be nourished therewith The third that it should go into the joynts for the suppling and moistning thereof for they are compounded of dry substances which without that kinde of suppling would bee unapt to any ready motion wherefore this humor may bee defined after this sort That it is an humor in quality cold and moist in substance crude and inconcocted in colour inclining to white or either of no taste or somewhat sweet which being bred in the stomach is from thence conveyed to the liver and from thence by the veines with the blood is distributed into all parts of the body This humor is either naturall or unnaturall to the naturall belongeth that which is before The unnaturall is made either in respect of it selfe or by admistion of other humors Of it selfe sometimes it is too thick somtimes too thin sometimes roping like birdlime sometimes like to molten glasse called vitrea pituita There is also a phlegm which is sowre which likewise is very crude another of no taste which is not so crude and another is salt and that in respect of it selfe Now by admistion of other humors the like depravation ariseth being mixed with choler it is salt or being mixed with some putrified humor it hath the like taste and being mixed with melancholy it is of a sowre taste But in all these sorts of phlegme wee must speake after two sorts eyther properly or improperly Properly that is to be understood for the humor phlegmatick which with the blood goeth into the veines Improperly all the cold and grosse matter that commeth out of the braine and out of the lungs and stomach is called phlegme Now for the Gout it may come either of the humor it selfe or being mixed with other humors If it come of it selfe then must it not be thick or grosse for that is not apt for a deflux but it must bee a thinne phlegme which may be fluent and this doth happen to old men and such as are of a cold constitution which through weaknesse of naturall heat do breed it and therefore in such wee shall often see towards night their legs to swell for the humor being not good the heart and stronger parts put it downe to the lower where it doth settle and swell But in yonger persons we shall seldome see the Gout to come of this humor alone but being mixed with choler which maketh it more fluent and more to afflict the patient Wherefore now I will entreat of the third cause internall of the Gout which is the humor cholerick It it is to bee understood that the food whereon wee feed is not of one simple condition and nature and therefore is not in us converted into one only humor but moe And as in the liver this food is turned into blood so in the same part is there a purification of the blood by separation of other humors and by taking of them to their proper places wherefore with blood there are made in the liver both choler and melancholy for the thinner part and hotter is turned into choler and the thicker and grosser into melancholy The choler is drawn from the blood by the gall and the melancholy by the spleen which two places are the receptacles of these two humors This cholerick humor as the former is either naturall or unnaturall the naturall is an humor in quality hot and dry but not actually dry for that in touching it is felt to be moist but potentially for that it hath the power of drying and in substance thin in colour yellow and in taste bitter This being bred in the liver is divided into two parts the unprofitable part is passed over unto the gall and the profitable goeth with the blood into the veines which is for two causes the one that it may go to nourish such parts as in whose composition and complexion this humor hath ought to do the other that by the sharpnesse and thinnesse thereof the blood may passe the better through the small veines That which is in the gall is evacuated by a conduct into a gut called jejunum the empty or hungry gut for that the choler comming into it doth clense and scoure it and so keep it empty And it is evacuated into the guts for two causes the one to clense and scoure them from slimy and grosse phlegm the other to excitate and stimulate them to expell the excrementall drosse of the guts The unnaturall humor of choler is made of it selfe by adustion or by admistion of other humors as with thinne phlegm and it is thin choler and of the colour of the pill of pome citron called cholera citrina or with thick phlegm and then it is thicker called cholera vitellina because it is like the yolks of egges which as they are some of a paler some of an higher colour so is this kinde of choler this choler by the action of greater heat doth become green and is called cholera porraria because it is greene like to leek blades and by greater heat it doth become black like unto rust and therefore is called oeruginosa cholera Of all these sorts of choler the fittest to breed the Gout is that which with the blood doth passe into the veines for together with the blood it goeth into all parts and according to the disposition thereof affecteth such parts as are offended therewith the signes whereof shall bee declared hereafter The last cause