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LETTERS

CAUSE AND TREATMENT

GOUT;

IN WHICH SOME DIGRESSIVE REMARKS

ON OTHER

MEDICAL SUBJECTS ARE INTERSPERSED.

^^.^^■^^Esa

BY TUB LATE

Robert Hamilton, M, D. of Lynn Regis,

Fellow of the Royal College of Physicians, F. R. S honorary F. R. Phy-
S. Edinburgh, and C. M. S. London: Author of Observa-
tions on Marsh Remittent Fever, Water Canker,
Scrophula, and other Medical Tracts.

Nihil tarn prodire possunt aut in rebus physicis, aut medicls, ad veritatera
acidendam quam exxicrlmenta, et viis insuetis removere tenebram.

-Qusequeipse raiserrima vidi

Et quorum pars magna fui.

VlRG!

PRINTED AND SOLD BY

tr, WHITTINGIIAM, AND SOLD ALSO BY

CROSEY AND CO. LONDON*

1806.

inh

ADVERTISEMENT.

THE Editor of these Letters on the Gout
is induced to offer them to the public y in the hope that
they may benefit those zvho suffer from that distressing
distemper : though most probably not so completely
finished for publication as they might have been, had
the author lived to have given them himself to the
zvorld. But as the treatises on Marsh Remittent
Fever"^ and Water Canker were received with ap-
probation and liberal criticism^ by an impartial pub-
lie, though labouring under those disadvantages which
every posthumous zvork must in some degree expert-
ence^from a want of the author* s superintendence, it
is hoped that the present work will meet with similar
liberality of judgment and candour of reception^

* Lundon, published by Mr. J. Mawman, Poultry, for the Editor,
t See the London Medical Reriew, &c.

DEBICATI^Nc

TO

arthritic stifferers of every denomina^
tion^ the following " Letters on the
Gout^'' written for the use of a friend^
are humbly offered by their

fellozv sufferer^

THE AUTHOR.

i%%^,-^;:^ %^^^f^^^^^^nM:^i^^^^^^^^^^^^^k0k^

Advertisement from the Author.

These letters were originally c^esl^ned for tlie private informa-r
tion of a friend, but as many facts crowded upon the author
which may be of utility to the public, he has thought it his duty
to present them to it in the mode of his intended cornmunicatioiit
to his friend. The novelty of his ideas at first withheld him
from offering them to the eye of the world, from diffidence of
its reception of them ; but as further experience has confirmedi
the efficiency of his practice, and probably his theory or patho-
logy of the disease, he commits his letters with confidence to the
inspection of a liberal public as well as to the arthritic sufFcrej
and medical practitioner.

He flatters himself that, although this work may not be
treated with systematic order, it may deserve some attention
from being founded chiefly on experience in his own person for
more than twenty years, and any theory that may be advanced
is founded upon real observation of fact or on deduction by rea-
soning by analogy from facts^

He is aware of the various opinions which may be entertained
^pon the novelty of ideas virhich mjlitate against received notions ;
and as most of the following letters were the sponta.neous effu-
sions of private correspondence, he has to crave the indulgence
of the public for any incorrectness which may be observed in
them ; but as they contain some new matter, on a subject old
indeed, and deemed th? Opprobrium Medicorum, he makes no

A

11

other apology for tKeir publication. He hopes, as he has repeat-
edly received benefit himself from the practice he recommends,
others may experience the same advantages, and should therefore,
from his conviction of the relief to be found from it, have deem-
ed himself a very unworthy member of scciety if he had not
communicated his letters to the world.

He must however caution his readers not to expect a complete
cure of an incurable distemper. If an alleviation of distressing
symptoms, during the fit, and an enjoyment of life with tolera*
ble ease in the intervals, with the prevention of decrepitude, too
often the effect of supine apathy and resignation, be obtained^
they are certainly no inconsiderable advantages to thosecondcma-
ed to arthritic punishment during life^

Table of Contents,

LETTER L

page

OfV'^KRVATIONS on the cause of the gout , „.„ 5

AU that is to be found concerning it in the best authors mere-
ly conjectural — Authors have ascribed it to a variety of
causes—no one allowed in this work but descent from
parents 6

it is immaterial whether the father or mother of those afflict-
ed had the gout or not, since it may remain latent, nor
appear in its inaammatovy form for a generation , 7

Where it does not appear in its acute form it may in a ehro=

nic one; as is shown by wandering pairts, (Src. .....„, 8, 9, 10

Remarks on the human foetus, the gouty virus, &c. — The
gouty fluid supposed to be coeval with the existence, or ra-
ther to exist before it 11, 12 13,14

Some modern physiologists deny all diseases to be hereditary

— examination of this opinion ,, 16j 1^

LETTER IL

The causes of the gout mentioned by authors considered-
regarded here as only accidental causes of exciting a'fit...... IS

As acids are said by authors to be a predisposing cause of goutj
and that tophaceous concretions or chalk stones are pro-
duced by an acid tartareous salt existing in the circulating
fluids, these opinions are examined.... ;J9

The aerial acid or fixed air not to be regarded as one of those
acids here meant ; since its existence unmixed as an acid in
the system has never been ascertained 20

The phosphoric acid, though a substance produced from ani-
mal matter cannot be allowed to exist in the system, since

. it h entirely the product of chemical' analysis by intense
heat , 21

Abstract of Mr. Bertholet's memoir conceining the presence

of phosphoric acid in the system ., 23

Mr. Bertholct's opinion must be founded in mistake, as ap-
pears from chemical obserrations on pho^phoxus ..,....»>,. 24

Phosphoric acid cannot exist in the circulating fluids, therefore
Mr. Bertholet's hypothesis that it exists in the sweat rnu't
be wrong: since the sweat is allowed to be secreted fiom ihe
blood by the exhaling orifices of minute arterial ramifua-
tions, opening on the surface of the skin 2':, 'j>

Fixed air was discovered by Mr. Bewley, and afterwards by
Bergman to be an acid, and it is now admitted into the
tables of chemi«al attractions ►. 27

The aerial acid is the cause of the apparent acidity in sweat,
by escaping from it, and, in fever, occasions the changing
l>lue paper to red, laid on a gouty limb , 2S

The sour smell perceived in a critical sweat is occasioned by
its acetous fermentation ; as much saccharine matter is
discharged with it 29

Observations on the acid fluid ejected from the stomach when

that organ is affected by the gout and other diseases SQ

This acid seems connected with the process of digestion— »
opinions of different authors upon digestion and chylifica-
tion examined 31, 32, 33, 34

Fermentation appears to be a necessary process in digestion,
from the fixed air and saccharine matter which enter iato the
composition of vegetable and animal food , 35^ 36, 37

In health a certain quantitityofan acid seems necessary in
digestion • » SS

A deficiency of an acid in the ^omach and a redundancy of

it seem equally prejudicial.... ." 39

Mr. Hunter's observations on the acid in the stomach 40

The reason of the great quantities of acids ejected by the sto~
jmach in the gout and other diseases, is the morbid state of
the digestive powers occasioned by those diseases^, 43

Acids are not the cause's of the gout) but the effects of it 44

The cause of the green or black colour of the bile in all dis-
eases of the stomach is the abundant quantity of acid pro-
duced in that state, which changes the bile to those colours 4Q

Instead of being an excrementitioui fluid, bile is necessary to

the process of digestion 4g

As the acid fluid ejected by vomiting is not the cause but the
effect of the gout, it is necessary to promote the evacuation

Xifit — the proper method of doing this .>...,.;.. 55

A jJure acid cannot exist in the circulating fluids ; therefote an

acid salt cannot be a cause of the gout 54.

LETTER III.
Continuation of observations on the supposed causes of the

gout alleged by authors.., «,,Mi»ift, ..••>.>•.•>><•»>. •!.••>; o5

V

p-g^

Peojjlc may drink with impunity, as to l!ie c:'>ut, if they
ha-c it not constitutionally, though hepatitis,- phrcnitis,
and other diseases may be caused by hard' drinking 55

Au instance of a gouty subject who drank hard bein^g- destroy^

ed by hepatitis, not by gout , ....^^,.... !S7

Tlie gcmt not contagious... v 50

Irregularities of every kind, exposure to ^veatl1er, &c. may act

as excititig causes of gout in a gouty constitution GO, 61,G2

A-ffections of the rnind from anger, grief, or sudden misfor-
fottune, may bring on a paroxysm in. those subject to the
gout 63

Debility, far from being a cause, is an effect of this- disease... 66

Tiie poisons of ar^ienic and lead do not cause this disease,
though they certainly will occasion the palsy : yet to the
disgrace of humanity these deleterious minerals are used fur
certain purposes by the manufacturers of wine.,,., 67

External injuries may excite the gout in a gouty constitatio.i,

but cannot cause it in a sound one,.., , 5S

From a retrospection of ail the observations it appears that

the only proximate cause of gout is heieditary descent , 69

DiflFerent divisions of the gout by authors— two o«ly thought

Tiecessaiy here, the acute and the chronic.............. 7G

The gout a disease of the whole system — and as the powers
-of nature become weakened by the repeated paroxysias,
and life declines, from an inflammatory disease it gradual-
ly takes on achronic form ,., 71

Professor CuUen's opinion of the gout considered 72

His Pathology of the gout liable to objectior;£,., , 74!

Of the same opinion with him that the nerves are the media
of the gout— Of an opinion contrary to him that there ex-
ists a real morbific fiuid possessing the whole, system in '

gouty constitutions..^ .,.......^.. To^ ff

LETTER IV.

'Inquiry into the natuoe of the morbific gouty fluid — It is of

too subtile a nature to be collected unmixed , ^9, 8;P

Observations on those circumstances which take place on the
resolution of a gouty paroxysm— An infiltration of a %.\vA
.into the tela cellulosa, surrounding -the pans affected, the.
cause of the swelling in the foot ia gout — Blisters found
-■useful to reduce the swelling' of the loot — Cause of the
collection of the Buid — Cause ot the cfJ5;salioa of pain when

the swelling takes place ,.,,, 8) ^ 82, 62

How the existence of the gouty fluid is raade obvious to the
seases— The peculiar smell accompanying ths discharge

VI

(torn the pores In gout— All odours deper.rl on
effluvia of a fluid nature-^As the gouty Huid e>-
capes the swelling subsides. This only takes place
liftor afew of the first fits of the gout ; because the
coats of the vessels become thickened and the liga-
ments, <i'c., about the joints enlarged ; -which seems
to be owing to the inspissation of the residuum of
the extravasated fluid ^'^^ 5"> ^^

The coasjulable lymph being mixed with gross earthy
matter and inspissated, lays the foundation of that
decrepitude which those experience who have much
of the gout entailed upon them : since as age ad-
vances there seems to be an accumulation of disea<;e 80

Circumstances besides the smell which evince the ex-
istence of the gouty fluid 90

It being concluded that there is a gouty fluid, obser-
vations rrising from that conclusion 93

Calcarious concretions concomitants of the disease in
the advanced periods of life, with other distressing
symptoms — this is not however the lot of every one
. — Cause of calcarious concretions in gouty constitu-
tions considered — Observations upon bones 93

Abstract of Baron Vanswieten's account of the form-
ation of bones .., «... 94, 95,96, 97,98,99

LETTER V.

The cretaceous earth of the bones allowed, according
to the theory ofBaron Vanswieten, to be the origin
of the chalk stones in gout^ but the process of theif
collection on the injured parts considered in another
point of view, from examining it by the rules of
modern chemistry fOl

The medium by which the osseous materials are helcj
in solution to be carried through the course of circu*
lation, is the aerial acid or fixed air, not in an acid
state, but in combinations with substances of an al*
lialescent nature ,.....„„„., 102

In all adult subjects the superfluous matter of the eartk

of bones must be excreted from the body — for this J

purpose the kidneys seem to be chiefly employ«d by

nature .,. ..^ ' j^^

Conjecture on the cause of the formation of chalk
stones from the aerial acid evaporating; being no
longer in the course of circulation, when the fluirf

Vll

page

matter of the gout is infiltrated into the tela ccllulosa, eavi-
ties of the joints, &c., a decomposition will take place, and
the earth will be precipitated from the fluid and deposited
in the cavities of the cellular texture, &c.— Situation of Mr.

Pigge, an apothecary, from chalky gouty matter 106, 10^

Account of the dissection of Whig Middleton l09, 110, Ul

Opinion of Mr. Watson on the calculi in the gout and stone
— Cases from Morgagni de Causis et Sedibus Morborum...ll2, jllS^ 1 1^
LETTER VI.
J^rom a supposition that the hypythesis given in the last let-
ter is a just one, it is intended to attempt to point out, ei-
ther a method to prevent the formation of the tophaceous
concretions, or, to dissolve and promote their absorption
into the system, and their expulsion by the emunctories
after they are formed — There has lately been relief in cal-
culus of the kidneys and bladder by an exhibition of fixed

air.. \ n^

Observations on the orighi of the calculus of the kidneys and

bladder llS

When the gout and gravel are met with in the same person,

they appear to alternate each other in their attacks 117

Vanswieten's detail of Boerhaave's observations Il8, 119, li'O

Inferences to be drawn from those observations respecting th0

ffjrmation of earthy ccoriGretions in the bladder L 121, 121?

The case of A. C. which proves that red gravel forms calculi.lj 123, 124

Experiment by Nuck showing that any extraneous body in*
serted into the bladder may form the nucleus of a stone—

a blunder related by Tulpius proving the same thing. 12(S

Preternatural ossifications have frequently been discovered by
dissection in the human body — their cause referred to the
earth of bones— concretions upon the teeth to be referred

to the same cause 126, 127

The formation of incrustations On the teelh quicker than that
of any other calculi ; though often scaled by the dentist^—
Probably this collection of iaCrusted earth on the teeth may
be designed by nature to preserve a decayed tooth from the
air — Foul breath docs not proceed from these incrustations,
but from other causes mentioned— La'rge collections of this
calcarious earth on the teeth may be prevented by a mode-
rate use of sugari — Acids injurious to the teeth 126, 129, 13#

Remarks from Mr Sheldo.: on calculus 131, 1S2

Mr. Hunter's opinion on the waste of osseous matter 133

The solution of solids must be occasioned by the solvent
power which resides in the finer parts of the lymph.., 134

vili

When boncf, ire de-^t oycd tbfcy are always exposed to the

action of io:ni: «aid matter......... ''5'*

Accoucit, of a dissectioa where there was a dissolution of bone 137, 138

Conjecture upon thenew ossifications discovered in the above

^^aissectlon.'. ...:.... : ^'^

* ' LETTER VU.

<}i7->crv?.tioris upon qvucr:ery iu the treatiiieut of gout— Yari-
OU-; impostors hav^ deluded the public under the pretence

ofcuringit..... ..; no. Hi

Story from I-iildanus f ^^-^

Belief that an exertion of mind upon extraordinary occasions
will cure a fit, but not effect a complete cure of the gout.

srom esu?

145

Another case quoted by Hildanvis \^-^,

Observations i\n the cases mentioned by Hildanus l-lp, \^

Detail of the author's observations upon the gout in his own

personj. c.nd his consequent treatment of himself in it... 147, 148, &c^

I.ETTER VIII.
Kemar'cs on the spontaneo'as sweating in the gout— rsweatin^
not the only evacuation, as all the emunctories are emplay-
cd by na^re for that purpose — The erroneous mode of treat-
2nent generally pursued in consequence of thinking sweat-
ing is the outlet to discharge the gouty virus 161, 16S

M ischiefs which ensue fram the above tr'-atment— Cool cloth-
ing and a free circulation of air recom-mended in the gout,
an accumulg.tion of heat being highly prejudicial from
rjauses mentioned : an incurable lameness is sometimes the

consequence, of too much heat , 163, 1G4, <5:C;-

Extremes of every kind prejudicial in the gout — rmediocrity
of conduct the best mode of eluding its woxst effeclSr— strong
liquors improper in the gout, particulaiiy in the stomach .. 171, 172
LE'I TER IX.
Abstracted arrangement of the opinions inculcated' in the fbfe-
going letters, farming a retrospective view of the system up-
on whi:h the author's treatment of the gout is- founded... 174, 175, ^c.
The raodc of treatment of the gout deduced from the forego-
ing system. .c ,., , 18!, 182, &c.

Observations on regimen 190, 19l, U'>2

^Qjiclusloii...... ..., ,.... , ,. loa, 194

iETTEKS

ON THE

GOUT

Dear Sir^

In your last letter you gave me a
very disagreeable account of your health. You tell
me that you have had the Gout, which has been
i^ery severe and left you much debilitated after the
paroxysm ended ^ that you are chagrined and disap-
pointed, and by no means satisfied with what you
have read of the treatment of that disease, in the
different authors which you have perused on the
subject ; that you had heard that I treated myself
differently from the common methods employed by
the generality of Practitioners, and with considera-
ble benefit. Wherefore you request my opinion
of the nature of this distemper, and desire to be in-

formed of mv method of treating mvsel

Instead of \Vishing you joy, on this occasion, aS
too many unthinking people would do, I am really
from a fellow feeling, sincerely sorry for you; as
you have now got one of the greatest evils that can
befal a professional man; for you certainly never
will be entirely free from it again ; that is, it will re-
main latent in your constitution, and occasionally
paying yoil a very unwelcome visit.-

I shall esteem myself happy in being instrumen-
tal in affording you relief, by furnishing you with
any means in my powei' for that purpose; and
therefore will give you all the information I can.
And as it is a matter which has particularly engag-
ed my attention for 50 years, with a view to alle-
viate my own sufferings, as well as those of others,
I flatter myself I am competent to say something on
the subject, which may be of use to you, and many
a brother arthritic.

i shall deliver what I have observed in the plain
language of candour; and what you will have rela-
tive to the treatment of it, you arc to recollect is the
result of experience, chiefly in my own person. But
in the prosecution of the task you have set me, you
must not expect a regular system, but a set of desul-
tory observations, interrupted by such digressive re-
marks as may occur in the series of letters I shall
have occasion to write, and you mubt excuse me for

repeating many things you are well acquainted with i
but which being closely connected with our subject,
it will be often necessary to reeal to your memory,
for the better elucidation of the matter imqiediately
under investigation.

