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
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
and some trouble before this Swelling can be removed yea if you do not take care it not only lames the Patient but also deforms him by Nodes and Schirres whereby the Motion of the limbs is for ever destroyed Qu. What then is to be done to judg aright of this Symptom An. You must hold it for a certain truth that the Humors which in the Gout breed the Swelling are not the peccant or Gout-breeding matter Qu. To make me the better comprehend this pray give me a clear description of this Swelling which hath been the occasion of so many Errors and hath deceived so many Learned men An. It is a Preternatural swelling in the Fleshy parts consisting of a serous humor pervaded with saltishness by the sharp pain penetrated into the Limbs and 't is soft pale and cold Qu. But how may we best distinguish this Swelling from the Gout An. If it be view'd at the time when its Efficient cause is gone for then it may be seen in its true essence and qualities and looks no otherwise than a Serous humor is wont to do Qu. I see you make two sorts of Swellings in the Gout An. I do so the one is Windy which is the Gout it self the other Serous which is a Symptom And they differ exceedingly from one another Qu. Wherein consists that difference An. Chiefly in these particulars 1. In respect of the Name which they receive from their several Causes for the Gouty tumor coming from Winds takes the name of Windy tumor the other coming from a serous humor is called the Serous tumor 2. In respect of the Part or Place affected for whereas the Windy tumor distends the Membranes of the bones the Serous fill the Carncous parts as water a spunge and render the Flesh very spungy 3. In regard of the Signs for whereas the Inward swelling excites grievous and intolerable pain the Serous none or little 4. The Internal swelling is a proper disease the other is raised by the pain and is a Symptom bred by Consent of parts Qu. But since that the Serous tumor in the Gout is not produced by any External cause but by an Internal what is this Cause An. The violent pain as hath been often said which is here the cause of the Afflux of humors it being known by Artists that Pain draws humors after it which therefore is by them assigned to be one of the principal causes of the Afflux of humors Qu. But are these humors of which this kind of Swelling consists drawn into the suffering parts by the Pain alone An. Artists are wont to add that sympathizing Nature as a kind Mother succours the suffering part by sending moisture to it and accordingly this Swelling should be generated by Sympathy of Consent of the parts Qu. What benefit or ease doth the part affected receive from sympathising nature by her sending those humors thither An. That the raging pain is thereby mitigated and rendred more tolerable Qu. In what manner is that done or how doth the conveyed humor asswage the enraged pain An. Though this be difficult to explain yet I cannot agree to the common opinion importing that the Pain-breeding matter by means of the conveyed humors is driven outward and dispersed thorough the neighbouring flesh and so the suffering member for a great part freed of the pain-causing matter For the conveyed humors can by no means approach or come to the dolorifick matter much less fotch it out of its deep seat and dislodge it because 't is so fast impacted and included under so firm and close a Bone-membrane Qu. What is then in your opinion the reason why the sharp pain is often diminished upon the afflux of moisture not only in the Gout but also in the Tooth-ach c. An. Methinks 't is probable that 't is done after this manner The musculous fleshy parts being by the conveyed humors rendred softer plumper and more spongious and consequently gentler do not in the first place press against or rather resist so much the sensible and distended periostium as before when the carneous parts had but their own native and proper moisture Secondly the periostium being by the conveyed moisture from without made gentler may with less pain be stretch'd and it may also come to pass that by that little warmth which this serous matter hath in it at first it being now come near the periostium doth somewhat attenuate the included gross damp and so the better dispose it to evaporate Qu. But doth the affluxed humor occasion no mischief An. Very much and sometimes more than the Gout it self for without care it causeth Dislocation of the suffering members and the Nodes CHAP. XII Of the Dislocation Qu. HOw is it possible that the Gout-breeding matter should cause a Dislocation An. By the plentious stock of humors conveyed and drawn in Qu. But how doth this abundant moisture falling into the cavity of the joynts forcibly thrust the bones out of their cavity An. Not so but 't is done in manner following Pain and Nature cooperating the one by drawing in the other by conveying bring such a quantity of humors to the suffering part