internall of the Gout is the humor melancholy which humor is in quality cold and dry in substance thick and somwhat slimy in colour black in taste sowre The originall whereof is in the liver and the thinner part goeth with the blood into the veines for the nourishing of such parts as are by constitution melancholick and the grosser part is drawn from the liver by the spleen which is the proper seat of melancholy and from thence is put over into the stomach and that because it should in the mouth of the stomach procure the sense of hunger For hunger is a want of food the feeling or sense whereof is in the mouth of the stomach and that sense is made of the sowernesse of this humor whereby the orifice or mouth of the stomach is shriveled and wrinckled and drawn together whereof is made a desire of food And these two sorts of melancholy are naturall
There are also some unnaturall as when by excesse of heat the naturall melancholy receiveth adustion then is it unnaturall and called adust which if withall it hath any putrifaction it breedeth bad melancholy fevers There is another melancholy humor unnaturall which commeth by the adustion of choler which is a most euill humor whereof commeth dementia ferina a belluine madnesse when one is as mad as a wild beast Another unnaturrall humor melancholick doth proceed of the adustion of other humors as of blood and of salt phlegme The fourth is when in the unskilfull cure of tumors there is left an hard substance for this if it should come to exulceration would proue a cancer a kinde of ulcer which is hardly cured or not at all Now the Gout doth indeed seldome proceed of the melancholick humor first for that there is no great store thereof in mans body secondly for that this humor is not apt for a deflux because it is grosse Notwithstanding sometimes it fal leth out being mixed with some other humor it may communicate with it in the procuring of the Gout And thus farre forth concerning the causes externall and internall of the Gout It followeth now that I deliver the signes whereby each cause is to bee knowne And first for the causes externall they are to bee found out by the inquisition of the Physitian and relation of the party for the Physitian must aske the patient of each one and the patient must answer particularly so shall it appeare by what externall meanes he hath gotten his Gout Wherfore â—ereof I surcease to speake because it standeth in the private conference of the Physitian and patient But concerning the causes internall they do only stand in the skill of the Physitian to judge of and to diserne by the signes Wherefore first of the first internall cause of the Gout which is blood Whereof when it proceedeth it is to bee known by these signes first of the manner of the tumor for when the Gout proceedeth of blood then doth there concurre a tumor or swelling and that very big Next of the colour for the tumor will be very red Thirdly of the heat of the part for it will be but of a tolerable heat Fourthly of the manner of the greife for it will not be extreme and that by distention for that the fulnesse of blood in the part doth by dissevering such parts as are united cause in the part affected a distending greife Hereunto must bee added the complexion of the patient which if it be sanguine it confirmeth with the former evidence that the Gout proceedeth of blood Also the age is to be considered whether the patient be yong and his manner of diet whether he doth use to eat liberally and that of the best and most nourishing meats and drinks Also his custome of life whether he live at ease and much rest enjoying many delights which if they concurre to the former it is the greater confirmation of blood And if any usuall evacuation of bleeding by the nose or otherwise bee suppressed after that the Gout befall to the person it is an argument that it is of blood If the Gout proceed of choler then is it known by these signes first the tumor is not so bigge The colour thereof is pale The heat that followeth this humor is most vehement The paine it procureth is untolerable It is greatly releeved by application of cooling things Hereunto must bee added the complexion of the patient whether it bee cholerick Also his age whether hee bee in the middle age which is from five and thirty to five and forty the hot and dry time of mans age And whether his diet hath been of cholerick meats and hot and dry wines And whether hee hath led his life in sorrow and care or watching or study or fasting or hath used great labour and travell which all or some if they concurre because they are the breeders of the cholerick humor they signifie unto us the cause of that Gout to bee the said humor But when the Gout proceedeth of a phlegmatick humor then the tumor thereof will bee very big and soft The colour thereof white The paine not great except so great quantity of the humor possesse the part as that by distention the paine is augmented The heat it procureth is little and it is releeved by application of hot things The complexion of the party is phlegmatick or having used meats of a cold and moist