The first quession you will naturally ask, is, what
is this formidable distemper, this enemy that has in-
vaded my constitution, and taken possession of if,
never more to quit the premises ? I can only an-
swer,— SI very painful disease, with peculiar symp"
toms and effects, the causes of which it must be
honestly confessed, I no more know than you
do; nor did perhaps any of the learned authors who
have written so much unsatisfactory matter on the
subject, and in no country more than this, know
any more than either of us; they have guessed it is
true, and we can do no more. Accordingly, I refer
its origin, to a certain inexplicable something-
in our constitution, derived from our progeni-
tors, and no more do I pretend to say of it, nor of
the cause of its existence in the human race. And
ail that is to be found in the best authors, that any
regard is to be paid to, from Hippocrates to the pre-
sent tinie,-is but vague conjecture, if we except the
description of the disease; and in this respect none
©f them is more accurate than Sydenham, who was
an ArthriiiG sufferer himself. But the poor invalid

8 2

has no occasion for this aid, to convince him of the
idenatT of the disease he labours under ; h's own
feel'n?/, and dire experience, being fuller, more des-
criDcive, and more exolicit to him, than all that has
been collec.ed on the subject; as to the theories,
they are the children of ingenious and fanciful ima-
g'nsifion, often contradictory, sometimes absurd, and
consequently the practice as contradictory as the
theory..

Medical writers on the Gout, have ascribed its
origin to a variety of causes. Among a great number
the principal are said to be hereditary descent from
ardiritic parents, acids, wine, particularly acid austere
wine, hard drinking, in the night especially, rich
hi'^h seasoned food, excessive and premature venery^
irregularities of every kind; affections of the mind,
as anger, grief, intense study, violent and fatiguing
eicercise, psrticularly on horseback in cold and wet
weather; to which Boerhaave has added, eating of
asparagus, contagion, and others mention the poi-
sons of arsenic and lead in adulterated wines, debi-
lity o: the nervous systern, and unnecessary exposure
to inc'ement Vv^eather, &cc.

Descent from parents is placed at the head of the
catalogue, because it is the onlv, or if that is a better
word, pioximate, cause that can be admitted here,
on which the real origin of the Gout depends. All

the rest may be with reason regarded, merely as subr
altern or secondary, or, as they aie called by some,
remote causes, which by their activity do occasio-
nally derange the economy of the system, from a
healthy state, by which the gouty matter or princi-
ple, is developed, roused into action, and a paroxysm
brought on, but how this is done we know not.

Tb's singularity of opinion may be deemed pre-
sumptuous, and must be supported by some facts
before it can gain credit 3 as it must appear very ex-
traordinary that authors of great reputation should
have advanced so many causes without some foun-
dation. It is therefore incumbent on me to give my
reasons for differing In opinion so widely, which I
shall submit to your consideration with diffidence,
relate with all the precision I can, and flatter myself
that in the course of the investigation, I shall be
able to adduce some proofs in the support of this
very different way of thinking from others.

I. The first cause m our catalogue, and the only
one here allowed as constituting the real origin or
proximate cause of Gout shall be first noticed.

Authors in general admit of this cause, and daily
experience proves, that it is a fact ; and also proves
that it is Immaterial whether the father or mother of
the arthritic persons actually had the gout, if their
predecessors were afflicted with that distemper : as

it is often found, that a generation may escape the
disease in its acute inflammatory form, yet the gout
may have lain inactive and dormant in the constitu-
tion, and for want of a Phlogistic habit, or some other
reason we know not, did not appear in an inflamma-
tory state. Yet upon examination those subjects
have been found to labour under indigestion, disor-
ders of the stomach and intestines, accompanied
with flatulences : and were frequently harassed with
wandering pains in the head, back, and articulations,
which were generally considered as arising from the
Rheumatism, but in fact a chronic gout, disguised
under a variety of shapes, was the real disease, and
their descendants felt the truth of this fact, in a very
distressing manner.

This I have seen in many families : I have known
one brother occasionally attacked witli chronic
Gout all his life without any confinement but for a
day or two; and who never had constitutional
powers to develop the gout latent in his habit, in
an acute or inflammatory way, no other symptoms
appealing than the wandering pains, and disordered
stomach 1 have named : whilst another brother was
tormented with inflamm^atory gout at certain periods,
which gradually increased as he advanced in life, and
rendered him a helpless cripple. Of the two the first
brother^s condition was the best, because he could

ft^llow business. It did not appear that his health
was much impaired by it, as he lived to the age of
70 The fathers in those instances were absolutely
cripples, and there could be no doubt of the disease's
descending from them to their sons. I am one of the
sufferers in proof of this fact. My father was afflic-
ted from an early period of life with inflammatory
Gout, and many years before his death, was con-
fined twice a year, between two or three months at
a time. My brother never had any other symptom
than wandering pains w^hich never confined him,
yet he was generally a hearty eater and a man of a
full habit, but lax fibre. I know several instances
of this kind, which I could adduce in proof of what
I have advanced; your own observation will no doubt
furnish you with many of the same nature; which
- may have passed unnoticed, as you were not before
so nearly interested in the inquiry. And I appre-
hend, that there is no person afflicted with Gout
but may trace it back to his progenitors, either in
an inflammatory or chronic form; although it may
have lain dormant in the constitutions of a generati-
on or two, without being excited to action, and yet
these people have been able to com^iunicate this
disease to their posterity.

Admitting what has been said respecting the com-
muiiication by descent ; it may bs asked, a^ gout

10

must have had sonic oiigin in the human systeth^
how was it first produced in the first gouty mortal,
v>dth the power of communicating it to his posteri-
ty ? And why m.ay it not originate in others, from
the same causes it did in him at first ? The answe
must be involved in darkness! That it had a beghi-
ning is most certain ; but in what manner, or from
what cause, is a problem as difficult of solution, as
the cause of gravitation, electricity, or any other inez-
plicable fact in philosophy: and therefore we must
refer it, widi other inexplicable facts, to the great
Author of nature; who constructed the human frame
in such a manner, and of such materials, that it
must be liable to disease, decay, and resolution into
its first constituent principles. For conducting
with unerring rules, a system of decay and renovati-
on, which seems necessary to the perpetuation of the
whole, the reasons are undoubtedly wise, though to
us incomprehensible.

I therefore make no doubt, but that every person
afflicted w^ith gout, had the stamina of the disease
in his constitution when he came into the world >
and that these stamina became evolved at a certain
period of life, if his constitutional powers were equal
to it, which in some may be sooner, in others later;
but if his powders were unequal to the task, it lay
dormant in the constitution, was conveyed to pes-

21

terity, and evolved in the constitutions of some of
his offspring of powers more adapted to produce re-
gular inflammatory paroxysms of the distemper.

But in order to point out the probability of this
disease^ accompanying the propagation of the spe-
cies, let us take a short view of the operation of
nature, in the formation, nutrition^ and accretion of
the human fcEtus, and see whether any hint can be
gleaned from this wonderful process which may
throw a light upon our subject j in sh,ort to read to
your mind,

** How the dim speck of entity began

T' extend its recent form and stretch to man.'" Garth.

I apprehend it will be readily granted, that the
human ovum was originally in a fluid state, and that
no appearances of its having taken any determinate
form in the ovarium^ are to be distinguished in the
eiarly periods of female life ^ after it has taken the
natural form, which we suppose is before the age of
puberty, it does not appear on examination by the
microscope, that the organized germ of an embryo,
i^ to be discovered in it. Therefore it is after the im-
pregnation by the semen masculinam, that we are
to date the incipient organization of the future ani-
mal; but by what modification this is effected,
or what quantity of seminal fluid is employed
for this purpose, we are utterly ignorant, and pro-

G

V2

hably shall ever remain so. All we know is that
th« ovum and the semen were both once in a fluid
state, and from certain cii cumstances of their ope-
ration on each other, the animal is formed* We
shall pass over in silence every conjecture relative
to this matter, and come to tliat period^^hen the
ovum in the uterus, has become so much enlarged
2h bulk, as to fill up its cavity, and come into con-
tact with it ; and that part of the ovum where the
rudiments of the placenta are, has become attached
to that part of the uterus to which it is contiguous:
a period, when we suppose the rudiments of the
living animal are formed^ and the materials furnish-
ed by the ovum and senieri, in what may be called
its vegetative state in the uterus, for its support, are
exhausted, and it now^ w^anrts assistance fvom the mo-
ther, for its nutrition and increment. The placenta
is the medium through which this process is con-
ducted; and the blood of the mother passes from it
through the umbilical vein in the navel-string to
the embryo^ and is received into its vascular system^,
where it is further laboured in the course of circu-
lation through this system; and by a wonderful pro-
cess of Nature's- chemistry, the different materials are
selected from this compound fluid, and by some spe-
cific attraction, applied, to complete the formation
already begun of the heart, brain^ nerves^ bl€K)d v«s-

IS

jsels, bones, muscles, membranet, &c. of the little
animal, and the recrement blood is returned through
the umbilical artery to the mother, as fast as it parts
With its nutritive principles^ and thus a circulation
is kept up between the mother and foetus, until it
becomes a perfect animal; and has sufficient powers
to live without the mother's assistance ^ when its
birth takes place. How all this is conducted I leave
to physiologists to inquire. It is sufficient for my
purpose to know that it is so : and as a proof of the
fact, that a total interruption being put to this circu-
lation between the mother and child ^ by any acci-
dent, will be succeeded by the death of the child.

From this short view of the matter, it cannot be
difficult to conceive, how easily certain distempers,
known to be hereditary, descend from parents to chil-
dren.— If a subtile particle of matter, too minute to
be an object of the senses, produces invariably a
distemper of the same kind, by only being convey-
ed into the circulating fluids of so large an animal
as man, by absorption or otherwise ; how much
more readily, may we not conceive, that a distem-
per blended vvith the very essence of the existence
of the parents, as much as the very materials which
furnish the existence of their little offspring, should
be conveyed to their posterity. And surely the par-
ticles of matter constituting diseases thought to I ehc-

c2

14

reditaiy, must bear a wonderfully larger proportion,
in the ovum, and the semen^ which impregnates it,
to the bulk of both : than the subtile particle of mat-
ter requisite to produce, for instance, the measles or
smallpox, although very different from the dise?.se
under consideration, in an adult, can possibly bear
to that adult.

As it is certain that the ovum was, at its first for-
mation, in a fluid state, and furnished from the juices.
of the mod^er ; that the semen is fluid and furnished
from the blood of the father ; it is natural to infer,
that they miist partake of the qualities of the origi-
nal constituent juices of both the parents, be they
good or bad. Hence therefore, it "is easy to con-
ceive, how the rudiments of disease may be blended
with the rudiments of the foetus at conception, and
how they may ba-'^fterwards continued to be con-
veyed with the materials furnished by the mother
for its nourishment and increase, and the foundation
of the gout laid in the constitution of tlie little,
offspring.

Some theorists have lately asserted that struma is
not a hereditary disease, but is brought on by som«
adventitious injury, in any constitution, either from
debility superinduced by othef diseases or some
other cause. This however is contradicted by ex-
perience. For instance, any abscess taking pl^ce

15

gn the crisis of any acute disease; or suppuration,
from a blow, or bruise, in any constitution, other-
wise sound or free from the suspicion of any here-
ditary leven of scrofula; digests kindlf, granula-
tions of sound flesh form, and fill up the cavity, and
it soon heals. Far different is it with suppuration
in any of the lymphatic glands, in a habit that is
scrofulous by descent. Instead of bland, well con-
ditioned, or what is called laudable, pus, the dis-
charge is sanious, crude, and indigested. Instead of
florid, healthy, granulations, a pale, smooth, glassy,
flaccid, ill conditioned, fungus arises, and the sore
degenerates into an ulser that does not heal, but re-
mains open for many months, and even years, and
if situated in the vicinity of bones, produces carie$
of them, and tedious exfoliations. Here we see
that accidental injury, in a scrofulous habit, will, if
we may use the expression, rouse, by an adventi-
tious stimulus, the materia morbifica of scrofula,
and produce the mischief we have noticed. Just
so does it happen with a gouty constitution, an ex-
ternal injury, does not, it is true, bring on, always,
suppuration and ulceration ; but a blow on the el-
bow, hand, foot, or knee, a sprain of the ankle or
wrist, will most certainly rouse the latent gouty
rirus, and bring on a paroxysm of the disease.
Some very ingenious modern physiologists, deny

the probability of the gout, or any other disease, be-
ing hereditary, upon another ground- They think
it inconsistent with the simplicity of Nature, to sup-
pose, that she would introduce disease, or any im«
perfection, into her work, at the creation of the
foetus s but allow only, that a tendency to ,the pre*
disposing cause of the disease, may be hereditary.
With all deference to those ingenious men, allowing
a tendency to diseased actions, which may fee con-
sidered as a predisposing cause, is allowing an im-
perfection in the formation of the foetus, as much, as
allowing the minute stamina of disease to descend
from the parents : and, in short, seems to be using
different words for the same thing. For in fact the
rudiments of disease, or that active principle, what-
ever it is, which constitutes the gout, and which
jnay be called the materia morbifica of the gout, is
not in a state of morbid activity, when first convey-
ed into the rudiments of the embryo, from the pa-
rents, but appears to lie dormant aud inactive in the
habit, till at a certain period of life, it is evolved,
and brought into action, by some accidental cir-
cumstance, or occasional exciting cause, and con-
stitutes a fit of the gout ; and after the fit is over,
it again becomes latent ; yet whilst the man is well,
the disease may be supposed not to exist; but it
certainly does so in a dormant state ; and experi-

It

ence shows that the particles are capable of being
again brought into action and a second paroxysm
is produced, whicji constitutes with certainty the
disease, which the repetitions of them suiHciently
evince through life.

From this state of the matter, does It not appear,
that even this tendency to a predisposing cause of
disease, contended for, thus supposed to be con-
veyed from parents to children, must have some
original cause, primarily existing, in the habits of
the parents, to occasion this tendency or disposition
to disease in their oiTspring ? And is it not natural
to think that the subtile particles of morbiiic matter
alluded to^ are the most likely causes to produce this
effect ? And notwithstanding ail that has been ad-
vanced to overturn the long received opinion, that
diseases, particularly gout, struma, and lepra, are he-
reditary: no ingenuity, no plausibility of reasoning,
can contradict plain facts. How rnany instances are
there daily to be met with, every where, of whole
families labouring under, either scrofula, or lepra, who
can trace those diseases back for several generations-^
among their forefathers y and who find, that neither
the strictest courses of medicine, nor regimen, have
«Yer been able to eradicate either of those diseases^
from a single individual, or prevent either, from de-
seending- to their cffspring.

18

LETTER if.

Dear Sii\

Having in my last given you mf
reasons for supposing descent from parents, to be
the only original cause of the gout j I am next to
consider the rest of the catalogue of causes alleged
by authors to be the origin of that distemper in the
human body, and which 1 have regarded only as oc-
casional or accidental causes of excitinor a fit. And
this we may believe is done by those several stimuli
on the nervous system, inducing pain and inflamma-
tion with a certain degree of fever necessary to de-
velop the latent particles, promoting their accumu-
lation, and bringing on a paroxysm of what is call
cd the regular gout. This is perfectly consonant
to the operation of every cause of fever whether
specific or adventitious; if the morbific matter in
the smallest particle of the small pox or measles
is introduced into the system, it certainly first sti-
mulates the nervous system, and excites pain and
fever, which cease on the appearance of the speci-
'fic characteristic phenomenon of the disease.

19

2. Acids are said to be a predisposing cause of the
gout ; and what appears to be very extraordinary,
is, that the generation of tophaceous concretions,
vulgarly called chalk stones, is said to be produced
by an acid tartareous salt, actually existing in the
circulating fluids. How far these opinions are found-
ed on fact v/ill appear from the following consi-
derations.

Acids in their pure state cannot enter the lacteals.
The corrugating power of this species of acrid mat-
ter, must most probably, stimulate the orifices of
this order of the absorbent system to contract, and
effectually deny their admission. Were it possible
for acids to enter these orifices, the chyle within the
vessels to which they led^ would be immediately
coagulated by them, many and perhaps incurable ob-
structions, must ensue, the body could not be nou-
rished, an atrophy, and probably death, v/ould fol-
low. But supposing it possible, that they did enter
the lacteals, even pass through the mesenteric glands,
and were carried through the receptaculam chyli
and ductus thoracicus, and did in their acid state
enter the lefl: subclavian vein, the consequence must
be an immediate coagulation of the blood in a large
vessel in the vicinity of the hearty through v/hich all
the nourishment of the body was conveyed, a stag-
nation of blood, a suspension of circulation, and al-
most instant death. p-

10

We may from these premises conclude, that adds
must be first neutralised and animalised in the sto-
mach and intestines, in short their acidity totally
destroyed, that they may, in their neutral state, be
rendered fit to mix, first with the chyle, and after-
wards with the blood, without hurting the fluidity
of either, before they can enter the lacteals, and be-
ing now become an Ingredient in a new compound,
can be no longer considered as acids.

It may be objected to what is here said, that acids
do actually exist in animal matter, can be detected
In it and produced to our senses. For instance, first,
the aerial acid or fixed air, which exists in all sni-
mal, vegetable, and we believe, mineral, substances,
and indeed enters into their composition, as a bod}^^
and really, in its fixed state of combination with
them, adds considerably to their solidity, weight, and
bulk: and it is mixed also with our fluids. But It
is certain that whilst it remains combined in the
composition of these substances, it does not disco-
ver its acidity, but must be separated by some pro-
cess before it becomes obvious to the senses as an
acid. — It is therefore not to be considered in the
light which we must here mean by an acid ; for al-
though it is more loosely connected with fluids than
other bodies, yet its existence, pure and unmixed,
^ian acid, iu the system, has never been ascertained.

31

although a small degree of heat, even that of the at-
mosphere, will separate it from fluids out of the bo-
dy; a decomposition must therefore take place in the
mixture before it can appear in its acid form, as daily
experiment sufficiently evinces.

The second is the phosphoric acid, a substance
produced from iinimal matter. This acid is entire-
ly the product of chemical analysis, and it is found
no tr fling process, by every chemist, to separate
it from the other matters with which it is combined^
and that a most intense degree of heat is absolutely
necessary for that purpose.

Every book of modern chemistry shows, and every
chemist knows, that the process for making
Kunckel's phosphorus from urine, is operose and la-
borious, and that an intense degree of heat is requi-
site t© complete it. Dr. Henry Qahn, of Stock-
holmn, first discovered a method of extracting
the phosphoric acid from bones, The excellent
Scheele prosecuted and confirmed the experiments «
and those ingenious chemists, by labouring together
in the same pursuit, extracted phosphorus from this
acid by means of the phlogiston of charcoal, by a
much less operose process, than that by which it is
obtained from urine. Macquer, Poulletier, Proust,
and others, hare repeated the experiments in France,
and gbtained the Phosphoric Acid from burnt hart-

D 2

liorn.^ All those chemists suppose that the earth
of bones is a composition of the calcarious earth,
saturated with the Phosphoric Acid. Macquer
tells us that Mr. Proust has discovered a particular
substance, which constantly accompanies the Phos-
phoric Acid in the animal fluids; he has not how-
ever shewn what it is, but is prosecuting the sub-
ject with assiduity.