for example the Hipp that thereby in time the strong ligaments which tye the bones together are so ouzed thorow that being debilitated they stretch and grow so lax that the bone falls out of its cavity and so causeth dislocation Of which we have many sad Examples Qu. Doth not this mischief fall often out in other Cases An. It may happen in all the members of the body and then especially when an unskilful or imprudent Master by the use of wrong means occasioneth yet a greater afflux of humors than hath been already drawn in by the pain and furnish'd by nature Of which Pareus records a memorable Example in the Dislocation of the knees caused by a Parisian Master called Greaulm fol. 256. Qu. May this Dislocation be prevented by Art An. Very well as shall be shewn in that part of our Book which is to treat of the Cure of the Gout and its Symptoms CHAP. XIII Of the Nodes Qu. IS there yet more danger to be apprehended from this Symptom or its matter An. There is for if you take not great care it will change into an incurable Scirrbus or hard tumor which in the Gout are called Nodes according to that of Ovid Tollere nodosam nescit medicina pedagram Qu. When comes this swelling to change to such an hardness An. To borrow the words of Beverovicius when the thin humor is insensibly exhaled and the sediment rests behind then will that turn into hard knobs which bursting of themselves or being opened render a chalky or such like matter whereby our limbs are not only deprived of motion but also disposed to crookedness Qu. How many ways are these stony swellings generated An. Two either of themselves or by the unskilfulness of the pretended Artist Qu. When of themselves An. The Evaporation of the subtiler or thinner
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
by laying them on glowing wood-coals where they must lie until you see them begin to fall-in and then they are to be taken off and rolled stiff together betwixt the palms of the hands and then to be unrolled and displaid again being yet warm and moist and so laid on the Escar Continuing this until it be time to heal up the wound when the leaf being prepar'd again after the former manner is to be laid on with the smooth side to the skin by which means it will heal up without leaving a mark upon the part and much better than if you had employed the best plaisters Q. Why must these Leaf-plaisters lie a great while upon the part with the rough side and at last only with the smooth side A. Because the rough side draws out and the smooth side heals Q. Is there nâ—thing else to be observed touching these vegetable plaisters A. They are to be kept from falling off by some compress of linnen rags and to be refreshed or renewed twice in 24 hours Q. But in case the burnt places could not well endure the use of linnen compress how then may these Leaf-plaisters be secured from falling off A. You may lay over them a Diapalma or Basilicum-plaister only to keep the Leaf upon the Escar Q. But if Plantin-leaves be not to be had may not other leaves serve A. In that case you may use red Cabbage or Colts-foot-leaves and if these cannot be had employ the said Diapalma or Basilicum-plaisters Which may chiefly stand you in good stead when you are travelling by water or land CHAP. VII Of the admirable Effects of this Caustick Q. MAY a man rest in this application and expect the desired cure A. You may by God's blessing and the Physitian may look for honour considering that in so doing he cureth surely without inconvenience and even with pleasure Q. Then it seems there is no danger in the right use of this remedy A. None at all yea it is such an one than which there will hardly be devised a better and of which you will really see a wonderful effect for the good of the Patient Q. Will it succour nature with most speed and free her of the evil that encumbers and torments her A. It will whereas Hippocrates l. 6. Aph. 49. saith that the Gout requires 40 days to cure it which Galen seconds with the adding this condition viz. if the Physitian understand his work and the Patient do his part in observing carefully what is prescribed But this our Moxa by means of the Burning described draws this Wolf with speed out of his den and delivers the Patient instantly from his pains and anguish Q. But is this way of curing sure A. So sure that it fails not but is always beneficial and the success of it is so manifest that it cannot be doubted Q. But you did add that it would cure with pleasure which I understand not since you have above acknowledged that this Burning is not without some pain A. I mean thus that the Cure is pleasant in regard that upon a little sharp pain which lasts but a short time there follows a great pleasure and joy the fruits of this short pain being great and every way delightful forasmuch as the poor Patient discharged from the intolerable pain of the Gout instead of his doleful lamentations and outcries hath now cause to rejoyce and to break out into thanks Q. But is this all which the Burning