constitution and lived in much rest without competent exercise giving himselfe to much sleeping or bathing and that immediatly after meat Also the old age is a signe of this humor and the cold time of the yeere as winter a cold and moist-habitation which are both causes and signes of a phlegmatick humor Now if the Gout proceed of a salt phlegme then together with the other signes there will bee in the part affected a great itching which is caused through the saltnesse of the humor The Gout doth seldome come of a melancholy humor but when it befalleth it is known by the tumor for it is little and hard and in colour black The paines will be as if the part were bored with a percer There will appeare little heat but rather a cold The person is in the declining age as from forty five to fifty five His complexion is melancholick and hath used to eat of melancholick meats and to give himselfe to much labour and travell even to overgreat defatigation his habitation is in a cold and dry place and commonly it haunteth him in autumne Thus farre of the signes of such particular causes internall as occasion the Gout which causes being somtimes confounded as blood and choler or blood with phlegme or melancholy or melancholy with blood choler or phlegme the signes are more hard to bee seene and therefore the cause more hard to be known and the cure very hard to bee performed for in a confusion it is hard for a man to determine upon a certainty and that which may be good for one is hurtfull to another whereas things of contrary natures and dispositions are confounded together wherefore herein doth cheifly consist the skill of a good Physitian as by the signes to judge whereof the confusion is made and to discerne the one from the other and so to moderate his medicine that in doing good to some one which principally hath the dominion it may not work any inconvenience to the rest This because it is a curious peece of work and standeth upon many termes of our Art it will bee but obscure and tedious if I entreat thereof wherfore here an end of this point which containeth the signes of such causes as procure the Gout Now to the next point whether the Gout may bee cured or not I would I could warrant the cure for I might bee the richest Physitian in England Many make many vaine brags to win them a name but if a
is and by what wayes it descendeth so wee shall the better finde a releefe to the part whereunto it descendeth And so to conclude this point the Gout is a paine of the feet depending upon some distemperature of the part or of some irregular humor either bred in the part by imbecility thereof or derived from some other part and that principally the braine which definition how it is to bee understood I have for better declaration sake verbatim expounded so that this may suffice for the first point to wit what the Gout is The second point conteineth the causes The causes of the Gout are partly externall and partly internall The externall are first too moist a state of the aire for that doth engender great store of rheum Also the use of many sorts of meats and too great ingurgitation thereof for that doth heape up great store of humors which one way or other must have a vent Also ill digestion for that doth engender ill humors Also the often use of strong wines especially fasting because they do send up many vapors unto the braine and fill it full of rheumatick matter and do withall procure a weaknesse to the nerves and sinewes whereupon must needs follow that nothing can bee worse for the Gout than to be often drunken The immoderate use of Venery is wonderfull ill for that it spendeth the spirits and decayeth naturall heat and so procureth a weaknesse to all parts of the body Also the Gout may come of overmuch sleepe especially in the afternoone and that immediatly after meat for that doth fill the brain full of rheumatick matter Also overmuch watching and fasting and study and labour and sorrow and care because they spend the body and cause a weaknesse in the parts thereof may occasion the Gout It may come also of too much rest and ease for that such superfluities are retained in the body as should bee discussed by exercise Also much walking and travell on foot because it draweth a deflux to the feet may procure the Gout Also the use of cold and moist meats as Cucumbers Gourds Lettuce Endive and such like Also it may come when any usuall evacuation is stopped for then the matter wanting an usuall vent will flow into other parts of the body And because exercise doth evacuate by sweat much superfluous and excrementitious matter the omission or long intermission of any accustomed exercise may be an occasion of the Gout Also too much cold in the feet because it dulleth the naturall heat of the part And too hot keeping of the feet because it resolveth forth the naturall heat of the part and so weakneth the feet may procure the Gout Sometimes the Gout commeth by inheritance The reason whereof is this The seed wherof conception is made is taken principally from the principall parts For the liver giveth the blood whereof it is made the heart