Mr. Bertbolet, a french diemist, in a memoir read
before the Royal Medical Society at Paris, says, that
the Phosphoric Acid is a very important agent in thq
animal economy; that it is every where active in the
system, and is expelled by perspiration and urine*
I'hat he has found it in a separate state or rather
combined to excess (so as to predominate) with cal-
carious earth in the urine, which has been deemed
an alkalescent fluid by physicians. That perspira-
ble matter tinctures blue paper of a red colour,
which he attributes to the Phosphoric Acid it pro-
bably contains. Thinks, that the urine of persons
subject to the gout and rheumatism contains natu-
rally much less of the Phosphoric Acid than that of
persons in heaUh : but during a fit of the gout much
more o^ this acid ; though not riiore than that of a
strong healthy person ; and in persons very subject

* Didtlonnaire de Chymie, Article Q$.

f3

to the gout, could tell if a fit was coming on, bj
the quantity of acid in his urine. And supposes
that' the Phosphoric Acid is not so well discharged
in persons subject to the gout, and wandering rheu-
matic pains, as in healthy constitutions, but that it
wanders, and when accumulated to a certain de-
gree, produces irritation, and reaction of the vital
organs, a natural effort of the constitution by w^hich
it is partly thrown on the extremities and partly on
the kidneys. But that this acid is combined with a
greater or less quantity of calcarious earth, and an
animal matter, and often forms depositions, greatly
resembling bone, and those gouty earthy collections
called chalk stones, in the extremities, and calculi
in the kidneys and bladder. — Supposes— that if the
sweat contains the Phosphoric Acid, may it not owe
its stimulating powers to it ? And may not this acid,
being dispersed in the cellular membrane, produce
catarrhs, or on the intercostal nerves pleurisies? And
when the urine appear* limpid and pale in fevers,
or nervous disorders, may not this acid be the irrita-
ting principle that disturbs the whole animal econo-
my ? And suspects that this acrimony, whose ex^
istence (he thinks) is certain, aiay be substituted ii^
many cases, for those imaginary acrimonies, by
which the nature of diseases has been attempted t«
be explained.

24

Here is a new species of humoral pathology, bj
fvbich the cause of many of the most terrible dis-
eases l^as its existence in the habit from the first for-
mation of the foetus, to the grave, which is the
Phosphoric Acid — if there really existed such a sub-
stance in an acid state in the system, which would
appear incompatible \Yith life, and even Berthokt
allows it to be combined with other matters, and it
therefore must undergo some decomposition before
it can appear in a separate, pure, acid, state, and as
this requires the addition of the strong vitriolic acid
^nd the most intense heat to effect it out of the
body, we cannot think it possible to be done in the
body by the power of mere animal heat, and there-
/ore this ingenious chemist must be mistaken. Be-
sides, some modern chemists have suspected, thai
the Phosphoric Acid does not exist even in combir
nation with other matters, in bones, in a state of
filature, but is formed by the vitriolic acid employed
in the extraction of it, which by combining in a
peculiar manner with animal earth, and other mat-
ters, perhaps Phlogiston, by means of the power of
an intense heat takes on this appearance. The ef-
fect of the compositions made to imitate the Bolog-
nian stone, seems to favour this conjecture. The
late Mr. Canton's was the best of any. His pre-
paration, taken from his paper in the Ph. Trans-

2^

actions^ is, three parts of the white powder of cal-
cined oyster shells^ and one part of the flowers of
sulphur, intimately mixed, and rammed into a cru-
fcible "I inch deep, and kept red hot in the middle ot
a good fire for an hour, and not turned out of the
crucible till cold. The parts found to be best on
tfial, are to be kept in a vial with a ground stopple,
A small quantity of this powder exposed a few se-
conds to the light, v/ill be so luminous in the dark,
as to enable one to distinguish the hour on a watch
dial plate. In this preparation there is the vitriolic
acid, and phlogiston in the sulphur, and the calca-
rious earth, and probably animal matter, in the oys-
ter shells, materials not w^idely different, from the
vitriolic acid and the earth of bones. Part of the
acid may be phlogistic ated, and dispelled with the
phlogiston by the heat during the process. Perhaps
also the phlogiston requisite to render it luminous,
may be supplied by the sun's rays. Phosphoric
Acid is not luminous itself, but only becomes so by
the phlogiston it receives from the charcoal in the
distillation of phosphorus.

The changing of blue paper red, by sweat, on
the surface of the skin, may be owing to other
causes. The sweat is now allowed to be immedi-
ately secreted from the blood, by the exhaling orifi-
cies of minute arterial raniJfic^tiQns^ opeuSng oh th©

28

surface of the skin. Were it acid, slCcording td
Bertholet, and that the Phosphoric Acid were ex-
creted from these orifices^ it must exist in an acid
state in the circulating fluids, which we^conceive to
be impossible ; and the only circumstance that could
give a colour to the hypothesis, of its being the
Phosphoric Acid that gives this change of colour to
the blue paper, is to suppose that a decomposition
of the sv^eat, and a separation of this acid from it>
must take place the instant this fluid passes the ex-
cretory orifices on the surface of the skin ; but as it
has been shown, that it requires the presence of the
vitriolic acid, and the most intense heat of a chemi-
cal furnace, to accomplish the separation of the
Phosphoric Acid, from the matters with which it is
combined ; I look upon it as being impossible to be
done by the heat of the human body. Therefore
this change of colour cannot be owning to the Phos-
phoric Acid, Nor is it at all necessary to oblige
Nature to perform a task she appears to be unequal
to ; as the change of the colour of the paper laid on
the sweating limb, from blue to red, may be more
easily accounted for; which I shall endeavour to point
out. I have tried the experiment and have never
succeeded in the most severe fit I ever had.

Fixed air was discovered by our late ingenious-
and worthy Friend, Mr, Bewley, and afterw^ards bj

S7

Bergman, to be an acid ; "although neith&rknew the
other's pursuit, they were both employed in the
same inquiry ; but Bewley was certainly the first
who discovered this Important fact, and it is now
admitted int5 the Tables of chemical attractions, as
an acid sui generis under the denoriiinatioii of the
Aerial Acid, This substance is perhaps the most uni-
versal acid in nature ; it has already been observed
that it enters into the composition of most bodies
perhaps into all, aad adds considerably to the
solidity, weight, and bulk of solid bodies, and is al-
so a component part of fluids, and certainly of those
of the animal system. It is perhaps most abundant
in calcarious earth, and is separated from it by fire,
or acids which have a greater chemical attraction or
affinity to this earth. Dr. Black has shown in his
ingenious paper on magnesia, that It is the expul-
sion of this principle by fire, that converts the mild
calcarious earth, to the caustic, or quick lime, a dis-
covery of the greatest importance in chemistry ; but
it is not the business of this inquiry to go any farther
into this matter, than what relates to the present sub-
ject of investigation^ the cause of the apparent acidity
in sweat. And therefore it is nov/ only proper to ob-
serve, that the aerial acid enters into the composition
of fluids as well in the animal body as out of it; is the
substance on which the properties of mineral waters..

as tiiose of ryrmoiit. Sec. chiefly depend, and which
from its predominancy are termed acidulous ; and
is the medium by which sohd matters, as calcarious
earth, iron, &c. are held in solution in those waters.
It is present in the fluids of the animal body, being
supplied by the ingesta, and copiously passes off by
the secretions, particularly urine and sweat But al-
though it requires fire or mineral acids, and some-
times both to expel it from solid substances ; fermen-
tation however will separate it from vegetable
matter ; and it is found to be so loosely connected
with fluids that a very small degree of heat, even
that of the atmosphere, is, when the fluid is in a
state of rest and exposed to the external air^ sufliei-
ent to loosen its attraction to the fluid, and then a
decomposition takes place, it escapes in its acid form
into the atmosphere, and the solid matters, as cal-
carious edrth, iron, &c. which were held in solution
by its means, in the watery fluid, are separated from
it and precipitate. As it is so loosely connected
wdth water as to be separated from it by the heat of
the atmosphere only ; no wonder that the heat of th^
human body augmented by fever, shouM separate it
from the sweat upon its surface, and being detained
and imbibed by the moistened blue paper, change it
into a red colour^ on the gouty limb, Jit the decliiie
®f a paroxysm.

29

Every one conversent with the treatmeiit of sick
people, in any epidemic season, or in some climates^
©r the local situations in the same climate where
fevers rage more extensively than in others, must
have observed a sour smell issue from persons under
the influence of a copious critical sweat. This cir-
cumstance, may, at first sight, seem to favour Ber-
tholet^s opinion, of the actual discharge of the Phos»
phoric Acid, by the pores of the skin. But on a
little attention to this matter, this sour smell will
probably appear to arise from another cause, and
that is the acetous fermentation of the sweat, copi»
ously ascending from the patulous orifices of the ex-
cretory vessels in the skin. There is not a doubt
but much saccharine matter is discharged In mix-
ture with the sweat ; and when the quantity of this,
evacuation is so considerable, as it very frequently
is, as to wet the sheets and bedcloths so much that
it may be wrung out of them by pressure, and the
bed itself is so thoroughly soaked with it, as even to
have it run through the sacking bottom and drop
on the floor ; it is not difhcult to conceive that a fer-
mentation may ensue, from the great heat, run
speedily into the acetous fermentation, and thus ac«
count for the sour smell. We know that such a
smell frequently occurs in women that give suck^
when their linen is wetted, by the redundant dis-

E 2.

30

charge of milk from their breasts, and that this h
owing to the saccharine matter in the milk running
speedily into the acetous fcrm.entatipn by the he^t o.f
the women's bodies.

Another thing worthy of notice, is, that by fer-
mentation the aerial acid is let loose and escapes, as
fast as the decomposition takes place of the matters,
subjected to that process, as in the case of wine and
been

The large quantities of an acid fluid ejected from
the stomach, when that organ, and some other of the
abdominal viscera, are attacked with the gout, have
been adduced in proof, that acids are among the pre-
disposing or original causes of the o^out. From
some inquiry into the production and existence of
of this acid, which is symptomatic to more diseases
than one^ it ,^all probably appear, that, as the acid
Yomited up is the same in all of them> it is in reality
the effect of the disease and not the cause of it.-— But
as the production of this acid seems connected with
the process of digestion, it may be proper, to make
some remarks on that necessary operation, in the
economy of animal life, which may throw some
light on this subject.

Notwithstanding the great number of experi«
ments put in practice by modern philosophers and
physiologists, we are probably still in the dark, as to

SI

the mode in which digestion, and chylification are
really carried on in the stomach and intestines.
This seems indeed to be evident, from the difference
in opinion which these gentlemen entertain, and
the different deductions they draw from their expe-
riments. We certainly do know, that our food
which consists of animal and vegetable substances,
is digested ; that the most nutritive part of it, is
converted into one uniform liquid, the chyle, which
we also know is carried into the habit, for the nou-
rishment of the body, and that, the unconverted part
of it is discharged as useless. That there are certain
liquors separated, as saliva, eesophagal, and gastric
juices, that the bile, pancreatic, and othcrjuices, are
secreted by their proper glands, and pass by their
proper ducts into the stomach and intestines ; all of
which are supposed to be concerned, in this great
alimentary process ; but we cannot positively say
what share each has singly in it.

The late Sir John Pringle, and Dr. Macbride,
from experiments on alimentary substances (which
you will find at large in their works) were led to
suppose, that digestion depends upon the fermenta-
tion of the food in the stomach. Abbe Spallanzanl
thinks, on the contrary, that neither the sweet, ace-
tous, nor the putrid, fermentation of the chemists,
takes place in the stom.ach 5 but that the solvent

32

power of the gastric juice is the only efficient cause
ot digestion. Dr. Edward Stevens and some others
have taken up the same opinion.

That excellent anatomist and ingenious physiolo-
gist^ Mr. John HuRter, thinks '^the process of di-
gestion different from every natural operation in the
change of bodies. — It is not fermentation, though it
may somewhat resemble it. Fermentation is that
spontaneous process, and is that natural succession
of changes by which vegetable and animal matter
is reduced to earth ; therefore different from diges-
tion which converts them into chyle ^ in the forma-
tion of which (he thinks) there cannot be a decom-
position, similar to fermentation. It is not a che-
mical solution, but it is an assimilating process, a
species of generation, two substances making a third:
"the most curious circumstances of which is, the con-
version of animal and vegetable matter into the same
substance or compound, which no chemical process
can effect; Chyle, (he thinks) is composed of gas-
tric juice, and the -.nost digestible substances per-
fectly converted, and that the quantity of gastric
juice is nearly equal to that part of the food really
converted into chyle ; which evinces the necessity
of a quick secretion of a large quantity of that fluid,
which however is not lost to the constitution.'* And
in the paper subjoined to that on digestion, in his

33

observations of different parts of the animal economy^
and which was before published in the Philos. Trans-
actions, Tol. 6^, he says that " animals, or parts of
animals, possessed of the living principle, introduced
into the stomach, cannot be acted upon so long as
the anhnal principle remains ; hence it is that worms,
&;c. may live and even be hatched in the stomach,
but the moment they lose the principle of life, the
stomach acts upon them and digests them like other
dead substances. Indeed if it were not so, the sto-
mach itself must have been mad^ of indigestible
materials,; for if the living principle was not capa-
ble of preserving animal substances from undergoing
that process, the stomach itself would be digested.
But we find that when the stomach is deserted by
the living principle, it is not only capable of being
digested by the digestive powers of otlier stom-achsj
but by the remains of that pov/er which it had of
digesting other things." The power he means is
the gastric juice, a quantity of which might have
been secreted before, and have remained in the
stomach after death. To the solvent powers of
this ju^ce he attributes " those holes found in the
2[reat end of the stomach in dead bof^ies, which
have been supposed erroneously to have arisen, from
disease, and to have killed th e patients; but as those
apertures are more frequently f^und in those persons

i4

Who have suffered a violent death, tlian in morbid
bodies, and as the apertures were large, ragged at
the edgesj and appeared to be as it were, in a ten-
der half state of solution, and the food wliieh had
been in the stomach had passed through the aper-
tures, into the abdomen ; he has no doubt but they
were the effect of the digestive process, by means of
the gastric juice after death." This is an outline of
the opinion of this ingenious gentlemanj the matter
at large you will find in his Physiological Observa-
tions, on certain parts of the Animal Economy.
From his further experiments and observation S;» pro-
mised to be communicated to the public, we may
hope to obtain further information. As in this how-
ever he has taken no notice of the use of the Bile
in Digestion^ I suspect from an expression (page
174) that he regards h as an excrementitious fluid.
He says, " that the digested or animalised part,
when carried into the intestines, is attracted by, or
clings to its villous coat, as if entangled among the
villi ; Avhile the excrementitious part, sucJl as Bilc^
is found unconnec ted in the gut as if separated
from the other."

Spallanzini wdli hardly allow that fermentation
ever takes place in the stamach. Mr, Hunter does
not doubt but it can go on in the stornach, but when
it does happen, it arises from the powers of digestjf?

35

on defective. It appears, however, from the fol*
lowing circumstances to exist pretty generally, if
not always, as a necessary process. Fixed air enters
largely as a principle, into the composition of ali-
mentary matters, vegetable or animal; saccharine
matter is also a large ingredient in them, particularly
jn the vegetable, and in the state of crystalized.
sugar, is separately used in abundance as an article
in diet. The experiments of Sir John Pringle and
Dr. Macbride have shown, that, with a certain de-
gree of heat, out of the body, the process of fer-
mentation, most readily succeeds In the decompo-
sition of alimentary animal and vegetable substances,
and that during this process fixed air is as freely extri-
cated, as in the fermentation of vinous liquors. The
ingenious Mr. Henry, from experiments related in
the Memoirs of the Society of Manchester, has sup-
posed that fixed air is the principle on which fermen-
tation depends; for by throwing fixe6. air, extricated
from chalk, by means of the vitriolic acid^ into a mix-
ture of flour and water, he made a ferment with the
same properties as yest, and made fermented bread
with it. But had there not been saccharine matter in
the flour I suspect this would not have succeeded.
Perhaps fixed air may have a specific attraction to the
saccharine matter, and perhaps from its abundance
in the sacchwne juices of vegetables, the great

F

36

quantity let loose by fermtntation arises, and proba-
bly without its presence fermentation would not take
place, as there would be none to extricate. But be
that conjecture as it may, Vv^e are certain of one fact,
that no fermentation will take place in vegetable mat-
ter, without the presence of sugar. Upon saccharine
matter, the intoxicating spirit of the vinous ferinenta-
tion, and the vinegar of the acetous seem to depend.
Sugar is contained in the grape, in all fruits ca-
pable of being fermented into wine; is added to all
made wines, to promote fermentation and give rhem
a body ; is in the germ of leguminous seeds in inci-
pient vegetation, and upon its being developed in
the barley by vegetation in the steeping, and after-
wards, arrested in the malt on the kiln by the lire,
the whole success of beer brewiHg depends. It is the
saccharine matter extracted by the hot water^ (after-
wards called wort) that is the basis of the whole
process. Chemists have detected sugar in all vege-
table and in some animal substances. A decoction
of the tops of the spruce fir, is, by the addition of
molosses, fermented into a vinous liquor or beer and
is a wholesome and pleasant beverage. A mixture
of sugar and water only, will ferment, first into a
wine and then into vinegar; many housewives make
their vinegar in this way. From the fermentable
properties of the ingesta, thus largely furnished with

37

sugar, the admixture of the natural secreted fluids,
the saliva, a^sophagal, and gastric juices, which may
perhaps act as ferments, and the uniform warmth of
the part; I am led to conclude, that a fermentation
probably comes on, after a meal, in the stomach.
We have indeed mare than probability on our side,
"vve have real evidence that it does take place, and
whatever solvent power may be ascribed to the gas-
tric juice, or any other, fermentation is part of the
process of digestion in the living body. Our evi-
dences are the following. >

Every person in full health, must have observed
eructations of air from his stomach after a full meal^
and that the air thus discharged, did in irs passage,
impress the fauces with an acidulous pungency, and
the tongue with an agreeable acid taste. Whiclv
impressions were exactly similar to those arising
from the eructations of the gas,, which happen after
drinking new beer in a state of fermentation 5 the
natural, or artificial mineral waters, or from the
mixture of acids and alkalies, taken in the act of
effervescence, which we kQow to be fixed air. There
can be therefore little doubt but these eructations
after a full meal are chiefly fixed air, which evidently
appears to be extricated from the alimentary matters
in a state of actual fermentation in the stomach.
But we have a further proof of this, sometimes^ (eppc-

S8

cmlly if much exercise is used immediately after tli^
meal) by the regurgitation of some of those aliraenr
tary matters with the fixed air ; which from their
sweetish acidulous taste, appear to be actually ia a
state of fermentation.