with Moxa produceth A. No for the same being timely used hinders the afflux of humors though not always totally yet at least in great part Q. What benefit ariseth from thence A. Thereby is prevented all the mischief which otherwise may be occasioned by the afflux of humors such as is Dislocation and Nodes Whereas 't is certain that those who use this way of Burning duly and maturely shall never have cause to complain of those grievous effects Q. If all this be true this remedy may be extrolled to the sky A. Not only that but it enables the Patient to be upon his legs and to follow his vocation if it be not too toilsome and even to travel without any considerable trouble By the same also he is exempt from all other tedious and costly stuff salves ointments plaisters c. CHAP. VIII Shewing that this Burning with Moxa goes beyond all other Remedies of Europe hitherto used against the Gout Q. BUT when the Physitians of Europe and other parts from hence have better understood the nature of the Gout will they not be able to find out a better Remedy against it A. 'T is probable that upon the acquisition of the true knowledg of this disease they will not deviate so far as before from the way of curing it and that in all probability they will eschew many errors and mistakes but they will never find out any better remedy than this Burning with Moxa it being the best because the speediest cleanliest and safest yea the most genuine most secure and most accommodate means that can be excogitated by men Q. May not the enclosed wind which you say causeth all the trouble be drawn out by Sudorificks Cupping-glasses Issues Leeches or common Causticks A. By Sudorificks possibly there might be effected the greatest ease but the evil would not be fully removed seeing that thereby only the subtilest of the gourty damps would be exhaled And for Cupping-glasses Issues Leeches and Causticks none of them is able to fetch out this evil from its deep-lurking hole which is under the close and firm membrane which invests the bones Q. Is it not advisable to employ Anodines A. By no means because the pain is thereby not removed but only palliated and dulled but is afterwards raised up into greater rage Q. Is not Letting of Blood beneficial as many would maintain A. Letting of blood is better omitted for these reasons First because according to the opinion of the best 't is not advisable when the pain is raging to open a vein Secondly 't is not the Blood that 's peccant or faulty but the ill-conditioned Damps which indeed run together with the blood and spirits in the vessels but do never so mix with the blood as to make one body but may easily be sever'd Whereas 't is otherwise with the Blood and Spirits they two making up one body as the heat and water constitute hot water or as wine and the spirits thereof make one body of wine Thirdly by Blood-letting the noxious Damps are drawn inwards to the Heart and there occasion much mischief and the benefit you look for from it will not countervail the harm Fourthly the forces of the Patient are thereby diminished and Nature is enervated in her conslict with the disease whereas a good Artist ought always to befriend Nature by strengthning her against her enemy and a wise Physitian will not be forward to shed blood but preserve it as the treasure of life And as a Seaman in a tempest will
not throw his Bread over board but rather such commodities as he can be without so a good Physitian will keep the blood of his Patient and drive out ill Damps Q. What do you think of salves oils or other unctuous medicaments in this case A. They close the pores and obstruct evaporation Q. What opinion have you of hot Pickle humane Vrine warm Cow-dung c. A. They are means which are apt to mitigate yea sometimes to remove the pain but not always or very slowly nor radically Q. Would not an Hot iron be convenient to make this damp exhale as was practised in the Sciatica upon Jacobus Vincus Ambassador of the Prince of Lansbergen witness Dr. Nicolaus Tulpius Burgemaster of Amsterdam in his Observations ch 26. p. 228 by which means that Gentleman was freed from his trouble A. 'T is too sierce and withal too dangerous a remedy practicable indeed notwithstanding the contrary judgment of Fabrit Hildanus in his 6th part p. 501 but 't is better to use our gentle way of Burning which by far causes no such pain and is more beneficial without putting nature so hard to it To confirm this I shall now only add what Herls saith in his Examen of Chirurgery p. 364. viz. The burning with a red-hot Iron is too violent a way for Chirurgions and too painful for Patients and can seldom be used without hurting the flesh and muscles And doubtless all Physitians and Chirurgions will be of the same mind as soon as this way of Burning with Moxa shall come to their knowledg my opinion being that they will never make use more of an hot Iron but in such cases wherein the said Burning is not powerful enough as for example in the Rottenness of bones and the like Q. What think