giveth the vitall spirit whereby it receiveth life the braine giveth the animall spirit whereby it receiveth motion and sense and secondarily it is taken from all parts of the body so that if any imperfection be in any one part of the parents the inconvenience thereof often befalleth the child These and such like may bee the causes of the Gout externall and they are to be found out by the inquisition of the Physitian and relation of the patient All which do not one way procure the Gout but some by breeding the matter thereof some by procuring the deflux of the matter some by weakning the joynts making them subject to the deflux Now to come to the internall causes they are either blood or choler or phlegme or melancholy and that simply some one or moe mixed together Blood is of all humors the best First for that it is the matter or substance whereof the spirits are made wherein doe consist all actions and functions either vitall or animall or naturall Next for that it is that that doth nourish the body for it is the treasure of nature and the upholder and maintainer of life and therefore Moses said that anima omnis carnis est in sanguine the life of all flesh is in the blood This blood is made after this sort The food which we receive into our stomach is there converted into a white substance called chylus which being put over into the guts is from thence sucked out by certaine veines called venae mesaraicae which are dispersed all over the upper guts and bottome of the stomach and by them is conveyed into a veine entring into the liver called vena pâ—rta aâ—d by that it goeth to the liver wherein it is converted to blood by a peculiar property and faculty naturally given unto the liver Wherefore blòod is a humour hot and moist made ex chylo that is a substance of food concocted in the stomach being from thence and the guts by certaine veines conveyed into the liver It is after two sorts either good or bad The good is knowne first by his substance it is not too thick nor too thinne but of an indifferent substance Next by the colour it is very red Thirdly by the tast it is sweet Lastly by the smell for it is of no ill savour or sent The bad is when it declineth from these conditions and that either in respect of it selfe or of other humors mixed therewith In respect of it selfe it is sometimes not good either for that the substance therof is thicker or thinner than is convenient or because it is adust or burnt blood the thicker part wherof goeth into melancholy and thinner into choler By admistion with other humors it may bee made naught after sundry sorts in respect of great variety of many other humors as may be mixed therewith As being mixed with melancholy it is made thick and grosse and black being mixed with phlegm it is made cold and whitish with choler it is made thinne and pale or yellowish and hot and fretting and bitter And being mixed with putrified humors it is wholly corrupted in substance in colour in taste and is of an ill savour This blood amongst the rest is one internall cause of the Gout when as it is good but in too great quantity whereof I have given a reason before but most of all when it is bad either in it selfe or by admistion with other humors for being once made in the liver it is put over into a great master veine out of the which a great multitude of other veines some big some lesse do ramifie whereby this blood is conveyed into all parts of the body and such as it is good or bad so doth it affect the parts of the body either in good sort or in bad The second internall cause of the Gout is the humor phlegmatick which is next unto blood for that it is indeed a crude or inconcocted blood and
amisse Vineger and all sowre sauces and drinks are not good for that they turne to melancholy It is most hurtfull herein to be sad and carefull Concerning the cure Neither this humor neither the former of themselves require any emission of blood for that the state of those bodies which they possesse is already too cold but if it chance to be mixed with blood then at the very beginning it shall bee convenient to let blood premising some solutive clyster or lenitive medicine Next the humor and body must bee prepared with such syrups or decoctions as do respect melancholy as with Burrage and Buglosse and Fumitory and tops of Hops and Cetrach and such like Then the humor must bee purged with such purgative medicines as respect the humor as with Sena Polipody the black Mirabolans Epithymum with Catholicon and if need be Diasenâ—a and confectio Hamech When as the humor is somwhat stayed by purging then must we come to locall medicines which first must be to repell next to resolve Such as repell must bee moderately hot because the humor is cold of it selfe as the leaves of the Terebinth tree and of the Cipres tree and the roots of Cyprus boyled in vineger wherewith the part is to bee bathed To resolve this or such like may do well Take of the tender Bay leaves and of Camomill Dill Penyrioll of Basill and the roots of the Flower-de-luce boyle all together and with the water bathe the part and stamp the herbs