We have here an evidence, that fermentation
takes place in the aliment in the stomach even in
fu'! health, and from Mr. Hunter's curious acount,
we may conclude that the gastric juice is a power-
ful solvent, and he further says stops fermentation.
How is this difference to be reconciled, §ince two
processes, the one actually destroying the other, can-
not go Oft at the same time, in the same matter ?
But, may they not go on at different times, and
may they not be necessary to succeed each other
in gradation, to complete the great object of diges-
lion ? May not fermentation be necessary to the
separation of the coniponent parts of the vege-
table matters employed in food, previous to their
more perfect solution by the gastric juice ? And may
we not suppose that the fermentation ceases before
the action of the gastric juice begins, or when the
fermentation is ineffectual, may it not stop this
process, and act on the undivided aliment, and by
the solution, and animalization of it, finish the ali-
mentary process in the stomach so far as that vis-
cus is concerned?. It certainly is not straining

3^

probability to suppose that the mixture of the bile
is afterwards necessary in the duodenum and other
small intestines, first perhaps to correct any redun-
dant acidity, and then to complete the assimiJatioa
and animalization ok the aliment and, in short, the
formation of the chyle 5 Sir John Pringle tells us
that alimentary mixtures with the addition of bile
never tasted sour after fermentation was over. We
know that the bile has always been reckoned parti-
cularly instrumental in this business, by Haller^
Boerhaave, and the other first rate physiologists of
the present century,* But be those conjectures as
they may, all the modem experimental physiologists
agree in one thing, the presence of an acid in the
stomach. — How is this acid produced ? Is it by a
natural process in health ? or is it the consequence
of a morbid affectio n? May we not conclude, that
the presence of a certain quantity is always neces^
sary in health, from this circumstance, that many
girls, from a kind of instinct, are fond of drinking
vinegar, and eating acid fruits; which seems to in-
dicate a deficiency of the natural quantity ? And on
the contrary, other girls, -when there is a redun-
dance so great as to become painful, from a similar
irtstinctive principle, eat chalk, lime, and other
alkaline substances, to destroy this superabundance'

* The eighteenth.

40

From these two extremes, thus tak uig on morbid
appearances, by which it is evident thit digestion
is much impaired in both, we may conclude that
a certain quantity of acid in the stomach is neces-^
sary to healthy digestion.

Sir John Pringle tells us, that in a diseased state
&( the digestive organs, the acid in the stomach is;
so acrid as to excoriate the throat and set the teeth,
on edge ; which fact I apprehend every person has
experienced less or more, at some period in life, as
this takes place in many diseases. He thinks, that
this can hardly be accounted for, from the
common theory of digestion, but easily, from the
principle of fermentation: by which not only a
strong but an austere acid may be produced, '' from
food consisting only of flesh, bread, and watery" as
often as the stomach is relaxed, or any way disabled
from conveying the whole aliment into the intes-
tines: for what is left having time to undergo a
complete fermentation is thereby changed into a
harsh sort of vinegar.

Mr. Hunter says. *'It may be admitted as an
axiom, that two processes cannot go on at the same
time in the same part, of any substance; therefore
neither vegetable nor animal substances can undergo
their spontaneous changes while digestion is going
on in them 5 a process superior in power to fermen-

41

tatlon. Bat if the digestive power is tiot perfect,
then the vinous and acetous fermentation will take
place in the vegetable, and the putrefactive in the
food of those animal which Jive w^holly on flesh. —
The gastric juice therefore preserves vegetables from
running into fermentation, and animal substances
from putrefaction; not from any antiseptic quality
in the juice, but by making theni go through another
process, it prevents the spontaneous change from tak-
ing place. In most stomachs there is an acid, even
though the animal has lived upon meat for many
weeks ; this however is not always the case, there-
fore we may suppose it is only formed occasionally.
Whether the stomach has a power of immediately
secreting an acid, or first a sugar which afterwards?
becomes acid, is not easily ascertained ; but (says
he) I should be inclined to suppose, from analogy^
the last to be the case; for animals in health seem
to have a power of secreting sugar, as Wc find in
the milk; and sometimes in urine, from disease.—
The acid prevails sometimes to so great a degree, as
to become a disease, attended with very disagree-
able symptoms, the stomach converting all substan-
ces which have a tendency to become acid, into that
form; the sugar of vegetables, and even vinous spi-
rits, turning directly into an acid. — -To ascertain
whether there is an acid naturally in the stomach, it

42

will fee. proper to examine the contents before birth,
when the digestive organs are perfect, and when no
'acid can have been produced by disease, or any
thing that has been swallowed. In the slink calf
*#ear the full time, there is no acid found in the sto-
mach ; although the contents have the same coagu*
lating powers with those of animals who have
nucked.

:As we find (continues he) stomachs possessed of a
power of dissolving the whole substance of a bone,
it is reasonable to suppose that its earth is destroyed
by the acid in the stomach."

J^rn inclifled with Mr. Hunter, to think> that
the conversion of substances iitthe stomach, into an
acid, is more likely to depend upon a saccharine
matter than an acid actually secreted irom that or-
igan : because, we kaow of no glands^ in the hu-
man body, nor indeed in any carnivorous or grumi*
nivorous animal, that secrete an acid liquor.- — I look
Upon the acid of ants and that of the small green
insect, called by the french pu9on or pu9eron, which
infests the stalks of gooseberries, currants, and some
other vegetables, the origin of which acid is not
known ^ to be more probably a collection of vege*
table acid matter, extracted for their nourishment,
and retained in the stomach or some other recepta-
f k for that purpose, in th^ same mi^nner as feeisrs do

,4.2

lioney — The acids of th.es.e ins.ects are I apprehend
out of the question in our present enquiry. Sir
John Pringle, we fiid^ supposes, that the acid in the
stomach is produced by fermentation Mr. Hunter
inclines to suppose tlic production of this acid to be
owing to a secretion of sugar, which ;afterwards be-
comes sour, rather than that there is an irnmediate
secretion of an acid from the stomach. It is cer-
tainly immaterial which way sugar is introduced in-
to the stomach, whether by an actual secretion from
a glandular system in that.viscus, pr in out.Yegeta-
ble food, or in the form of cfystali/ed sugar itself,
of which large quantities are continually used as, ar-
ticles in diet; it must, .sooner oj later, undergo the
acetous fermentation before it beeomes sour there.
Unless we can suppose, that the storriach has a pow-
,.€r of decompounding the sugar, in a chemical sense,
and speedily separating the saccharine acid from it,
{an operation of no small difficulty to every working
chemist) which I cannot help thinking is at least as
irnprobable, as the separation of the Phosphoric
Acid already- noticed.

-Jfut in, whatever way acids are produced^ it is
immaterial as to the fact uf their exigence in the
stomach; as there are certainly great quantities ge-
nerated there, and ejected by vomiting in simple
inflammations of the stomach and adjacent parts^ the

43

cholera morbus, the onset of several fevers, parti-
cularly those of the remittent and intermittent kinds,
dypsepsy, as well as the gout in the stomach, and
every other disease by which that organ is affected.
The reason of this I am led to think, is the morbid
state of the digestive powers, brought on by those
several diseases^ by which circumstance, as diges-
tion is impeded, the acetous fermentation is pro-
duced. ^

The acid ejected by vomiting in any one of the
diseases above named, does not appear to be differ-
ent in quality, from that which is ejected in any of
the others, and the quantity in all, seems to depend
entirely upon the violence or quantity of the disease.
Whence it appears evidently to be owing to the dis-
ease's l)avhig materially hurt the powers of diges-
tion. It may be alleged that gout is essentially dif-^
ferent from several of those diseases. It certainly is
so, but the parts generally affected with the gout, in
its acute form, whether the head, stomach, or ex-
tremities, are affected with inflammation less or more
at the attack. Most certainly simple phlegmasis,
and erysipctalous inflammation affect every part of
the human body. So does inflammatory gout^ and
we may with as much parity of reason say, that
because acids are ejected by vomiting in simple or
erysipctalous inflammation of the stomach, of the
same quahty as they are of in inflammatory gout in

u

the stomach, therefore those several inflammations
affecting the head, lungs, pleura, abdominal visce-
ra, and the different extremities, are owing to an
acid existing originally in the constitution^ as that
because acids are thrown off by vomiting in gouty
inflammations of the stomach, the gout is, in those
different parts affected with gouty inflammation, al-
so caused by an acid originally in the habit, a thing
which appears improbable if not impossible. I am
therefore convinced that the ejection of acids from
the stomach, when that organ is affected by the
gout, is no more a proof of acids being the causes
of the goiitthan of tlieir being the causes of any of
the diseases above nam.ed ; and that the superabun-
dant production of the acids in the stomach, when
it is affected by the gout, is the effect of the inflam-
matbn upon the organs of digestion, just as mu^
as it is in those diseases above recited, and not the
cause of the gout, any more than it is the cause of
any of them.

As it is by no means unconnected with our sub-
ject I beg leave to make some remarks on the green
colour, and quantity of bilious matter ejected, in
the gout in the stomach, and the other diseases,* in
which this circumstance takes place.

* Some remarlis of the same tendency as these, are, from the author's
conviction of their connection with the treatment of that disease, inserted
in his treatise upon Marsh Remittent Fever.

g2

46

It is a very commoa observation, tliat the patient
has vomited a large qaantity of green poraceoiis bile
in such a^id such diseases^ and a Hipposition from
this syrtiptom arises, that this is the offending matter
in the stomacH Srtd intesHues, and the cause of the
disease i and therefore its evacuation is absolutely
necessary, and if it v^'as completely effected^ the
disease, would soon: g.lve way ; upon this groul-id^
repeated emetics and cathartics are given. I wilt
take upon me to say that this is but too frequently a-
very erroneous opinion,, and the practice founded
upon it also eiToneotis : because this Very pora'ce-
ous bilious vomiting li merely the 6^ct, and not
the cause of the di^e^se.

To make this oJ)!nf6n clear, it is A^cces^aiy to ob^
serve that the quafttity of b'ile secretecrfrdhr th^rs^ liver
Si twenty-four hoiirs by & person in. lYrattb, is e^
mated by Hallar and otht^^s to be between 20 aiKl
24 ounces in a middle sized man. B:it thi^iia-tural
secretion may be increased by various ca^tfses, as ir-
ritation, compression, &:c. a cOmm'on em-e!ic will
wonderfully increase the secfetiD'n, and what l^
thrown off tbe stomach is mostly secreted by the
act ton oftheemetiGi d(i ring its €>perati6n ; although
it is commonly supposed to. be c6}Iected theiie before
the medicine was taken: some morbid stimuli will*^
increase the secretion more. But the bile thus pre-
maturely or precipitately secreted has no bad qualitj

4:6

in itself. It is indeed rather thmner and less active
thaft cystic bile^ and is rendered offensive only by mix--
tutts of other fluids it meets with. ' And perhaps one
of the oilmen sive mixtures is the acid, whose quality
from its superabundant quantity, k is uiiable to coi?-
recti AH acids are known to chj^nge bik to a gireert
colour, and the stronger the acid is, an4 the larger
quantity there is of it ki the mixtttre wMi t\m bile,
tlie deeper is the gresn^ ; I have frequently seen itscj-
deep as to appear black. But the acid here is by ue^
means an admixture that will produce pmtvef^^ticm^
on the contrary it will retard it^ ^id ks osily :&ak
here is its predominant abiand^dce^ whkh the bi^
b^« not a sufficient power to G^rreet^ by Ms alkales-
€jebt saponeous prc^perty : and %1^-efefmt it stiti keeps
acting as an acrid stimulus OS ttie secretory organs^
so as to forqe z larger secretion, and create an uiine-
eessary waste of this fluid t which w^ste, lam stroi^-
If of opinion, is one calise, of the sudden pr€^s>trati#m
of strerigth, in many diseases a^Gompanied by
vomiting. ^

Jn the iiiarsh rernittent fever. We som^^tiiireg^nd
that spontaneous vomiting takfs place. Which will
often firee the patient df the disease ^ in the course of
twenly-fotif bouts. Thjs is a great proof that the
itiarsh tlii^smMiajlhi^mtlsesqf ttiis fever are swallow-
ed, and descend into 4he stC]^iiiaGh With the saliva i
and if the patient ha§ the good fortune to bring up

47

all this matter entangled in the mucus which he vo-
mits, he thus gets rid of the disease. But if this is
not effected, by this spontaneous effort of nature, the
digestive powers are impaired^ a redundant acid is
the consequence, and the miasmata act as stimuli to
promote an increased secretion of bile, v/hile the acid
changes its colour to green after its secretion. The
mischiefs which then ensue are repeated Vomitings
and ejections by stool, and, from the stimuli and ab-
sorption, fresh exacerbations of fever follow , In
this process we have now the ineffectual efforts of
nature to get rid of the original offending causes of
the disease, the march miasmata in the primse viie,
but it is now too late ; the poison is absorbed into
the system, and nature again makes efforts to dis-^
charge it by the pores of the skin. The practioner,
observing that a vast quantity of green bile, mixed
with other offensive juices is thrown off by these
evacuations, is sometimes deceived by such appear-
ances into an opinion that this bile (from the quan-
tity thus thrown off, the disease has obtained the
name of billious fever) is the cause of this disease ;
and therefore to cure it, that it is necessary to get
rid of this matter. With this view he accordingly
continues repeatedly to accelerate both evacuations,
in his patient, I believe erroneously ; because the
stimulus of the operating medicines he takes, as well

48

as the mechanical effect of the operation, will in-
crease the secretion of the bile, and, consequently,
the quantity of that very offending matter, which he
supposes to be the cause of the disease : wherefore
instead of removing itj he will certainly increase the
mischief, which, if he does not stop his hand, may
help to sink his patient to the verge of the grave*
which experience has taught us is more readily pre-
vented after the absorption of the poison has taken
place, by an early and liberal use of wine and peru-
vian bark, Chan by any other means. An emetic
first, and a cathartic afterwards, certainly ought to
be employed in the beginning, in imitation of nature,
with a view to expel the miasmata from the ali-
mentary tube : but if the fever appears again, the
miasmata are most probably absorbed, and are now
out of the reach of these medicines ; and therefore
they are not only useless but hurtful, and repeated
evacuations from their continued use, must evidently,
from the above state of the matter, do mischief.

So necessary does bile seem to be to the process
of digestion and nutrition, that if, by the liver's be-
ing obstructed, it is not secreted in due quantity, thq
body is not nourished, wastes, and soon becomes
diseased 3 the juices become vapid, the vessels tor-
pid, dropsy, and other diseases ensue, which end in
^trophy and death, unless the obstruction is re-

49

moved atid digestion restored. In ^^ounds of the
gall bladder, the patient dies in a few days, I believe
from the waste of the bile discharged from the
wound, if the bile was an excrementitious fluid
this waste would no more endanger life, than the
waste of urine in wounds of its reservoir, the uri-
nary bladder, and every one knows, that after litho-
tomy the edges of the -wound sometimes become
callous, and an incurable fistula often remains, com-
municating with the bladder, through which the
urine constantly drains for many years, without the
patient's life being in danger from this circumstance.
Tmust indeed confess there is a difference in wounds
:6f the gall bladder and those of the urinary bladder,
which must increase ^@ danger of the former,
which is this j the gall bladder is placed high in the
abdomen, and the bile may for that reason be liable
to escape into that cavity, and by being more acrid
-ihan the naturd abdominal 'fluid, may inflame the
viscera and peritoneum, and, by an additional dis-
ease, increase the danger and hasten the catastrophe.
'^ Wounds in the bladder from lithotomy are not so
"liable to this misfortune, except the higher operas
ration, because they are depending; the urine there-
fore i5 less liable to dislodge and inflame the con-
tents of the pelvis: although this sometimes does
happen^ and proves rao rtal. It is, from what has

b<!eri said of this matter, pretty evident, that bile h
necessary to digestion, and the formation of chyle;
and the want of it, either from obstructions of the
liver, or the waste of it from any cause, will pro-
duce diseases, which will endanger life^ frorh the in-
jury the digestion sustains from this want.

Moreover^ if we consider that the liver is the
largest conglomerate gland in the b<jdy ; its situa^
tion at the upper part of the abdomen, contiguous
to the stoniach; the singularity of its structrue, hav-
ing not only its proper arteries and veins for its sup-
port like other glands ; but another solitary large
arterial vein, like no other in the body, the vena
portarum, ramifying through its substance, whose
ramifications enter every single glandule that con-
tributes to compose the conglomerate structure of
the liver, and are supposed to be the only congeries
of vessels in this viscus, provided by nature for the
purpose of conveying the blood loaded with the
bilious fluid, to be separated from it by those strai-^
ners ; and that from these glandules distinct rami-
iications of excretory ducts proceed, conveying the
bile thus secreted, which uniting at last form the
large hepatic duct : if we consider that curious re-
ceptacle for the bile,, thus separated from the liver,
the gall biaddei*, so different from every other in
the body, having only one orifice and one tube call-

H

bt

cd the cystic duct, proceeding from that orifice^
through which bolh the entrance of the bile into the
gall bladder and its exit from it are performed ;
which duct uniting with the hepatic, form the duc-
tus communis choledochus, which enterin g the du-
odenum not far from the pylorus, conveys the brie
into thi3 upper extremity of the intestinal tube, in
no less quantity than from 20 to 24 ounces in twen-
ty-four hours : if we also consider the alkalescent sa-
ponaceous solvent, and assimilating properties which
the bile possesses out of the body, we cannot sup-
poae that all this wonderful apparatus was contrived
only for the mere purpose of separating and dis-
charging an excrementitious fluid from the blood •
From these circumstances we may therefore conclude
that the bile was certainly intended for very impor-
tant purposes ; and that its entering the iiitestine so
Bear the pylorus must be for promoting the solution
and assimilation of the alimentary matters in the
small guts, of essential use in chylification. Were
it merely excrementitious one would have supposed
that its exit lower would have been more ready for
exclusion than where it is, and attended witli less
inconvenience than in the duodenum.

I ought to apologise for detaining you on a subject
(the bile) which, at first sight, might appear to have
na relation to the principal object of your inquiry; I

s^m howerer by no means^of that opinion ; for, when
the gout attacks the stomach and liver, and prevents
digestion and nutrition, it becomes an object of se-
rious magnitude, and requires all the light which
investigation can throw upon it, therefore you will
readily forgive the intrusion of this digression, as
it certainly has a strong relation to our subject.

