A treatise on the nature and cure of gout and gravel. With general observations on morbid states of the digestive organs; and on regimen

Front matter

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Contents

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GOUT.

Dr. Cullen’s Nosological Arrangement examined, 1.— Observations on Sauvages and other Authors, 11.—

Preface

TO THE FIRST EDITION.

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AutTuovuen the subject of Gout has engaged the attention of Authors from the earliest records of Medicine, there are few diseases which have remained more enveloped in doubtful theory > or in which, the practice has been so unsettled and involved in prejudice.

It may indeed be affirmed, that the Gout has at all times been a favourite object for the exercise of Empiricism; and every day’s observation demonstrates, that, whilst the impositions of quackery are received by gouty persons with the fondest credulity, the art of regular medicine is treated

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with indifference, or even rejected: so powerfully does an unknown agent affect the imagination, and indispose the mind to the exercise of the more sober faculty of judgment.

How irrational, in principle, the employment of empirical remedies really is, may in a few words be pointed out. Even the occasional success of a nostrum is injurious in its consequences, from the numerous misapplications to which such success gives rise; and, in this way, the more popular its character, the more extensive is the evil.

In a medicine even of known composition and properties, when administered as a remedy for the same disease in different persons, we see the action so much modified by individual constitution, that in one instance it aggravates the symptoms, as much as in another it gives relief. How much more indefinite and hazardous must be the application of a medicine, which is offered as a remedy for almost every kind of disease, and indiscriminately adopted in every kind of constitution! If any active powers belong to such a medicine, its inappropriate employment must produce occasional

PREFACE TO THE FIRST EDITION. Xlil injury ; if it be inert in its properties, it becomes a strong negative source of harm, by excluding other means which might be beneficial.

It is now to be asked, in what degree has the reproach which has fallen on the Medical Art, with regard to Gout, been really deserved °

A large class of gouty subjects surrender themselves wholly to empirical treatment. Another portion, and probably not the smallest, prefer their seeming security in exercising the difficult philosophy of pateence and flannel. They do this, either because they distrust the efficacy of remedies; or because they labour under the infatuation, that the gout is a certain remedy for other evils ; and should rather be invited than forbidden, in its approach and stay. The observation of the late experienced Dr. Heberden is still applicable to the present question. ‘‘ But as the supposed hazard of curing the gout is now the general belief, it seems reasonable that it should not be made the opprobrium of the art of healing, till the patients will conquer their fears, and allow that it ought to be cured. Happy, however, would it be for man-

Xiv PREFACE TO THE FIRST EDITION, kind, if the difficulty of curing the gout were to become as little as the danger of it*.’’

The greater number of authors upon Gout, from the earliest period to the present, have adopted a species of empiricism, in founding their whole rule of practice on some imaginary hypothesis. of a prozimate cause. Nor can the regular physician be entirely acquitted of having lent his sanction to empirical remedies. In proof of this, I may advert to the medical patronage at first so freely bestowed on the Hau Medicinale. Its magic powers of ease were very naturally hailed with delight by the suffering patient ; and Gout no longer appeared a disease of difficult management, or a source of terror. The sequel, however, has shewn the fallacy of the charm ; and has served to illustrate the fact, that the best remedies are not those which hastily produce a palliative and transient relief : but, on the contrary, such as are administered upon sound general principles; are carefully adapted to the variations of every particular case and consti-

* Commentaries, p. 47.— “It is not a sacred disease:

There will be no profaneness in handling it freely.’ —Rush.

PREFACE TO THE FIRST EDITION. . XV tution ; and are pursued with steadiness and perseverance.

It must, I fear, be allowed, that the regular treatment of Gout has been considerably neglected by the Profession. It appears to have been less an object of attention than any other disease of equal importance ; and it is usually pronounced by all parties to be intractable in its nature, and but little understood. In this reflection, however, I do not overlook the several modes of active practice which have at different times been proposed within these few years. Yet it has always appeared to me, that the views which have been formed of the nature and cure of Gout, have been too partial ; and deficient in attention to that code of general principles, which is essential to the true understanding and treatment of every disease.

Upon this conviction I was led to the present undertaking. I am well aware how imperfectly I have supplied the deficiency of which I complain ; but I shall have performed no useless task, if it should appear that I have entered into the right:

path of investigation ; and have succeeded in mak-

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ing some advances towards a clear and comprehensive illustration of the subject.

In the tabular arrangement which is annexed to this Treatise, I have detailed the analytzcal method of examination, which I have adopted in the study of the cases which have come under my care, and within my immediate information. From the method itself I have derived great facility of arranging my facts, and establishing my conclusions; and it is after no inconsiderable exercise of observation and reflection, that I venture to present these pages to the public.

On these grounds I feel myself entitled to advance the following general positions:

That the Gout is a disease not only injurious to the constitution, but destructive of the organization of the particular textures which it affects; and, by such united influence, tends both to shorten and embitter life :

That it is as completely within the useful influence of Medicine as any other severe disease :

Preface To The First Edition. XVI

That the fit may be immediately relieved in its painful symptoms, and materially shortened in

“its duration :

That most of its natural bad consequences may, by timely care, be prevented ; and, finally,

That all these advantages may be afforded by means, which, in removing the disease, tend at the same time to restore the constitution.

