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
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
or some other convenient liquor This being done the humor is to be purged with Rheubarb yellow Mirabolans and some of the former contrived into a potion As take of the decoction of cold herbs or of the distilled water of Endive foure ounces infuse therein all night two drammes of Rheubarb and of the yellow Mirabolans one dram in the morning straine it and expresse it som what then adde thereunto of Cassia one ounce and an halfe of the syrup of Roses solutive two ounces mixt altogether and drinke it in the morning fasting abstaining to eat by foure houres after then take some of the broth of a Chicken if the deflux continue then the purpation must bee taken againe untill the cause be somwhat stayed Next hereunto must bee used locall medicines to strengthen the part affected and to coole it and to appease the greife that the part abideth Take oile of roses the yolkes of two egges and a little vineger it shall both coole and comfort and mitigate the paine Or take the juyce or decoction of cooling and astringent herbs as of Plantaine Polygonum Sorrell Purslaine Nightshade Singreen or such like which being grreene and stamped in a mortar may bee applyed to the part for the cooling thereof and repelling of the humor If hereunto bee added some oyle of roses and some barley flower it shall bee better Also the seeds of Psyllium being boyled in water and brayed in a mortar untill it come to a pulp with the flower of barly and so applyed to the part doth in excellent sort both coole and mitigate the pain Aetius reporteth of one that being in most intolerable pain of the Gout put his feet into cold water and received singular reliefe The pulp of Cassia with the powder of Camomill flowers is well commended to be applyed to the part Now if the paine be so outragious that nothing can asswageit then we do use some things to dull the sense of the part which are to bee used with great circumspection Such are Henbane and Poppy and Hemlock and juyce of black Poppy called opium This must bee used in little quantity and must not lie long to the part And when the part is amended then some warme things must bee applyed to recover the cold disposition which by these extreme cooling things is got into the part Now to come to the cure of the Gout proceeding of a phlegmatick humor And first for the diet The aire must be hot and dry whereunto if the time of the yeere doe not serve then it must bee procured by art Much sleepe is not good but some watching is better because it doth dry And for the same cause fasting is good in this kinde of Gout moist meats are hurtfull as Veale Lamb Pig Conies and such birds as are rehersed before are better Fish is not good but if it bee taken it must bee boyled with Hysop and Thyme and winter Savory and some such hot dry herbs to correct the moistnes therof Wine is forbidden but yet it may be best tolerated in this kind of Gout All fruits cold herbs must be avoyded The manner of cure is to procure a vomit if the patient be apt thereunto and do it with some facility Next the humor must bee prepared with such things as doe extenuate and rarifie the humor as hony made with roses and hony made with vineger called oxymell or with the syrup or decoction of staechas and betony and such like Then must the humor bee purged with such purgatives as do respect phlegm as with Agarick and the seeds of Cartamus and the great Mirabolans and Diaphenicon and Electuarium Indum and such like infused and mixed in a convenient liquor After purgation if the person do much abound in cold humors it shall bee good to give him Treacle or Mithridate After this wee may come to the locall medicines which in the beginning must bee somewhat discussive and more astrictive in the encrease of it they must be lesse astrictive and more discussive and in the very rigor thereof they must be such as ease the paine and discusse and in the declination they must be wholly discussive to resolve out that matter which by deflux is descended into the part But therein this observation must bee used that things of too hot operation bee not applied for the thinner part of the humor will be resolved and the grosser will grow into a hard substance whereof commeth that incurable Gout called nodosa the knotted Gout Wherefore in the beginning it may bee good to take Thyme and Penyrioll and winter Savory with Mallowes and Holly-hocks the roots of white Lettuce and Fenygreek and Linseed boyle them in sharpe vineger and being throughly boyled take of the decoction poure it upon the part and also bathe it therewithall In the encrease Neats dung or Goats dung with barly meale and Barrowes grease all mixed together over the fire with a little vineger being applied to the part will do it good In the vigor this may bee used take the oyle of white Lettuce and the oyle of Roses and oyle of Camomill and Dill and some May-butter and of Deare-suet and of Ammoniacum and Galbanum dissolved in vineger and with wax make thereof a plaster and lay it upon the part If there bee no great heat in the part it may be made stronger In all sorts of Gouts some do use a defensive of bole armoniack and whites of egges binding it hard below the knee to straighten the passages whereby the deflux descendeth and so to prohibite any further deflux as in the toothach by a rheume wee use a plaster to the temple to prohibite the falling down of the rheume To this kinde of Gout the Bath is most good especially when it declineth for otherwise it may be too hot and so procure a greater deflux and augmentation of heat Also Snailes being brused in a mortar and layd to the part is excellent good Take of Castory and Frankincense of the marrow of a Hart and of Goose grease of the oyle of Dill and Nard oyle of Baellium and Galbanum dissolved in vineger and of the meale of Linseed and Fenygreek and so much Vigin-wax as will serve to make a stiffe plaster This doth resolve very well as many mo which I omit to set downâ— because it would be too long When the Gout consisteth on a melancholy humor which chanceth seldome then the diet must be accordingly prescribed As the ayre must incline to moysture and heat sleeping and watching must be in moderate sort The meat must be of the best as Partridge Fesant Capon Chicken and such like All wilde fowle is naught as also Venison Hares flesh and Beefe and all salt and burnt meats Such fish as doth live in gravelly sandy and stony waters being boyled with some of the hot herbs and Burrage and Buglosse is not