To return then from my digression, we may pre-
sume, from what has been said, respecting the acid
fluid rejected by vomiting when the stomach is at*
tacked by the gout, that it will appear that the acid
is not the cause but the effect of the disease : and
upon this ground the necessity will be evinced of
promoting the evacuation of this acrid matter, thus
generated, and of diluting and blunting the acrimony
of what may remain,that it may not irritate this scn°
sible and irritable organ now under the influence of
the gouty inflammation, and increase the malady.
This seems to be best done by promoting the vomit-
ing, with warm v/ater, barley water, gruel, or any
other soft beverage, which, if it does not return by
vomiting, may dilute and render inoflrensiye what
acid crudity may remain, and when the vomiting
does cease, the acidity may be effectually destroyed
by the addition of a small portion of fixed alkaline
salt to the diluting drhik : after which the exhibit!-

H 2

on of proper anodyne and other remedies will prove
ipore efficacious.

From all that has been advanced it seemes to be:
evident that a pure acid cannot e^ist in the circulat-
ing fluids, and therefore, that it is impossible for an
acid salt, a supposed cause of the gout, to be depo-
sited from the blood, on the joints of a gouty person,
and for that reason the tophaceous concretions cannot
originate from that cause. Indeed the very concre-
tions, or as they are called, chalk stones, found there,
f:ontradict this opinion in the strongest manner j for
they are found to be alkaline earths, and dissolve
entirely in acids*

55

LETTER III.

Dear Sir,

The next in order in the cata-
logue is wine, in which article I shall beg leave to
include hard drinking,

3. Acid austere wine, upon the same principle
that acids do not produce the original cause of the
gout, are not I believe predisposing causes of that
distemper in a sound constitutiou. Excess however
in the use of any vinous liquor, by exciting an un-
usual stimulus^ may, like any other stimulus, bring
the latent matter of a gouty constitution into action,
and produce a paroxysm. But I cannot allow even
drinking wine in excess, to be the primary cause
of the origin of this disease, in a constitution other-
wise sound ; for the following reasons.

The number of inhabitants in this town is esti-
mated at near 12000; perhaps three or four hun-
dred of them are wine drinkers; that is some con-
stantly and others occasionally so. There are not
in the town that I can find, upon strict examination,
more than 39 or 40 people afflicted with the gout^

56

and these are of all ranks in life from the gentleman
to the porter. None -of these arthritics are hare}
drinkers, and some of them of the lowest class sel-
dom or never taste wine ^ their beverage being ge-
nerally beer. Three of the gentlemen are abstc-
meous men, both in the aricles of food and drink,
and although they constantly use wine in a moderate
way, were never known by any of their acquaint-
ance to be intoxicated. I have moreover to observe
that in forty years* practice, I have seldom known
^ hard drinker afflicted with the gout ! — ^We have
gouty drinkers here it is certain, but not above one
or two, and theiFe is sufficient evidence that the dis-
ease descended to them from their parents. By
hard drinkers I mean those who are drinking from
morning till night, and are seldom sober; but keep
perpetually heated with liquor, and are often intox-
icated for days, I may say weeks in succession.
Their days are generally shortened by this excessive
intemperance, and phrenitis, paraphenitis or hepa-
titis, puts a speedy period to their existence, or a
more lingering yet premature death is brought on by
the constant stimulus destroying the tone of the ali-
mentary canal, which bringing on obstructions of the
liver and all the glandular system of the chylopoe-
tic viscera, consequent jaundice and dropsy finish
the catastrophe, without a single symptom of gout
making its appearance.

57

A gentleman, a very near reJation of mine, be-
Game a hard drinker long after he was attacked by
gout. The gout did not kill him, he fell a victim
to dropsy brought on by this kind of intemperance,
and, upon opening his body, five gallons and up-
wards of water were discharged from the abdomen;
the liver was schirrous, and weighed nine pounds;
the pancreas, spleen, and in short the glandulous
system of the whole abdomical viscera were enlarg-
ed and obstructed. This happened in an early pe-
riod of my life, but I have seen many similar instant
ces since that time.

From these facts we are in some measure autho-
rised to infer that wine, even acid wine, is not a
predisposing cause of the gout. But that an excess,^
sitting up late at night employed in hard drinking,
with accidental cold when heated with liquor, may
so far derange the system in a gouty constitution as
to produce a fir, by thus rousing the dormant gouty
matter into action .

4. Premature and excessive venery shall come
next under consideration, as^ a supposed predispos-
ing cause of gout. How this came into the cata-
logue I know not; I must however differ from the
authors of this opinion, because,, it appears to bring
on very different diseases. By it the constitution h
enervated and debilitated^ the vis vitae: is exhausted^

53

paralysis, tabes dbrsaiis^ and atrophy ensue, and death
frequently brings up the rear of this species of in-
temperance. I have seen an instance of a young
man losing his sight, and becoming totally blind by
it. He recovered it is true, but by very slow de-
grees and with the greatest difficulty. Yet he had
no symptom of gout^ nor did I ever hear that he
ever had any;

The gout on the contrary docs not appear to be
the child of a debilitated or enervated system. Ic
generally comes on in a full habit, and firm tone of
fibres; is, in its acute state, which I believe to be
always the case, or with a very few exceptions in-
deed, attended with inflammatory symptoms, often
of the very highest kind. Tlie gout does not appear
till about, or after, the middle age : though it must
be owned that some few exceptions are to be found :
I know one person who had it at twelve and another
at fourteen years of age, the latter of whom be-
came afterwards a miserable cripple: but both of
these evidently had the disease by descent. We
may from the above considerations fairly conclude
that venery is not a predisposing cause of the gout^
and that the opinion that it is so is not founded on
fact.

5. Contagion is among the original causes of gout
mentioned by Bocrhaave; and his commcntatoTj

69

Vanswieten, is at some pains to point out the pro-
bability of it by adducing instances of <iistempers
becoming contagious which were not naturally so;
and the dysentery is mentioned, which is a simple
disease in the beginning, but becomes highly con-
tagious in the end. But people conversant in the
diseases of fleets and armies, know, that the con-
tagion of this disease, and fevers,^ depends oh par-
ticular circumstances arid situations; that the vapour
of putrid animal matter from the privies is the prin-
cipal source of infection, among the sick soldiers
and sailors; aiid the air contaminated by human ef-
fluvia, in crovfc^ded camps, hospitals and ships: and
that human effluvia in apartments filled with the
sick v^riM not only produce the gaolj hospital, or
ship fever, from the most simple beginning, but
dysentery: which are certainly very diiFerent diS'^
cases from the gout.

1 shall not follow Vanswieteti through the strange
stories which he has adduced from Helmont and
others in proof of the gout's being a contagious dis-
ease. I shall only say that they furnish tokens of a
credulity which degrades the learned commentator.
The only apology we can make for him is — "in-
terd\!m bonus dormitat Homerus."

The peculiar smell, which I shall hereafter notice,
emitted with the perspiration from the diseased limb

1

60

Gh the resolution of the gouty paroxysm, might lead
to a supposition that these effluvia contained miasms
of the disease of an infectious nature, capable of
propagating the gout by contagion; but experience,
I believe, proves the contrary* I am convinced of
•it from having seen a great number of miserably
crippled arthritics with chalk stones, ulcers. Sec. in
the coursre of my medical life, and some now, are
immediately under my eye of twenty five and thirty
years* standing : but I never knew a single instance
of a wife, who was constant in her attendance on
her husband day and night, nor of any other attend-
ant or memiber of the family, ever receiving .gout
by infedtion from the diseased person. Yet surely^
in circumstances like these, were it contagious, the
infection must operate, and. In a town w^ith a large
number of inhabitants, where many families live in
confined yards, and several under the same roof, it
must soon become general. On the contrary we
have at most 40 arthritics in near 12000 inhabitants
in this town, and therefore I cannot think the gout
contagious, and believe that It is generally true, that
no hereditary disease is so.

6. Irregularities of every kind; 7. unnecessary
exposure to Inclement weather; 8. violent and far
tiguing exercise, particularly on horseback in cold
and wet weather. These' with others will certainlv

61

act as occasional exciting causes of a paroxysm in
a gouty constitution, and really do so. But we may
truly venture to say never did so In a sound consti-
tution. This vfill appear evident from experience
and observation, if we consider that there are no
men in active life but are exposed to some irregula-
rities, to the vicissitudes of weather in inclement
seasons, and indeed all seasons: many to severe and
fatiguing exercise, in every season. For instance
seamen who live very often on but indifferent pro-
visions, in which a large proportion of salted ani-
mal food^ of not al ways the best kind, enters. They
cannot be called temperate men, but are exposed to
^s many vicissitudes in the articles of meat and drink
as in those of the weather which they combat; and
are generally known to drink freely, or rather ex-
cessively, whenever they have it in their power.
Yet a very small proportion of those men we ob*
serve afflicted with the gout: perhaps not one in
1000 or we may possibly say thrice that number.
Here then we may find irregularities of eating,
drinking, and every other kind, with exposure to
every variety of weather; yet the gout is produced
but in an insignificant number, and perhaps if in
those the origin of it were traced, it might be re-
ferred to an original leven from hereditary descent.
To these we rnny add the labouring husbandman^
I 2

62

who perhaps does pot eat so much anrmal food as
the sailor. His diet consists generally of fat bacon
and coarse fare, and when he has it in his power,
he will not resist often the temptation to get drunkj
he however is inured to hard labour, and the vicis-
situdes of weather, and perhaps as few of his clasfi
are subject to the gout in its acute form as of the
other, yet they sometimes have symptoms of chronic
gout.

The next we may notice are the working mecha-
nics of every denomination. They are in their diffe-
rent occupations exposed to hard labour, some to
the yicissitudes of weather, many to gross food> and
many are addicted to hard drinking occasionally^;:
yet very few of these men ai|"e subject ta the gout*

Lastly I y^dll narnethe gentlemen sportsmen, the
sedulous followers of the field diversions of hunting,
shooting,, and coursing; among whom I shall in-
clude the gentlemen farmers and farmers of a lower-
order, who, besides the vicissitudes of weather they
experience in their necessary business, endure thenv
in the pursuit of field diversions. These people are
less or more exposed to all kinds of weather, and
every species of intemperance; yet a very trifling,
number of them wc find subject to the gout, and in
those it can easily be deduced from ahereditary origin.

If these causes therefore were actually productive

63

pf the original gout in the constitution, every man
exposed to theni would be more or less afBicted
>yith it; the contrary of which darly experieiie«
evinces.

9> Violent affections of the mind from aaiger,
terror, grief, or any sudden misfortune or distrc?is.
These repeated causes will occasion 3 paroxjrsnjf;,
A sudden shock from- aay unforeseen distressing ac-
cident, I know from experience, wiH produce a £t
of the gout. But this can only happen in a consti-
tution iqipregnated with the original levcm conveyed
by descent. For if these were really original causes.
pt the first generation of the gout, in an otherwise
sound constitution, every human being, male or:
female, upon tiie face of the earth, wouM be sub-
ject to the goi^t, as all, one time or other, are ex-
posed to the vicissitudes of those several passions.
Therefore this cannot be true.

10. Intense study. Sydenham in his *^ Letter t^
Dr. Short," (Swan's Trans. Pag. 462.) tells him, that
an immediate application to a large work cm the
gout and dropsy, which he was composing, occa-
sioned the severest fit of the gout he ever had, and
that, a& often as he returnetl to this study, the gout
recurred, which made him abandon it and consult
his health, and content himself w^th the short essay
he had wTitten, to which his Letter Is prefixed.

64

Sydenham was terribly afflicted with the gout, and
an unusual exertion of mind, in a habit s^ charged
with the disease, by this appUcation might excite
the action of th(? gouty matter, and occasion a pa*-
roxysm; and the same thing may happen to other
people. Nothing of this kind ever happened to me :
on the .contrary I can apply closer and with more at-
tention to a subject , and discuss it with more clear-
ness and recollection in a state of convalescence af-
ter a fit of the gout than at any time. But, how-
ever that may be, it cannot be concluded that, be-
cause intense study excites a fit. it must lay the origi-
nal foundation of the gout, in any sound constitu-
tion. Were it so, every studious man in the world
would be liable to the gout, the contrary of which
is well known.

11. It would be useless to run through the whole
of Boerhaave's list, most of the articles of which
are-^ounded on mere speculation and conjecture.
He reckons eating asparagus as one cause of the
gout, as also fat bacon. Vanswieten tells us in his
commentary on this aphorism, that the subputrid
peculiar smell which asparagus communicates to the
urine after it has been eaten, shows it to be a very
penetrating substance; he however acknowledges
that it may be eaten in large quantities by men of
sound constitutions, vvithout any injury: yet in

gouty peof)le It had sometimes been observed that a
copious use of it brought on a fit; and asks, whe-
ther by its penetrating virtue it does not move and
bring into action the hitherto dormant morbific mat-
ter? he says that Trallcanus condemns cabbage,
cresses, rocket, leeks and garlic, as inimical to the
constitution in this disease, and that these occasion
a different smell in the urine. I have not sufficient
experience to decide In these matters. It strikes
me however that boiled beef and boiled mutton very
soon convey a peculiar smell to the urine; and food
of this kind, and many other substances may as well
be condemned upon this ground, as those above
named. For my own part I eat freely of aspara-
gus, cabbage, beef, mutton, &c. and hitherto with
impunity, and when a fit does come on it must be
from some other cause, as it generally happens when
asparagus is not to be had. I therefore believe this
opinion to be without foundation.

Upon the same ground many other substances
may be said to produce the gout, because they are
active and penetrating ; as most of the tribe of diu-
retic medicines^ in particular all the turpentines,
from whatever origin ; whether in the form of gross
turpentine, burnt turpentine known by the name of
tar, resins, balsams, or essential, or distilled, oils:
all which ^onyev a violet smell to tbe urine^ whether

m

tmkcn inwardly or applied externally. Even the ef-
Suvia of them are known to produce that effect, as
GveTy one must have experienced who has remained
any time in a new painted room, where OI. Tere-
binth had been used in the colour : but as it will ap-
pear in the sequel that the kidneys are employed as
one of the outlets of the gouty matter, in the decline
of a paroxysm, it is reasonable to suppose that those
renpsdies which promote the secretion of urine^ would
rather conduce by expelling a large portion of the
offending matter, to relie\'e the patient, than to
bring on a fit.

12. Debility — from its latin origin, means no^
other than weakness, feebleness, decay of strength.
It can mean no other in a medical sense. To sup^
jK)se that the gout originates in the system from
debility seems to be contradicted by common expe-
rience. The gout generally attacks men of strength
and vigour, in the prime of life, with firm fibres
and a full habit, and it is with them a truly phlogis-
tic or inflammatory disease. Men of this descrip-
tion cannot be said to be in a state of weakness,
feebleness, or debility. After the inflammatioa
abates, the intense pain gives place to a real debi-
lity, in the part affected chiefly, but by consent in
some degree in the whole habit. This appears ma-
niffstlv to be the effect of the disease. The action

bf the goUty matter seems first to have produced the
paroxysm with great inflammation, and after that
has abated, to act as a sedative poison on the ner-
vous system, and bring on debility. This must be
ubvioiis to every ob^erverj as must also be the in-
crease of this debility^ by the repeated irritation of
the cause of the disease, after every paroxysm, as
people advance in life. To suppose debility, then,
to be a cause of the gout, is to suppose cause and
effect the same thing*

13. Some have lately supposed that the gout ori-
ginates in an otherwise sound constitution, free from
suspicion of any hereditary cause, from the poisons
of arsenic and lead, which, to the disgrace of hu-
manity, are used, for certain purposes, in wine, by
the manufacturers of that otherwise wholesome be-
verage. It is however well known that many ab-
stemious people, who very seldom taste wine, are
dreadfully afflicted with the gout, whilst ninety nine
wine bibbers out of a hundred (or we may go much
farther) and hard drinkers too, are never afflicted
with it^ therefore this cause requires no refutation.

It rs not my purpose to enter uito a discrimina-
tion of the well known deleterious powers of these
minerals. It may be however observed en passant
tfiat arsenic and lead will produce the palsy. We
know that severalmechanics use arsenic In their dif-

K

6S

ferent occupations, without being afflicted with the
gout; some few of these and manufacturers of lead,
plumbers and painters, are afflicted with it, but not
in a greater proportion than other people; and if
these poisons, particularly lead, would produce the
gout, a great majority of these artists would be
afflicted with it, which is not the case.

14. Others have added to the catalogue, strains
and bruises, as exciting causes of the gout. It
W(pild be inconsistent to suppose that those external^
injuries would lay the foundation of the gout in a
sound constitution: since if that were the case na
one could be safe. We find that in sound constitu-
tions with regard to gout, these injuries produce but
temporary maladies, and seldom, unless extremely^
violent, amount to simple inflammation ; therefore
to consider them as original or- proximate causes of
the gout must -be injudicious. But we know that
external injuries will produce a fit in a gouty con-
stitution. For instance the sudden application of
cold, particularly to the extremities; blows, hurts^
bruises near the joints, producing acute pain the in-
stant they are inflicted, wounds, sprains, &c. are
frequently sure to produce a paroxysm out of the
comnion course. I have twice had a ^eveffe iit
brought on imr^ediately, by falling accidentally with
my foot under me ; twice by sitting up all night in

69

my professional duty in a room with a brick floor,
although there was a good fire in it; and once by
sitting only during the time of dinner, on a cool day
in summer, with my feet on a painted patent floor
cloth, over a boarded floor, in a room where there
was no lire. It struck a chilness through my whole
frame as if my feet had been placed uncovered sud-
denly on a cold marble slab. And I have had fre-
quent relapses by being obliged to travel in cold,
wet, or snowy weather, in attending my professional
avocations. I have known a blow on the elbow,
the fail of an inconsiderable weight on the joints
of the foot, a sash window upon the fingers, and
many other accidental injuries, bring on a fit of the
goat directly, and, exclusive of the temporary mis-
cJiief, superinduce a thickness in the ligaments, a
total lameness, and sometimes chalk stones have ap-
peared near the injured joints.