The security of the patient from future attack; is a question of separate consideration. It is true that it depends much on the Medical Treatment which is pursued in the paroxysm, and during the period of convalescence ; but it is still more connected with the patient’s own peculiar care. The gouty diathesis being established in the constitution, it is excited into action by many remote causes; and, certainly, of the chronic diseases, this appears to be influenced by a greater variety of hurtful agents than any other. Hence, without a corresponding observance of regimen, and general care, the gout, ere long, returns. In this case it will probably happen that the treatment which b

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was successful in the paroxysm, however judicious it may have been, is regarded as of little value ; or is even accused as being the source of disappointment.

The prophylactic means, indeed, deserve the most serious and attentive consideration in every individual case. In no disease, however, can the skill of the Physician be proof against a want of care in the general habits of the patient ; and those who are not their own Physician in this respect, have no right to censure the advice which they but imperfectly follow.

Upon the subject of Rheumatism, I have, on the present occasion, confined myself within narrow limits; and the practical consideration of the chronic species of this disease, I have entirely reserved as matter for a future volume.

I have long conceived that some useful light might be thrown on the phenomena of Rheumatism, both in relation to its theory and treatment, by attempting a more accurate principle of classification than has yet been laid down by authors ;

PREFACE TO THE FIRST EDITION. KIX and by employing that analytical method of inquiry, which unfolds to our view all the various causes and phenomena, both local and constitutional, which can be discovered in any way to influence, or to be connected with, the disease.

The illustrious Sydenham remarks, ‘“ The improvement of Physic, in my opinion, depends upon collecting as genuine and natural a description, or history of all diseases, as can be procured ; and laying down a fixed and complete method of cure.”

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Preface To The Second Edition

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An early demand for the first impression of a work, is one of the most satisfactory proofs which an author can receive, that his labours have neither been altogether devoid of interest, nor exerted in vain.

Under the influence of this consideration, I have carefully endeavoured to render the present edition more copious and useful than the former. For this purpose, I have attentively revised the opinions before advanced; I have again studied the cases from which I had drawn my conclusions ; and have also added a detail of all those results” and observations, which a progressive experience and more mature reflection have since afforded.

Convinced of the real and extensive benefits, which are to be derived from a scientific, and patient

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cultivation of the healing art, I have strenuously opposed every innovation of empiricism and empirical principles ; and have endeavoured to shew, that it is only by a steady and unremitting observation of natural phenomena, that the philosophy of medicine can be established on a firm basis ; and the profession itself be elevated to its proper dignity and rank.

Between the diseases Gout, Gravel, and Rheumatism, there are so many points of natural affinity, that they have appeared to me to form a very suitable class of objects to be embraced in the design of the same work.

In the Treatise upon Rheumatism, which I have still offered in a limited manner, as compared with the extent of the subject, I have, in my introductory observations, entered into an apology for its brevity, which I hope will be found satisfactory.

In advancing many critical objections to the opinions and experiments of other authors, I trust that I shall not be found guilty of injustice or want of candour. I have used only that freedom to-

PREFACE TO THE SECOND EDITION. XXill wards them, which I desire and invite towards myself,

In the formation of every science, the collision of ideas, and comparative observations, invariably tend to elicit information and establish truth.

In an art like that of practical medicine, which, under the most favourable circumstances, is difficult, and often deceptive, the distrust of received opinions and high authorities is calculated to lead to the discovery of new and useful facts; and to render the researches of genius and wisdom more firm in their foundation. A passive contentment with what has already been accomplished, would at once tend to narrow the avenues of science; to arrest the progress of improvement ; and to present a strong barrier to the advancement of human knowledge. :

The mere desire of novelty is an unworthy passion; but that spirit of inquiring scepticism, which urges the mind to examine with strict scrutiny the present records of science, I hold to be the very spring of action towards all improvement.

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How, unless in this manner, could the chaff be winnowed from the grain? How could the illusions of false or mistaken philosophy be dispersed, and made to yield their place to. the substantial forms of truth? -

Impressed with these ideas, and at the same time desirous to cherish a due respect for the opinions of others, I must agree in the sentiments of

Pliny, when he says, :

Preface To The Third Edition

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Tue additions to the present Treatise are so numerous, and so much interspersed throughout. the work, that I have found it impossible to embody them into an Appendix, as I should have been gratified in doing, for the convenience of those who may have purchased either of the former editions. But should another at a future period be required, I fully purpose to publish the work in two volumes, confining the subject of Gout entirely to the first ; and to print a certain number of additional copies of the second volume, for the accommodation which i have stated.

The edition now offered to the public, will be found to contain nearly one third proportion of matter more than the last. The additions consist almost wholly of practical observations and cases ; together with a Series of Experiments, chiefly relating to the examination of those gout nostrums

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which have so long engaged the curiosity of the public, and still give occasion to doubt and discussion, both as to the nature of their properties, _ and the propriety of their administration. Upon the subjects of Gravel and Rheumatism, I have enlarged as far as my limits would permit; and have endeavoured to furnish some useful materials, although professedly very incomplete.

With respect to the Experiments, notwithstanding that I have already introduced them with some prefatory observations, I shall beg leave in this place also to say a few words. It was at first my intention to have printed the details separately from the Treatise, and to have offered them to the sole attention of the Medical Reader ; but; on mature reflection, I considered that they might prove both interesting and useful to the gouty patient, as furnishing some important hints respecting the immediate treatment of his disorder. The recital of animal sufferings, inflicted in the way of experiment, certainly in itself requires some apology ; and I should willingly have considered the delicacy and feelings of the general reader, in suppressing many particulars; but as constantly as