By the first sort of humors the first kinde of bodies is maintained and by the second the second kinde of bodies is corrupted and by the third kinde the third sort of bodies are molested Now for the Gout it cannot come of good humors for that they bring no paine to the body but comfort And of the second sort it cannot proceed for then there should alwayes a bad fever go with the Gout for that such humors have alwaies in them a putrifaction Wherefore it remaineth it come of the third sort either through their overgreaâ— quantity or ill disposed quality or some depravation of substance and these are the humors which I call irregular for that they are not obedient to nature and yet not altogether repugnant to nature but by some slender meanes may bee corrected and reclaimed unto a good and naturall state It followeth that these humors are either bred in the feet or by a deflux descend thereinto from some upper part When ill humors breed in a part it is through an imbecility and weaknesse of that part The strength of all parts consisteth in a naturall heat grounded and setled naturally in that part by vertue whereof there is drawn to the part a competent food to maintaine it and by it that food is concocted and converted into a profitable nutriture for the same part retaining that which is good and expelling that which is excrementitious and nought Now when this naturall heat by any sinister meanes is infirmed and weakned then do the functions of that part faile in their duty for neither can there bee good concoction in the part as should be neither sufficient expulsion of the superfluities left of that concoction in the part as should bee Wherefore three inconveniences follow through this infirmity of naturall heat First good and profitable matter is not bred in the part so affected And the bad is not expulsed And thirdly the part is made a sinke to receive the drosse of other parts Now if by some meanes an imbecillity happen to the feet that neither they breed for themselves a profitable nutriture and yet cannot expell that which is unprofitable it must needs follow that in keeping thereof they cannot bee well but ill affected This is to shew that the matter of the Gout may be bred in the feet through the weake state and condition of naturall heat appertaining unto them whereupon doth grow humorum decubitus as we terme it that is when for lack of good concoction in any part ill humors by little and little are laid up in that part which after some season either by their overgreat quantity or ill affected quality and by some depravation of their substance prove offensive and hurtfull unto that part It followeth now how the Gout may come by a deflux of some humor descending from some upper part into the feet which is in two respects For either it may proceed from the braine or from other parts in the podagricall body The deflux of an humor from the braine is called a rheume which is the mother of many diseases For somtimes it taketh course to the eyes and thereof commeth a dropping and inflammation of the eyes and a dimnesse and losse of sight somtimes it taketh course by the nose and is called the pose sometimes to the mouth and causeth great expuition and spitting and the falling of the uvula and toothach somtimes to the windpipe and therof commeth raucedo the hoarsnes somtimes to the lungs and causeth exulceration or putrifaction thereof or some great obstruction which bringeth a difficulty of breathing and strangulation sometimes it taketh course to the stomach and causeth lack of appetite and ill digestion and if to the guts then falleth out the flux of the belly called a lask somtime it setleth in the braine and groweth into a grosse and thick substance either in the fore part as in the nerves optick which are the conducts whereby the power of seeing doth come unto the eyes and causeth either dimnesse or losse of sight or in the conducts that convey the power of hearing unto the eares and there causeth a dulnesse of hearing or deafnesse or in the conducts that convey the power of smelling to the nose and cause either a lack or losse of swelling or in the conducts that come to the tongue and there doth occasion the like imperfection in tasting Also if it settle in the fore part obstructing the cels or ventricles of the braines three ill diseases do grow thereupon called three of the dead sleepes carâ—s coma apoplexia Also in the fore part it causeth a hurt to imagination The middle part of the head is the seat of understanding and reason where if this grossâ— rheumatick matter do settle it causeth stultitia foolishnesse In the hinder part it causeth the lethargy another of the dead sleepes and the palsey and the falling sicknesse and the convulsion and oblivion or losse of memory And if it come down backward into the neck it causeth a kinde of convulsion called tetanos when as the neck cannot turne to nor fro but it standeth stiffe and stark without motion If it flow downe to the back it causeth another kinde of convulsion called â—pisthotonos wherein the head and the heeles are made to meet backward If it flow forward into the muscles of the breast another convulsion is caused called emprosthotonos wherein the head and the feet are drawn together forward Now if it go to the joynts it is morbus articularis if to the hands and fingers it is chiragra if to the knees it is gonagra if to the feet and toes it is podagra the Gout And the reason why the rheume should occasion all these diseases is this The braine is the fountaine of nerves principium nervorum and in the braine are made animall spirits which do give the power of moving and feeling and are conveyed by those nerves into every part of the body so that when the braine is affected in rheumatick sort partly by them and partly by other meatus as it were passages the inferiour parts shall feele the effects of this ill disposition of the braine And between the head and the feet there is a great consent by reason of many and great nerves and veines extended directly from the one to the other so that many shall bee ill affected in their head by taking cold in their feet This deflux also which is in cause of the Gout may proceed from other places as the liver and therefore in every deflux there are foure points to bee considered The first is the mandant from whence it proceedeth The second the matter that floweth The third the passages whereby the matter descendeth The fourth is the part recipient wherein this matter setleth it selfe Now when we are to deale with a disease that dependeth upon a deflux wee must find out from whence it proceedeth what it
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