From a retrospective view of what has been of-
fered, it seems to appear that the only original, or,
if you will, proximate cause of the gout, in an
otherwise apparently sound constitution, is heredi-
tary descent : that all the restare secondary, occa-
siona4, or remote causes, and can only produce a
fit; and that the application of any extraordinary
specific stimulus, whether from within the system
or from without, will derange the economia anima-

K 2

70

lis of an arthritic, excite the latent gout into action,
and bring on a paroxysm, even out qf the course of
what is commonly supposed to be the time for the
regular periodical returns of the disease, in either
spring or autumn. This consequence will not howr
ever always be the case : and the powers of the
Constitution, by the exertion of ?ome particular and
unknown process, are gften ^ible to avert the mis-
chief. Thus we see that every fit of intemperance,
ever}" instance of grief or terror, every application
to intense study, or any thing that the mind is anxi-
ously employed on,, every violent exercise, applica-
tion of cold or external injury, will not constantly
produce a paroxysm of the gout; although these
causes frequently do produce this effect: but the na-
tural resources of the habit have very often powers
unknown tons of getting the better of those stimu-
li, without a fit of the gout being the consequence.
Different authors have given different divisions of
the gout, which it will be unnecessary to take up
your time with here.— A very respectable one. Dr.
Cullen, divides it into the regular and irregular, and
the latter into atonic, retrocedent, and misplaced.
Perhaps it maybe more simple to divide this disease
into tvyo kinds only, the Acute and the C/ironw
Gout ; because, agreeably to the different pheno-
mena, the several gradations, if I may so term th.enx>

71

between the highly inflammatory acute state of if,
and the low^t debilitated chronic state, the two
extremes of the disease, involving all the irregula-
rities of it, may be readily comprehended.

It must be remembered that the gout is a disease
of the whole system ; and although the extremities
are first affected, in its acute form, every part of the
body, from its continuance, is liable to be attacked
whilst that form lasts, with inflammatory symptoms.
And we can easily conceive that the inflammatory
diathesis does gradually lessen, as the powers of na-
ture become weakened, by the repetitions of the pa-
roxysms,, and the concomitant decline of life; that
this lessening of the inflammatory diathesis will con-
tinue in proportion to the increasing debility of the
system, from these causes ; and all the intermediate
symptoms of gout, with ineffectual Inflammatory
powers, may seize difier^^nt parfsof the body, and have
the appearance of retrocession or being misplaced, al-
though j in fact, it may be the real progression of the
(disease, excited to act in diflferent parts, according
to the quantity of it, and the power applied. In
course of time the debilitat-ed system becomes so
Weakened, and the eflbvts gradually so feeble, that
tlie natural powers can do no more in the inflamma-
tory form, and then it may be presumed that the
chronic form of the disease bec*inS;s and spasms ini

duced in this state are ineffectual in throwing It off.
Hence we may conceive that as the gout is an
aSection of the whole habit, from a hereditary labes,
the morbid matter is diffused through the whole
body; that it lies dormant until an adequate power,
by a process we are entirely ignorant of^ rouses it
into action ; that although the extremities are gene-
rally first affected: as we know from experience, in
some constitutions other parts are attacked before
the extremities; and that, in an advanced period of life,
with a concomitant quantity of the disease, different
parts are indiscriminately affected ; the feet or hands
no more* than the knees, thighs, ischia, loins^ spine ,
shoulders-, clavicles, sternum, &c. this has therefore
been called wandering gout, probably with impro-
priety, as the cause was present in every part alike,
- A living author* of great respectability, to whom
medicine is much indebted, is of opinion that the
gout is hereditary, and also believes that it may be
acqutred. He is at much pains to prove that it is
not owing to a fluid morbific matter descending
from father to son : but supposes it to arise , as a
disease of the whole system, from a general confor-
mation of the body; yet says that the general state
of the system depends on the state of its primary mov-
ing powers, therefore the gout is an affection of these,
and chiefly of the nerves. This is briefly the sum.

♦ Professor Cullen.

•7'3

of his theory respecting its hereditary origin, =1
leave you to consult his arguments against the :ex-
istance of a morbid fluid cause of the gout, at ;your
leisure, and shall only observe that the most rigid
sceptic will not deny that the rudiments ^ef eveFy
living being were originally in a fluid state ;'tbat
the constituent principles upon which the formation,
organization, nutriment and increase of < th« » foBtes
depend, existed first in the blood of the parents :
and we can no more discover the different materials
upon v^rhich those different processes in the body
depend, by any examination or an aly nation of the
blood, than we can the particles of morbid matter
which we know have actually been conveyed into
the blood, of both young and old subjects, and wliicb .
do produce disease. And on the other side^thaty
apon dissecting the offspring of gouty parents, no
difference in the texture and general conformation
of parts, particularly those parts mostly affected witb
the gout in adults, has been discovered from those
©f other subjects, where there was no suspicion of
a hereditary gouty leven in them. We do not find
but mefl descended from gouty parents have their
joints as wellformed,andareas athletic, vigorous, and
active, before they are attacked by the gout, as tho$e
whose parents never had the gout themselves^ nor
any su^piciJon-of its-being ia their constitution,. l;>y

descent, frorti their forefathers. We find that the
difference which appears afterwards in the articula-
tions of gouty people, is, beyond a doubt, owing
to the consequences arising from repeated parox-
ysms of the gout, and has nothing to do with the
author's general position, in regard to the general
tonformatiort of the body, as hereditary from father
tdsoni but is ihe effect and not the cause of the
'disease.

The suni of this Professor's pathology of the goUt
^moutits to this: he supposes— that a plethoric and
vigorous system irt some, at a certain time of life,
causes atony in the extremities; that this is in some
measure communicated to the whole system, but
chiefly to the stomach. That if the energy of the
brain and nerves is still as great as ever, the vis me-
dicatrix naturae is excited to restore the tone of the
parts, and accomplishes it, by exciting an inflanfi-
matory affection in some part of the extremitic's,
which, subsisting some days, the tone of the extre-
mities is restored, and the patient returns to his or-
dinary state of health.

This ingenious hypothesis is liable to objections.-^-*
If by some, is meant people of a hereditary gouty
constitution, and th.is manoeuvre of the vis medica-
trix naturae, is merely introduced to account for the
production of a paroxysm, this machinery is alto-

7S

getlicr unnecessiiry : because a plethoric habit is
not absolutely required to excite ^ fit; any stimulus,
even blows or hurts on or near the joints, in gouty
constitutions where no plethora exists, are from ex-
perience found to be sufficiently competent to this
purpose.

Plethora is supposed to cause different inflamma^
tory diseases, and it may. bring on the gout in a he-
reditary gouty habit. But if he means here that
this supposed manoeuvre of nature is to produce what
he c^lls accquired gout in an otherwise sound habit^
We hav6 qlready^ in the examination of different sup-
posed existirfg causes of the gout, said so much on
the improbability qf its being produi:ed In any ^ other
way but from descent, that we must have better
proofs than mere opinion or bare assertion before wc
can accede to this hypothesis*

^\ The inflammation, subsisting some days, is sup«
po^ed to restore the tone of the extremities, and the
patient returns to his ordinary state of health."

Were this really so, we should have no gouty-
cripples ! For, according to this hypothesis, the in-
flammation excited in the extremities^ supposed to
be in an atonic state, produces a reaction of the ves-
sels, which, by these, means, recover their tone, and
become better able to perform their functions than
they were before the fit. This supposed atony how-

h

t

6

6v^r, at' this pen66 ,13 much to be doubted ; beeaus^
I apprehend it is not supported by expencnce. I
know ma-ny who Appear to be more alert and active,
hatve greater fiexJbiHty in their jbints> and more;
Strength and ^ility in their limbs, immediately be-
fore a paroxysm than at any other time. 1 am one
of the number, and have fconstahfly experienced this
for many yo^rs ; afid froiii this very eircumstante
know f 0 k cerf^'fnfy when a fit is tiear ^t hsind Peo-
p\^ of this descrfption^ in which may be mcliided
the vigorous ^nd pJethoric, catmdt be said to have
any ^ppeararite of greater debility, or, in othei:
tvords, atony, or wSiit of action^ in their extremities
befbTe the iiti than at aily other timfe; itideed it li
notorious that instead of the \Vonted hdalth ^nd vi-
gour being restored,- a real atony is produced by the
fit, this atony progressively iricrfeases \Vith every pa-
roxystn, the functibfts of the parts are gradually im.-
paired, arid detrepittide, itl a greater or less degree^
becomes the CGnsequehcei

I perfectly agree with this author that the nerves
are the media through which this whole intricate
busitiess is transacted : for, as the whole system is
coriceived to be impregnated with the gouty origi-
nal cause, the nerves bi^ht to possess at least
their proportional quantity. As th^ir extreme sen-
sibility renders them first susceptible of irritation.

77

being diffused so full}^ through the system, thc-y be-
come readily obnoxious ^o >be affected by every sti-
Hiul'js; tho application iof wiiic^ 4:oaises ^hera iuj-
mediately, and that portion cf Xhe gouty matt'erj
which they possess, may he supposed to be fh-us de-
veloped, diffused, and brought into action, and to
bring on a paroxysm. This seems to be mo^st <:<m^
spicuously evident in the gout brought on by an ex-
ternal injury. As I do not however pretend to know-
any thing of the secret operations of nature, I only
allege l; e probability of this being the case from
what ici evident to the senses.

The irregularities of retrocession, translation, &c.
of the gout, are supposed by this author to arise from
an alternation of the action of the external with the
internal parts : but I, who suppose that there exists
a real morbific fluid which possessesthe whole system,
apprehend it to be more probable that these pheno-
mena are only variations of the disease, in perhaps
a natural progression, by the application of the sti-
mulating cause to that part which is attacked : for
that no solids can act, in the animal body, without
the introduction and circulation of the fluids through
them is pretty certain. Whateverstimulus, therefore,
external agents may give, to produce spasm in the
living fibre, the internal fluids, I conceive, must
Jiavt a large share in the business, both as to the

^L 2

78

production and continuation of the symptoms of
this disease, and that the probability of such a fluid
agent, of a very subtile nature, in mixture with the
constituent parts of our system, does actually exist,
I trust will appear in the sequel, not from the plau-
sibility of conjecture only, but on the more certain
ground of being obvious to sensco

79

X.ETTER IV.

Having endeavoured in my for-
mer letters, to show, from a sketch of what is known
respecting the formation of the human foetus, &c.
on what ground I had formed my opinion^ ttiat the
only cause of the origination of the gout in the hu-
man frame, is hereditary descent : and that the al-
leged causes thereof to be found in authors, from
an examination of the principal of them, are nothing
more than occasional or accidental stimuli, which, in
certain circumstances excite the dormant gouty mat-
ter into action, and thereby produce a paroxysm : and
indeed some of them I conceive not even equal to have
this effect: it will now, my friend, naturally occur
to you, that some inquiry should be made into the
nature of this morbid matter, so often mentioned by
authors, and repeatedly named in my letters.

This inquiry will be a very difficult task, and will
prove, I believe, a medical problem, which never may
be solved. This matter is of two subtile a nature to
be collected in a separate state, and free from mix-

so

ture with other adventitious adjmicts, so ss to be
the subject of accurate investigation : nor, were a
quantity in the gross mixture to be collected, can it
be separated from its grosser parts, so as to show the
pure gouty matter in its origina], I may say, ethe-
rial, fluid state, by any chemical process that I
know: nor, if this could be doce, do I think it
would answer any beneficial purpose, either as to
tbe iavestigation of its real nature, whilst it is in
the rsy:stem3 or, to the pointing out any method of
curing th^ disease: at least I do not find, that the
Tesolution &£ any animal matters into their constitu-
^nt pdncipks, by chemical analysis, has been of
•any 'manifest utility either in the prevention or cure
t^ diseases, or in explaining the nature of any one
idistetnpea:^ A^y one of the constituent pinciples
.must be extremely different in its properties, when
thus separated, to what it was in the aggre.gate mass
4n the iiviifg i)Qdy .—You may perhaps say, "' it is
^ qiaery ifthe mat. morb. prodagrae be animal mat-
ter f" If it is not, it certainly is nearly allied to it,
as tv-e know not of its existence any where but in
^a^ animal body. I havejsaid it is a fluid, and in this
I am countenaiaced by almost every one who has
written on the subject. I shall however pass over
in sikflce that mass of conjectures to be found in
authors j lanid Joffer, in proof that it is a fluid of a

81
tery subtile nature, some facts that are obvious to
every one's senses But before I enter upon this
discussion, it will be necessary to mention some cir-
cumstances, which happen on the resolution of a
^uty paroxysm, which may help to throw- some
ilght on this very intricate and curious subject.

When the inflammatory stage is at the height, a tu-
mefaction of the parts affected commeiices, whether
the seat of the distemper be in the footer in any other
articulation -, which is greater or less in proportion
to th(S violence of the symptoms, and probably the
quantity of the disease. For the sake of perspicuity
let us consider the foot, because the progress is more
particujiarly and distinctly marked there, than any-
where else^ in a regular paroxysm.

AVhen thfe tumefaction of the foot takes place, the
pain begins to abate, and gradually lessens until it
ceases, at which period the foot is much swollen :
but the concomitant inflammation ends with the
pgin. It is diflicuit to investigate the cause of this
singular fact, but as I have attended to it with great
solicitude for many years, I shall attempt some ex-
planation of it, which I will give you as it strikes
me.

The sw^elling of the foot appears manifestly to be
owing to the infiltration of a fluid, into that con-
-aecting medium, the tela G^Uulosa, surrounding the

8^

parts affected, that part 6( it I chlefiy meaii which
contains little or no adipose or oily matter, and even
into the cavities of the articulations, and mucous sacs
in the neighbourhood of such articulations, wher'^
they are seated. This however is more evident in
the mucous sac under the insertion of the rectus
muscle into the patella, than any where about the
foot. This infiltration, so far as I have been able
to judge by inspection, is at first mostly limpid and
colourless: but afterwards, by the evaporation of
the finer parts, it becomes more inspissated and
opaque.

That this is the cause of the swelling appears evi-
dent, by its subsiding on a fluid's being discharged^
by any outlet on or near the part, either from a spon-
taneous crack in the skin from the great distention,
or the application of a blister. I have often emp-
tied the cellular membrane, and reduced the swell-
ing by blisters, in less than twenty-four hours, the
discharge being always great and of long continu-
ance, if the cuticle was removed.

The first cause of this collection and infiltration
of a fluid, is, in all probability, that particu lar de-
rangement, which must take place in the absorbent
system, in the parts aOectcd, wliilst they arc under
the influence of the gouty inflammation, which
must render it impossible (ov this wonderful procervS

in nature to be carried on with regularity. By the
action of the heart and arteries, increased by the
gouty inflammatory fever, the inhaling arteries will
continue to pour their fluids into the cavities, whilst
the power of the absorbing lymphatics is wholly sus-
pended, their orifices being shut by being involved
in the disease.

Although this may aflford a plausible reason for
the cause of the swelling, it, by no means, accounts
for the cessation of pain, which so speedily takes
place at this period. From a careful attention to my
own feelings, I am led to conjecture, it may be this.

About the height of the inflammatory stage of the
gout in the feet, when the pain and spasm are
dreadful, the coats of the vena saphena and of the
ramifications of it upon the foot are so exceedingly
inflamed and painful, that thay cannot bear the
slightest touch ; and the whole of the ramifications
on the parts affected, appear exceedingly turgid,
black, and obstructed, as if the blood was stagnant
in them. Whilst the capillary extremities of them
are in such a state, is it not probable, that they may
be so contracted, as to prevent the blood from the
capillary extremities of the arteries from entering
them, as in the ordinary course ot the circulation ? by
which an obstruction is formed to the passage of
the blood in those vessels. The blood then being thus

M

^64

-denied admittance, whilst, at tlji^ fame time, the in-
flux, of it receives a stronger impulse from the in-
creased, action of the heart and large arteries, excited
;t>y nature, to overcome the resistance met with in
the capillary .extremjtie?, those capillaries must be
;so ,much .distended that they are ready-to burst ; and
would actually do so if their orifices did not give
Way,.anda]low the fluids tbpass in greaterabundance
: thaa w.h en: ihe natural secretion of the usual limpid
form, in th^ process of secretion and absorption, is
duly performed, in the eel Is of the tela cellulosa and
..every other cavity. in .an animal body. -Tha fluids
which thus And their way are mingled, most certain-
-ly, with, morbid particles o£ gouty matter, although
.they are, mostly forced in the colour of serum, from
the finer arterial, orifices,; into the cavities, above
named; or else, in the state of red blood,. :either
through orifices of a larger diameter, or a. rupture
. in the vessels themselves. One of those circumstances
must sometimes take place, as it is. not uncommon
to see large extravasations in the tumefied part at
this period, several instances of which I have seen
on the tops of both feet at the same time, in the form
of. a large ecchymosis, on each of them, like that -
occasior,ed by a contusion, but much blacker, and
they were many wrecks longer in dispersing than ec-
chy moses produced by external violence generally are.

So

The violent distention of the obstructed capillary
arteries above named, must occasion gr^at pain,
and, in all probability, must be one of the leading
causes of that dreadful pain and spasm so distressing
to arthritic sufferers, at the period immediately pre-
cedins: the tumefacrion of the foot : and the rdaxa-
tion which must take place after the capillaries
find this exit for their contents, whether in the form
of serum or blood, may be part of the cause of the
relief afforded to these terrible symptoms,^ when the
^welling is produced by the infiltration or extravasa-
tion of blood or serum, in the manner abovemen-
tioned. At the same time that this process is going
on, the pain in the coats of the ramifications of the
venal system and other inflamed tendinous or ner-
vous parts, will, in all probability, disappear with
the resolution of the inflammation, beginning about
this period to take place.*

We now, my friend, come to that period of the
paroxysm, when it is about to resolve, and then it

* This may afford a plausible reason for the symptoms above related ;
but what can account for that peculiar shifting and transi tory pain, which
so often takes place in gouty invalids ? I do not mean that pain which moves
from joint to joint, in a regular progression of a paroxysm j where, for in-
stance, the gout seizes the foot on one side, then the knee, and moves frora
tiicnce to the knee and foot on the other side j or from foot to foot and
knee to kaee ; all which are so common in a fit of the gout : but that in-
stantaneous darting pain, v/hich strikes without warning, and springs like
au eledric shock from place to place : sometimes rapid, sometimes slower^
in its progiessioiij with little or no acceleration of pulse, and little or no in-

M 2

86

is that the existence of the gouty fluid is rendered
obvious to our senses.