into a pulp whereunto adde the flower of Barly and Fenygreek and Linseed with some Capons grease or oesipus or Goose grease and May-butter and apply it warme to the place and so change it often And if one thing cannot doe good wee must devise some other for it falleth out oftentimes that some one thing may doe good at some times and sometimes it can do no good and being applyed a little while it doth good and being longer to the part it doth harme Now if the Gout come not of any severall humor but by the mixture of mo then is there a great discretion to be used of the Physitian either to judge of the predominant humor or of the manner of their mixture and accordingly to apply his remedy As if choler or blood or phlegm or melancholy be predominant then the medicines or cure must cheifly be appropriated to that somewhat respecting the rest or if there be an equall mixture of all which doth seldome befall then there must be such a mixture of things for the cure as shall respect all not doing harme to any but good unto all And this makes the Gout so hard to bee cured for if in a deflux one only humor would descend we should easily know it and sooner amend it but it falleth out for the most part that one brings downe another and mo do concurre and such as are of a contrary nature as choler and phlegm then groweth it out to bee hard both to judge of the cause and determine of the medicine for that that doth good to the one may do harme to another Thus in rude manner I have gone over the Gout first shewing the nature and essence thereof Next in giving the causes thereof Thirdly in delivering the signes whereby each cause is to bee known Then in discussing whether it may bee cured or no. And lastly what method or kind of cure is convenient for the Gout in respect of such causes whereof it proceedeth Now because hee that hath once had the Gout and he that feareth lest he shall have it would gladly have some meanes how to avoid it It remaineth that I set down an order of preservation which albeit I cannot do so absolutely for that it must cheifly be referred to the person affected so that one only rule cannot serve all because we are not all alike in constitution in diet and such like yet I will endevor a generall order which shall bee good for all such to observe as would bee willing to avoid the Gout And first in these diseases that are reciditive and chronicall long lasting diseases the the cheifest and principall point is to observe a good diet This diet must concerne certaine points first that it bee such as doth not breed distillations and rheumes Next that it bee such as doth not frait the body too full of humors Thirdly that it be such as doth not breed any weaknesse in any principall part or in the joynts To these purposes first we must take choice of the ayre avoyding a moist and cold situation as by some river and standing poole or marrish ground or moted habitation Cloudy or rainy and misty weather is naught wherein we must keep within and keep a good fire Hippocrates saith that the Southerne winds do fill the braine full of rheumatick matter because from the meridionall point they blow crosse over the seas and by the vapours thereof are made moist so that being hot of themselves and moist by the sea they become unwholsome disposing things to putrifaction and filling them with too great store of moisture wherefore they in this case must bee avoyded A cleare ayre wherein the Sunne shineth the wind standing somwhat Eastward or Northward is best In meats and drinks wee must observe certaine points as the substance the quantity the quality the time of taking them and the order how they are to be taken First for the substance the meat should bee of a good substance breeding good humors and of no hard digestion as Mutton Veale Capon Chicken Partridge Feasant Pullet Rabbet Wilde fowle is held but of a grosse substance but Woodcock Snight Mallard Teale Whinder Heathcock and generally such as have the whiter flesh may be taken but Goose Duck and such as are of a black flesh are reproved Beefe is of a hard grosse substance Hart Hinde Buck and Doe are the like And because they are prepared with much pepper and salt and thereupon wee poure in great store of wine they procure much inconuenience Salt meats breed no good juyce nor humor Fish is a moist meat but being such as wee call petrosas or saxatiles that live by rocks or upon gravelly waters being boyled with some of the hot herbs Whiting-gurnat Haddock are good Sammon if it bee boyled in water and vineger with rosemary may bee eaten Pike is not amisse especially if it bee taken in a scowre or put into a stew to be clensed So Bream and Carp should be used and generally such fish as live in muddy or in grosse water either is to be rejected or to bee corrected in the keeping or dressing Herbs breed no good substance especially in our Climate for that the heat of the Sunne is not sufficient to concoct their watery moisture and to bring them to a perfection wherefore wee use them for sauces and not for food Some roots may bee good as Carrot Skirwirt and the Parsnep if hee