you of Spanish Flies now of so frequent use of which Jobus van Mekeren writes in his Observations that he hath used them with much benefit against the Gout following the advise of Dr. Vopisus Fortunatus P. lempius A. I esteem that all intelligent Physitians and Chirurgions will much rather make use of our Moxa for the good of their Patients they knowing sufficiently the venemousness of those Spanish Flies and how hurtful they are to the Bladder and other viscera and having used them long enough of necessity because they knew no better means And 't is remarkable what Aquapendente warns of the qualities of Spanish Flies in his Art of Chirurgery ch 3. p. 246. concluding with these words That 't is madness to use this deadly remedy Q. Is the Burning with Moxa less painful than that with an Iron A. Incomparably less nor is it so Dangerous according to the golden rule of Hippocrates lib. 2. Aph. 12. That to heat much and suddenly is dangerous but to do it by little and little and slowly is without danger And this is it what the expert Physitian Guilandin confesseth in Prosper Alpinus de Medic. Aegyptiorum ch 12. in that remarkable practice of the Burning in Cairo and thereabout Which Chapter highly deserves to be considered Q. But Sir do you not apprehend that the Aegyptian manner of Burning will go beyond that with your Moxa A. Not at all being well assured that the Aegyptians will be very glad to exchange their Cotton and Stramineous linnen with our Moxa as soon as they shall know the admirable vertue and effect thereof Nor is the Burning with Moxa by far so painful as all the world will judg when they shall see and compare both Q. Then I pray Sir be pleased to repeat in short what remedy it must be that shall free a man from this disease A. The genuine Cure of this Evil which attacks suddenly and will not bear delay without great injury to the Patient consists in the removal of the Cause and requires a remedy having these following proprieties First it must powerfully open not only the Pores of the Skin but those also of the Membranes of Bones Secondly it must attenuate the cold thick damps and resist their malignity Thirdly it must strengthen the innate heat and the expulsive force of the part affected thereby the better to master and remove the Evil. Now the Burning with Moxa performs all this It strongly draws out from the deep and resists all malignity it attenuates the cold and crasse vapors lurking under the membranes consuming or extracting them and so disburthening nature of her enemy lastly it so corroborates the weak suffering parâ— that it will not so easily receive and lodge again Damps of that nature CHAP. IX Shewing that this Burning is very tolerable Qu. BUT do you think you can easily induce your Patients to undergo this Burning A. Certainly being well instructed they will quickly submit to it though that kind of Burning which hitherto hath been used in Europe hath made men very averse from that way Q. How may they be best perswaded to it A. I would rather have them perswaded by other prudent and understanding persons than by the Physitian himself For as to him it will be more advisable he should seem himself cool in this business and stay to be intreated Q. But in case they will not be induced to it out of that perverse apprehension what then A. If they be so delicate as not to submit to so slight a pain they deserve not to be cured and so must keep their Disease But I presume it will be with you as 't was at first with me who having from an idle fear refused this Burning was afterward constrained by the grievous and raging pain to desire the use thereof And since that Gouty persons must day and night combat against the intolerable pain of the Gout certainly they will not easily be afraid of this innocent way of Burning I have seen weak and timorous women and young maids which made nothing of it in respect of the pain they had indured in their teeth and head Not now to speak of Children who without much cry and tears have endured this Burning to be cured of that kind of Dropsie called the Tympanites and of other infirmities and particularly of Convulsions Q. But many Doctors and Chirurgions are like to condemn this remedy as new and unknown and so render it suspected among their Patients A. The Effect will soon silence you and convince you of envy and ignorance Q. But may not this Disease be cured by gentler remedies A. No You may indeed mitigate the pain by gentler means but not remove the cause nor root the Evil out of the part affected which may best be done by this our Burning CHAP. X. Of the Qualification required in the person that is to perform this Burning Q. IS every one fit to perform this Burning A. No certainly but it must be one that hath a perfect knowledg of what is requisite to it both before and after and that is experienced in it because considerable mistakes may be committed therein Q. What are the particulars of which this Artist must be well
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