When the tumefaction of the foot is arrived at its
height, the parched cuticle cracks, and a sweat be-
gins to issue from the pores of the skin. At this
period the pain is abated and the inflammation be-
gins to resolve. This discharge from the pores is
accompanied with a very peculiar foe tor, which is
the first and strongest proof, that is obvious to the
senses, of the existence of the genuine gouty fluid.
This smell is sui generis, and like ne other existing

flammatory heat; and after shifting for sometime from place to place, seems
to affect one spot more than the rest, which is generally in the vicinity of
some lymphatic glands, and here a puffy trifling swelling appears. The
seat of these singular pains seems sometimes to be in the tendinous fascia;,
which is spread over the muscles, immediately under the adipose mcm-»
brane, in rnost parts of the body j but is particulary distressing, on those
expansions which cover the loins ai^d os sacrum; and the periosteum of the
bones of the thighs and legs seem to my feelings chieSy affed^ed ; from this
it seems to afFe£t, in a distressing manner, the ligaments of the joints and
the tendinous insertions of the muscles ; although those parts have been
supposed by Haller and others to be void of sensation : and the lymphatic
glands in the neighbourhood, particularly those seated between the flexor
tendons of the leg at the back of the articulation of the knees, and from
them darts along the lymphatics. The nervous system, in those parts, is
affected, in a wonderfully distressing manner, with excruciating torture-
particularly on the least alteration of posture. The cause of this evidentlv
cannot be a gross agent, but seems to be one as subtile and active as the ner-
vous inflnence itself; but in what manner it does act, is a mystf ry I believe
beyond the reach of human wisdom to discover. All that inexplicable chain
of malady here recited,! have repeatedly experienced in the course of my
»rthriticlife.

S7

in nature. It strikes the olfactory nerves ot gouty
people themselves in a singular and forcible manner,
but much more so does it those of the attendants
and bystanders. In every critical evacuation by
sweat in fevers, rheumatisms, &:c. there is some
smell, and in those diseases the smell is pretty much
alike, but very different from the smell of the pers-
piration of a gouty person, at the resolution of the
paroxysm, which is most readily distinguished from
all others on the face of the earth. Philosophy
teaches us that odours of every kind, depend on
effluvia of a fluid nature, ascending from odoriferous
bodies, in very minute particles : whether the bo-
dies are aromatics or fcetids, in concreted masses or
a liquid form, makes no difference, the odoriferous
particles are diffused through the circumambient air,
and most probably are in a state of solution in it.
These gouty effluvia are certainly very minute parti-
cles, and sufficiently evince the presence of an ex^-
ceeding subtile, I may say, ethereal fluid, escaping
in the form of vapour, mixed with the sweat ot the
diseased limb, and whilst part of it mingles with the
surrounding atmosphere, a much greater part, mix*
cd with the sweat, is absorbed by the bedcloths, &c.
and impregnates these so much that it is long before
it leaves them, even after the fit is over. In pro«
portion as this fluid escapes^ the symptoms abate^

88

the swelliri^Tf subsides, and the extravasated fluid, its
ciise, gradually lessens from the absorption being
restored to the lymphatics, in cavities of the cellu-
lar texture: and' of course the general secretions,
arid therefore the reduction of the swelling of the
fdot keeps pace' with the quantity of the discharge
by the pores of the skin. The decrease of the smell
aCcbrripanies the decrease of the swelling, until the
foot returns to its natural size or nearly so ; but this
lasVcirciinistande only takes place after a few of the
first fits of the gbut, because the coats of the ves-
sels become thickened, and the ligaments, &c about
the joints enlarged in every succeeding fit, in a few
years after the first attack, and g radually increiase as
people advance in life. This seems to be owing to
tbeinspiissatiori of the extravasated fluid, at least
the residuum of it, if I may so call it ; for the fluid,
which was at first thin, and after the inflammation
first abates, begins to be taken up by absorbent
lymp'hatics, is probably thickened by heat; and
partly from its moibid state, perhaps cannot be all
taken up, the most watery parts of it alone being
capable of entering the mouths of the lymphatics.
For secreted lymph, in a healthy state, was found of
different thicknesses by Hewson, according as the
animals w^ere nourished on which his experiments
were tried; those that were less nourished having

a9

more water and less of that, part' of it which is coa:«'
gulable, and tliose that were more nourished more
of -the coagulable part and less water. .,As; the most
watery part is the most readily absorbed, we may
suppose it - is soonest taken up in . the diseased sitate
of the gouty limb above, described ^ apd jmost pro-
bably the coagulable lymph is the latest,- .a^d hay «
ing the admixture of some gross gdy.entitious earthy
matter hereafter to be noticed^ it is. easy to cQiic^ive
that it may by the addition of heat be so much in-
spissated as not to be capable of being absorbed in-
-to the system: and being retained, may lay the
foundation for that decrepitude which afterwards in
general takes place in those unfortunate people, who
have a large quantity of the disease^ entailed upon
them : for as age advances, there seems to be an
-accumulation of disease, and the dimensions of the
parts involved in. the succeeding fits, as before ob-
served, gradually enlarge, their natural functions
are irnpaired, and the articulations losetheir freedom
in motion : indeed some of the small ones become
actually apchylosed.

AYhen the foot is reduced as far as it can, and the
freedom of the joints restored; in short, when the
paroxysm is completely ended; then it is that the
odour leaves. the part affected, no longer accompa^
nies the sensible perspiration, and does not appear

90

again during the intervals of the paroxysms. The
very singular smell arising with the sweat from the
diseased parts only as above mentioned, is sufficient
alone to evince the existence of the gouty fluid.
But there are other circumstances in the course of
the disease, by which this fluid is developed, ren-
dered obvious to the sense of smelling, and its ex-
istence further established. The first of these I
shall take notice of is not indeed the effect of a na-
tural but an artfficial operation : which is after the
application of blisters. The same peculiar odour
accompanies the discharge from the vesicated part,
after the cuticle is removed, which attended the
evacuation by sweat from the diseased foot, and is
undoubtedly part of the materia morbifica propria
of the gout escaping that way, which shall be far-
ther noticed in the treatment of the disease.

The next instance of its being developed and
rendered obvious to the senses is, the same smell at-
tending the collections of calcarious earth deposited
in the cellular texture about the joints and other
parts of the gouty limb, so frequently met with in
all consistences, from that of a milk like fluid to that
©f a solid concreted mass, in the advanced periods
^©f life and the accumulated load of disease, which
force their way through the skin, forming very trou-
blesome ulcers. The discharge from ulcers of this

91

■sort is generally called gouty matter. Part of it cer-
tainly is so, as the smell eviriceSj but the recre-
ment, solid 5 earthy^ matter is not so, it is pretty
Evident; for as the fit goes off the thinner parts are
^]ischarged, and the grosser are often left, when it
is perfectly over, a mere concrete, inert earth, to-
tally soluble in acids, without that peculiar foetor at-
tending the other.

The gouty fluid appears by its action on the net-
vous systeni to be a kind of sedative poison : for it
is wonderful what a distressing debility it leaves be-
hind it, if even the Inflammatory stage has not lasted
above twelve hours, a debility which is long in go-
ing off, and, froni the frequent repetition of the
paroxysm, continues iti the intervals ignore 6r less,
through the rerhainder of the arthritic's life.

We may from these premises, my friend, without
much hesitation, affirm, that there is a subtile fluid
matter, sui generis, concomitant v/ith the exit of a
gouty paroxysm, and I apprehend it will not be any
presumption to believe that this is really the morbific
matter of the gout. This then being granted, at
least to ourselves, observation has extended this ob-
jett still farther 3 for from hence we learn that there
are some peculiarities or particular circumstances^
which lead to a conjecture that this gouty matter
h:\'' a power of increasin-g in quantity and extend-

92

ing its distressing influence as we advance in lite.
What this maj be owing to I confess is beyond my
comprehension ; the fact however is so, indisputa-
bly; and whether this fluid has the power of some
other ferments of assimilating other fluids of the
body to its own nature and thereby increasing the
quantity of the disease, I shall not take upon me to
determine. However that may be, observation
proves that the frequency and length of duration of
the paroxysms^ gradually increase as we advance
in life, and atony, and a gradual accumulation of the
quantity of the disease, keep pace with them ; that
calcarious concretions are only concomitants of the
disease, with its accumulations, at an advanced pe-
riod of life; and that at length gout, under these
circumstances, takes so entirely possession of the
frame, that the symptoms of it, in some instances^
never totally leave the patient. There is scarcely
any interval between the paroxysmsy unless a partial
remission of pain may be called so; there is indeed
a partial resolution of the swellings of the joints,
but the rigidity of the parts, and debility increase,
and the miserable arthritic is never twenty four hours
w^ithout pain : chalk stones, and ulcerations in con-
sequence of them, appear, and the poor cripple is
just enabled to crawl from the bed to the cough, and
from the couch to the bed again.

93

This however is not the lot of every arthritic, but
it is the lot of many; and as the calcarious concre-
tions at this period are the niobt distressing circum-
stances, let us inquire into their cause. These cal-
carious collections, whether in a fluid or a concrete
state, although vulgarly called gouty matter, I have
already observed are not altogether so. It is indeed
evident from the smell, that this subtile agent is
certainly present in the admixture, but the grosser
adjuncts have by many degrees the largest share in
the compound, and indeed these last appear rather
to be an effect th^n the cause of the disease. Cal-
carious concretions are undoubtedly to be met with
in many parts of the body, and probably, when ex-
amined, may have nearly the same properties, but
those in question are always confined to the same
parts, and their formation in those parts in a gouty
constitution, and no other, evidently marks them to
be the effects of the disease.

Let us try to develop the origin of them.

Bones are known to be of a fibrous reticular struc«
ture, of a cartilaginous, elastic, and flexible nature ^
and an earthy or cretaceous matter fills up the inter-
stices, and gives them solidity and stability. This
has been discovered by experiment, and the creta-
ceous matter is soluble entirely in acids. Anato-
mists have availed themselves of this knowledge,

N 2

and by destroying the earth by acids have further;
developed their texture by boiling thern in turpen-
tine varnishes, by which they become iransparentj
and the ramifications of injected blood vessels run-
ning through thcni are rendered visible. You can-
not have forgotten the many beautiful preparations
of this k;ind in the possession of that excellent ana^
tomist, the late Dr. Hunter.

Baron Vanswieten gives so good an account of
-this curious subject from Baron Haller and others,
that I shall take the liberty to add the following ab-
stract of it.

" The Illustrious Haller, by an uncommon indus^
try, discovered in the newly created animal the for-
mation of the boner., and although he modestly offers
his opinion as conjecture, he relates what he actually
saw. He observed that the whole body of the be-
ginning animal, bones and all, was composed of a
soft gluten, that this gluten, which formed the
basis of the bones, changed first into cartilage and
then into bone : that the change of the gluten into
cartilage WcTS rapid and easy ; as it only seemed to
acquire more solidity : but that the alteration of this
cartilage into bone was a much slower, and more
obscure operation : that the cartilage was at firskt
pellucid, and that the signs ot its turning bone were
an opacity and yellov^^ibh colour. At this period its

95

fibio^s tcxtcre began to appear. On the eighth day
of incubation this changq was perceived. On the
tenth day the rudiments of blood, distinguished by a
yellow colour, appeared : on the eleventh day it wa§
ycd and that part of the cartilage which began to be
opaque and yellow on the eighth day reddened on
the eleventh, the arteries being so much dilated that
the globules of red blood could pass and in their
place the bony hardness was perceived at the same
time to have taken place in the cartilage; this
pircumstance appears also on the callus of fraictured
bones, before the same is consolidated : the increasing
firteries press nxor.e and more on the neighbouring
parts, they become firmer whilst they are dilated by
the blood, and more capable of transmitting the
thicker parts; first the earth, which, being in-
sinuated into the cartilaginous substance, gives it
hardness and fragility, diminishes its flexibility, and
hence, from a flexible, elastic, cartilage, a hard and
brittle bone is generated. When the acid of vine-
gar, unites with this earth, a neutral salt with splen-
did, shining, crystals is formed, the bones become
at the same time soft, and return to their cartila^
ginous state again.

This earth appears to be perfectly soluble in acids.
Storck macerated the bones of fowls in aquae fortis
diluted with water, by which they were rendered

96

flexible and elastic. An addition of al. tart, per
deliq. to this solution, occasioned a precipitation,
which being collected and washed, proved to be a
mere earth. He then immersed a skull, which had
\)t^n many years in a cemetery, in a dilution of aq.
fort, in water, which by these means became flexibly
and elastic.

Madder seems to act only on the earthy part of
bones, and imparts to it its red colour. It, for that
reason, does not tinge cartilages, unless they ossify,
ilor the callus uniting broken bones, before it begins
to acquire the nature of bone.

A cartilage therefore differs from bone only be^.
cause it wants this cretaceous or earthy matter, and
if this earth is taken away by macerating the bone
in acids, it then becomes cartilage again : as if in-
deed the cartilage lay concealed in the bone, an4
was thus developed.

If bones tinctured wath madder are macerated
in acids, the tophaceous, coloured, earth is dissolved »
the colour is destroyed, and the cartilaginous part
remains in no degree tinctured by the colouring mat-
ter. Herissant observed, that tophaceous, gouty,
concretions dissolved entirely in the nitrous acid,
and that neither cartilage iior membrane w^as left ;
that also, in an old hen, who had concretions of this
sort about her toes, it was observed that after the

97

use of the Rub. Tinctor. the concretions were deep-^
ly tinged with a red colour, and wholly dissolved in
the diluted nitrous acid. From these experiments
it is confirmed that it is the cretaceous or earthy
part of the bones, which receives the tinge from the
Rub. Tinctor. and that as the gouty concretions con-
sist wholly of this earth, they are therefore more im*
pregnated with the colour than the bones themselves.
If here it be considered that the solid parts undergo
perpetually an abrasion or waste by the vital actions
in perfect health, it must be requisite that there b^
a constant restitution' of lost parts that health may be
preserved.

It appears from many experiments instituted by
the celebrated l)u Hamel, and confirmed by others^
that if the madder root be added to the fo©d of ani-
mals the bones will be tinged of a red colour. If
afterwards these animals are fed without madder the
part of the bone which grows during this period will
not be tinctured : but if they are again fed with
madder, the red colour will appear. Du Hamel
found the thigh bone of a hog, cut transversely
which had been fed in this manner, variegated alter-
nately with circles of red and white. It was obser-
ved that when the animal was fed with madder for
the space of a month, a part of the bone of a remark-
able thickness^ was tinned of a red colour. And as

D8

it was before demonstrated that the earth j part of
the bone is alone tinctured witbinaddv r, it shows that,
in the space of a month j a considerable quantity of
cretaceous earth is furnished, partly to repair the loss
sustained by abrasion^ and partly towards the ir.cre°
ment of the bone ; those expefiment being made
on the younger animals. And he demonstrated by
experiment that if the animal was afterwards nou-
rished by his common food, without the addition of
madder, in six weeks the red colour entirely vanish-
ed : because, whilst the earthy matter of the bone
(which had been tinged) was carried off during this
period, its place was supplied by a similar substance^
but not kt all tinctured with a red colour. From
hence it may be concluded that this earthy mat-
ter is separated from the bones, that this separated
part passes out of the body by the usual out-
lets by which the useless parts are comn^only dis-
charged; but at the same time (whilst this pro-
cess is going forward) that there is furnished by the
proper vessels, not only a supply for the waste, but,
also, for the grov^^th, of the bones required in the
young animals. ,.

- If therefore, the vessels ate so changed by repeated
attacks of the gout, the fabric of the bones may
be §0 injured that the matter destined for repairing
the waste of them, is denied entrance to the usual

99

place. It does not seem extraordinary that thi^
matter should be deposited in the neighbourhood of
them, and constitute the gouty concretions: and from
what has been said before, it appears evident that
the chalky, gouty, concretions have the same quali-
ties, v^hich are found in the earthy substance of the
bones 5 which earth, added to cartilage, renders the
cartilage, bone: therefore, when that, which ought
to be employed in repairing the bone, is collected in
the cavities of the articulations, incurable anchyloses
ire produced : if it should possess the ligaments, it
takes away their flexibility, insomuch that their mo-
tion is destroyed, and the shape of the parts deform-
ed in a surprising manner.'*

Thus far I have followed the illustrious Baroti
Vanswieten, and have now to remind ybu that the
experiments which he has adduced have been re-
peated with the same results by eminent anatomists
in this country, and, if I am not mistaken, Mr. John
Hunter stands foremost in the list of those philoso-
phers who fed hogs with madder, and confirmed
all Du Hamel's experiments, by which it is
proved that the bones are composed of a fibrous,
cartilaginous matter, and a cretaceous earth : for al-
though we may suppose the fibrous, cartilaginous
matter must suffer some abrasion in the general
course of constant waste and renewal of animal

o '

100

parts, in a state of healthy this waste is not so ob-
vious to the senses v and it appears, that the creta-
ceous earth is the matter that is principally and
largely carried off, in this natural process, and nmst
abundantly renewed to restore the waste of parts, in
a state of health.

Hence the Baron concludes , that as the vessels in
the vicinity of the joints are contracted in their
dimensions by gouty causes, this cretaceous matter,
although in a dilute state, may be detained in its
passage, and form the tophaceous concretions so fre-
quently distressing to the gouty patient.

101

LETTER V.

Deal' Sir,

Baron Vanswieten''s is a plausible
theory of the formation of gouty concretions, com-
monly called chalk stones. My conjectures on this
subject lead me to deduce their origin from the same
cause, the cretaceous matter of the bones ; but the
modern discoveries in chemistry have induced me to
consider the process of their collection and deposition
on the injured parts in another point of view, which
whether eiToneous or not I give you as follows.

It being evident that it is essentially necessary for
our existence that the bones, as well as other parts
ofthe human body, should be furnished with materia
als for their nutrition and increment in young sub-
jects, and nutrition, and a supply to recruit the
abraded parts, in the adult, it is plain that these os-
seous, or rather osteageneous, materials, must be in
a state of perfect solution to be carried through the
eourse of circulation, and we may readily suppose

02

102

that this solution must constantly exist in the thinner
parts of the blood. Now this solid matter must have
some medium by which it is held in solution in a
-watery fluid. That there is such a medium actually
existing in our constitution in large quantities, is
most certain^ not in an acid state^ but in various
combinations with different substances of an alka-
lescent nature. This medium is the aerial acid^
more commonly called fixed air; because it is found,
in a fixed state, to contribute to the weight and com-
position of many bodies, and, when let loose from
these bodies, is discovered to be an acid, volatilCj
vapour, or permanently elastic fluid, with many
properties similar to common air. This acid fluid
readily unites with water, and modern chemists have
discovered that the most solid matters^ metals^ chalk%
marble, and every other kind of-calcarious eartha
are held in a state of solution in water impregnated
with fixed air, and that, by agitation, more iixed^
air is absorbed by the water, and more calcarious
earth, or other matters, may be taken up and dis-
solved in the fluid; and that this power of keeping
the solid matters in a state of solution^^ in water
thus impregnated with fixed air is, in proportion to
the quantity of aerial acid i^ it and the quantity and
continuance of the motion. For it has been found
by experiment that water, thus impregnated, when

103

ieft in a state of rest, soon becomes decompounde(ig|^
The aerial acid is volatile, flies off by heat from the
water, a heat even not greater than that of the com-
mon atmosphere, and although heavier than atmos-
pheric air, it easily mixes with it by a kind of soluti-
on ; of course it will leave the earth, with which it
was combined, in a state of solution in the water,
the fluid will become turbid, and the earth will pre-
cipitate to the bottom of the vessel. The greater
the heat is the sooner the decomposition takes place,
but heat will not so readily produce this whilst the
fluid is kept in agitation, particularly in close vessels;
but this evanescent principle will escape in the open
air. Upon the presence of the aerial acid, in water,
depends the impregnation of the mineral waters of
Seltzer, Pyrmont, Spa, &c. with the different mate-
rials of which they are compounded; it is what
gives them the sparkling briskness and agreeable
subacid taste, and -is that which escapes when these
waters become effete and lose their virtues, and the
other component parts, viz. iron, calcarious earth,
ScC. precipitate. It is upon the escape of this prin-
ciple in calcarious waters, that the incrustations of
stony matters, or half petrifaction of vegetable
substances and real petrifaction, depend.

There is great probability that, by means of wai-
ters impregnated with calcarious earth, which ar$

104

exceedingly common in all marly and chalky soils,
a portion of this calcarious earth is introduced into
the habit by the constant use of these waters, and
may help to furnish some part of the materials for
the cretaceous matter of the bones, as well as that
furnished by our nutriment.

Trtm the recruit and decay which the system is
perpetually undergoing, it is evident that it may
suffer either from a defect or superabundance of the
different materials furnished from the aliment, for
nutriment and the restitution of wasted paris abraded
in the constant course of circulation, to the diffe-
rent parts j and the bones as well as soft parts must
be greatly affected by these processes of nature, and
suffer remarkable vicissitudes. Facts have evinced
this, and the cretaceous earth, which gives the
bones stability, is proved, from the experiments be-
fore mentioned, to be the matter which is constant-
ly changing: hence it requires no great stretch of
imagination to suppose, that the instances upon re-
cord, of the bones having become flexible in adult
subjects, might have arisen from a deficiency of sup-
ply of cretaceous matter to keep the firmness and
solidity of their texture, whilst this matter was con-
stantly carrying off by the emunctories; and there
appears to be little doubt but the rickets in young
children, wliere there is a softness and flexibility in

lOS

ail the bones, in particular those of the extremities^
an enlargement of the heads of the long bones, and
the spongy texture of these and the cranium, is ow-
ing to the same cause, viz. a deficiency of the cre-
taceous matter to give stability and firmness to the
bones. On the contrary that exostoses and preter-
natural ossifications must arise from a superabundance
of the osseous matter thus furnished, particularly the
cretaceous part of it.

It is evident, from the laws of the. animal econo-
my, that in adult subjects, where the bones have
acquired their acme and utmost state of solidity, less
will be required to repair the daily waste, and there-
iorc the superfluous matter becoming useless must be
excreted from the body by some outlet or other: for
which purpose it must still be circulated with the
fluids and still in a state of solution: and no one of
the emunctories is better calculated for this excre-»
tion than the kidneys, which I believe to be more
generally employed (if not chiefly) by nature, in this
salutary office, than any of the other secretory or-
gans.

You will readily, my friend, excuse me for trou-
bling you with this preliminary digression on mat-
i;ers you are well acquainted with, because it is ne-
cessary to be kept in remembrance for explaining the
hypothesis I am about to give you.

106

Having already shown that the swellhigs of the
gouty limb, which commence at the height of tlic
paroxysm and subside with its resolution, are caused
by the infiltration of a fluid into the tela cellulosa, Sic.
I shall now hazard a conjecture on the cause of the
formation of the tophaceous concretions; which is
this.

As the earth of bones is held in a state of solu-
tion in the thinner parts of the fluids of the human
body, is it not probable that part ot this earth is
dissolved, and mixed with this fluid, before men-
tioned, infiltrated into the tela cellulosa, cavities of
the joints, &c. and beihg now out of the course of
circulation, and in a quiescent state, the evanescentj
aerial acid, the principle on which the solution (we
suppose) depends, will leave the calcarious earth,
to which the heat of the parts, and perhaps a great-
tf elective attraction to some saline or other mattery
may contribute,* a decomposition will take places

* The ingenious Mr, Henry; of Manchester, and other modern chemist^
think that fixed air is a menstruum to the putrid effluvium. The gouty
eiffluvia have a. singular foetor, which may perhaps depend upon a peculiar
putridity in the system • at least the fcetor from the arthritic's breath,
seems to Indicate a certain degree of putrefaction in some of his fluids. It
hiaybea^kedthen, \vhy may no! the gou^y matter attract the aerial acid ?
i— Perhaps the volatile, gouty, tnatter is the substance that does (by a
greater degree of affinity) attract it, and promote the decomposition of the
Buid ih the tela cellulosa, &c. how out of the course of circulation^ and
the fixtd air, deserting »he **rth, leaves it to precipitate, nhile thd nevr

107

and the earth w'lU precipitsLte from the fluid lii its
earthy form, and be deposited in different consist-
ences in the cavities of the cellular texture, cavities
of joints, and every other part where the fluid has
been diffused in the diseased liqib? Fqr you know
that the tela ccllulosa enters into the texture arid is
Ihe connecting medium of all parts, and abundantly
so in those in which the tophaceous concretions are
found: and although they are commonly deposited
about the joints, I have known tkem every whpre as
far as the disease extended. The whole tela ceHk-
iosa in both legs and feet of the late Mr. Andrew
Pigge, an ingenious apothecary, in this town,' from
the knees to the toes, was filled with chalky mat-
ter, and appeared as full as if liquid mortar had been
injected into the cells, and there left to harden by
the evaporation of the water that suspended it, the
^hole appearing like a coat of broken hair mortar,
under the skin. By continual accumulations, it had

c9iTibin^tion, of the aerial acid and gouty etSuviuum may escape with the^
isweat from the pores of the skin, or the open ulcers which discharge
cha^^:y matter: for, we find, as the gouty fluid escapes, that the cretace^
ous matter from the ulcers has, according to the degrees of its spissitude,
les3 or nv)re of the arthritic 3mell, until, a5 before observed, it entirely
leaves it. Soma experiments might discover this °, perhaps by ecllecting
:he s-weat upon oiled silkj and adding it to lime 'vRteij, th« aerial a«id^ ii

P

108

made its way through the skin in a great many ul-
derations, and hard and soft cretaceous matter was
discharged from them many years before he died.
He often had the gout in his viscera, and a fit seiz-
ing his stomach, at length finished the catastrophe,
a vomitirrg of black, putrid, matter, indicating
gangrene, ensued, which carried him off in forty
eight hours.

It is highly probable that in some gouty constitu*
tions, and perhaps it miglit be so in that of the gen-
tleman above mentioned, collections of this earthy
matter are deposited in many other parts besides the
vicinity of the extremities. Dissection has disco-
vered concretions of chalky orcalcarious matter not
only in the glands and cavities, but in every part
where secretion and absorption are performed, in
short wherever the cellalar texture enters; and in
many places ossifications take place at the same time
in the same subject, which leads me to a presump-
tion that these different states of those preternatu-
ral formations are dependent on the same cause;
which we may infer is the redundant earth of the
bones.

I shall take the liberty to mention some other in-
stances, and first that of a gentleman known in Lon-
don by the name of Whig Middleton, whose dis-
section is given by the Ingenious Mr. Watson, in

109

the 1st Vol. of the Medical Commen: a brief ab-
stract of which is as follows.

This gentleman ' died of the gout at the age of
fifty. He was a free liver in early life, and so soon
a martyr that he was an old man at forty. His last
ten years were most uncomfortable. From a tail,
active, well looking man, he lost all strength and
vigour of mind, became emaciated, dejected, and
his faculties impaired: was unable to lie straight in
bed, his legs being contracted to his thighs, his
thighs to his belly, and knees to his breast, He
was in this state, when dissected.

The first joint of one great toe was cased in chalk,
like a fossil shell, yet the bone was unaltered.

The joints of his fingers were swelled and knotty
with chalk, and he was said to have scored his game
with his knuckles when he played at cards.

There was an oblong tumour on the right tibia
like a node, found to be a mere deposition of chalky
between the skin (which was thin and ready to
burst) and the periosteum, which; although thick
and large, had not injured the bone.

He complamed often, a little before death, of
excruciating pain in his head, with a sense of falling
. down headlong.

It was impossible after saWing, to remove the
cranium without dividing the dura mater , which

p 2

seemed owing to an inflammation, thickening, and
induration of that niembrane: which accounted for
the excrueiatin^ pains in feis head, which distressed
him often before death. The fo^cicidated texture
nearthesinusses was remarkably strong; the glands,
^'s they are called, large and distinct^ the brain it-
self, firm as #ax: a large quantity of lymph like
the clearest spring water was in the ventricles*

The pia mater was pale, with a sort of clear jelly
deposited in the cellahr membrane connectirrg its
two li^mellce. Its outer siirface was srrieared with
a smooth chalky mucus Irke cream.
, The m^dalhd oblongata and medulla spinalis were
much iirmer than the brain. The tunica aradmoi-
des was tbickerred, harsh^ and gritty. The gtan-
:dula pinealis quite ^e^troyed, nbthin-g remaining
but its membrarious coafs, filled \vith concretions
resembling sfnall pearls.

Althougli the t)ody w^s emaciated, ^rm fat dt'
tivo inches in thickness, 'was imder the sk/n of the
kbdbmen. The mesentery wirs ^o much loaded
\yith fat, that two thii*ds of the ci4*cifmference of
the :|^iit were invisible.

The stomach and guts \^^re healthy although pale ;
the spleen and pancreas were sounds the liver was in-
durated, and of a pale yellow colour; the gall blad-
(Jer was buried in fat, aiid contained a little pale and

in

wiitery bile : the abdominal portion of fhe ^mtn.
was ossified from the diapbmgm to ttie iliac artenes.
The kidneys were small ^nd filled with hj^dattds,
and the external surface of the right kidney Was al-
most covered with them. The ■urinary bkdd-er was
thick and cr^ntracted, little iJtlm With itt its cavttyi
neither was there gravel, ^tone or chalk m it 0t
in the kidneys.

The valves of the heart, the ^eat vessels 5sMitvg;
from itj and the whole thonicic porti<!^n <!yf the aorta
were free from ossification. Tlie lungs Were 'soft
and pretty healthy/ex^ceptrng one small stone in one
of the lobes > the bfonchial glands "accon^pftnymgtlte
trachea were 'filled Witli gouty Ttraft^ter.

The rigid contraction of the %wer litirbs, #a&,
owing: to the ^hardened anfl tMcken^d state 'of ^e
Trgamchts, whicli had lost their polished 'hue. The
synovia warlike a mixture c^ chalk, ail -and water,
and beconie thick as cream; the cartilages not
dtered.

From this cxamrnaltion Mr, Watson infers that
gouty matter has the Strongest tendency to tTie ex-
tremities, where the Weaker impe^tus of ^the circulat-
ing Euids is most likely to lea ve it.

" Is it not remarka[ble (says he) thsft there were no
marks of it in the hollow viscera : ^neither in tte
"liver, kidneys, spleen nor pancreas ? " He thinks it

112

pronouncing rather too much, that those subject td
gouty concretions are subject to the stone, and vice
versa ; because of all the lithotomy patients of every
age and sex cut at the hospitals, few have the
slightest indication of the gout. Gout and stone
(he thinks) are morbid secretions, and may exist in
the same subject, but differ essentially in their ma--
terial principles and tendencies ; calculous matter is
formed in the urinary passages ; — the gouty depo-
sites itself on bones, cartilages, membranes, and lym-
phatic glands. Gouty seems to be a different earth
from that of the urinary calculus: it never appears
laminated, or to have formed a nucleus; but is soft,
%vhite and uniform throughout ; may be dissolved and
ground by the motion of the joints, mixes with the
synovia forming a smooth creamy fluid.

Gouty earth is then a kind of greasy bole, easily
rhadc to mix with oil and water, which in general
a calculus cannot do ; so that in every respect (says
Mr. W.) colour, form and consistence, it seems to
differ essentially from that which lays the foundation,
and causes the increase of the stone.

Morgagni (de causis et sedibus morborum lib. iv.
p. 277) gives an instance of a nun, about thirty, who
had a tumour in one of her breasts, attended with
much pain, which burst spontaneously. It was
suspected to be cancerous, but the attending surgeon

115

was of a different opinion, which was confirmed hy
the event. From the opening during the treatment
of the sore, he extracted a round body about the size
of a walnut, which Morgagni found to be compqsed
of pieces of bone of different dimensions, as if they
had been broken asunder, placed in no regular order,
but connected together by the interposition of a ligu-
mentous like substance, which, on drying, became
black but the bony fragments preserved their white
colour.

He tells us likewise of a cartilaginous substance
found in one of the mammse of a bitch he dissected,
calcarious granular in the membranes of her lungs^
calculi in both kidneys, which were otherwise
diseased.

He also in the same page gives an instance of a
learned gentleman, who in the thirty first year ol"
his age, had a small glandular knot appear on the
upper part of his right breast, which in the space of
a year increased to the size of a man's fist, but with-
out any shew of malignity. This tumour about the
beginning of 1742 (fourteen months after its first
appearance) broke of itself, and under its coverings
of integuments and some fleshy fibres, nothing but
calcarious matter, hard in some places soft in others,
was discovered. In a consultation held on this case,
the safety of extracting this matter was daubted i

114

becaus;e it was alleged^ as the father and gfand-
father of this gentleman were severely afflicted with
the gout, although he never had had any symptom?
of it himself, hut a short transient pain in each great
ttie, dbis was referred to a gouty origin, and it ivas
therefore supposed that by removing the gouty mat-
ter which had taken possession of this place, there
would fee same hazai'd of diverting it to some other
and more noble part. However, after all the learn-
ed arguments which Morgagni gives at large, and I
forbear, as useless, he committed himself to the care
of a surgeon entirely, who, regardless of ^11 that had
been iirged, opened th^tuniour, removed the chalky
substance, and cured the WQUOd livithpijt any trou-
ble or any ill consequence, evincing the futility of
the fears of the ieztrned gentlemen consulted.

115

LETTER VL

Dear Sir^

In my last I gave you my hypo-
thesis respecting the formation of cretaceous c6n-
cfetions in the gout. You are to observe, my
friend, I give it you as a probable conjecture: whe-
ther I am right or wrong let time and experience
determine. If right it may furnish a hint for afford-
ing relief, if wrong it can do no harm: however, upon
the supposition that it may be right, I rriean to in-
stitute a set of experiments with a view to discover
a method of either preventing the formation of thos'e
concretions, or of dissolving and promoting their ab-
sorption into the system and their expulsion by the
emunctories, after they are formed. There has been
lately some relief, in the calculus in the kidneys and
bladder, reaped from an exhibition of fixed air in
what is called by the name of our much kmented
fiiend, Bewley's mephitie water or julep, which you
know is a perfect saturation of a solution of fixed

alkali in water, by the aerial acid. I refer you to

Q

116

what Dr. Falconer has said, in his appendix to Dr.
Dobson's Commentai-y on fixed air, upon that sub-
ject. Bat there are two different opinions on the
similarity or dissimilarity of the gouty calcarious^
earth and urinary calculi. Yoii have seen what
Mr. Watsbii says on this subject. As however the
gouty conGretiohs have been supposed by some'
respectable authors, to originate from the same cause
^s^the calculi abovjc^namedi and we suppose that the
sameagent hjas a very considerable share rn both ^
since it is aot very foreign to aUr principal subject,
Jet.us.make a few observations on the origin of the
ui-inaryiealaujjiis, ran:d the relation it bears to gouty
concretions.

It has been pretty , generally supposed that fevtr
gouty pe^opie are ifree^from calculous complaints, ei-
ther in the shape of tege oi" small stones in the kid-^
neys or bladder.- 6y dienham, i rom i believe his own
feelings, s^ys :th^t ithe ,gQUt breeds the stone in many
subjects, in the kidneys. This, with the frequency
with which both diseases have been met wrth, in
the same subject, has perhaps led to this opinion^
although I cannot assert frora my own knowledge
that Lth.ey are always existing in the same subject at
tixe same time : I must own I have often observed
^r^tvel and small calculi afflict4rtg gouty patients.

One remarkable fact has fotcibly struck me, I

117

speak from experience in; rny^rff and;QtherS;; I bayj&,
seldom or never seen a paroxysm of both diseases,
existing in the same subject ^t the' same time, I
know a gouty subject who was habitu^ed.to a, djs?
charge of red, sand)% gravely many years, before, he
had the gout; particularly after travellirig on horse
back: fram which circumstance it appea^-ed as if jt.did
not- fprii): altogether in; the bladder, hut came dpwn
from the kidneysin tha.tforni; qn these, occasions ij^.
detention in the uretlira was frequently distressing.
After the gout attacked hini, ^bout two, months be-
fore the/ return of th^^ paroxysm the grayel left hin^i:
during which period he: felt very aleri andiaptiye*
When the gout werit off the grav.el a gaift^ returned,
apd these; alternations of disease continued, for many^
years ^. butas.th^ gout increases in the violence- and
duratipn, of the parox^ysnis, th^ appe^r^nce qi gr^yejl.
din^inishes.:, y^ from, his. painful sensatioiis it: seenis
ta me that all is not well c^bout the kidneys. Hpnc^^
I pi:esume to corijectiire, that he who. is afflicted
tyith. a load of gout and.a constant apcgLpiulation of
chalky, depositions on. thp cellular texture, is lesa
li^j^l^, to have gravel Qf stone 3 because the earthy
ipt^t^. of bpneis.diyerted another way : and perhaps
from this circumstance, a reason may be given why,
when the gout and gravel, are naet with in the same
person, the paroiJO^ysnis of each^ distemper s(^ein (a|

r% <^

IIS

least from my observation) to alternate each other lu
their attacks.

The urine of a healthy person is known to abound
with an earthy matter; this appears evident from
the concrete incrustations deposited on the bottom
and sides of the vessel if it stands any thne. Vanr
sw^ieten gives a detail of Boerhaave's observations
on the urine of a healthy person which afforded some
curious phenomena : exhibiting the formation of
these concretions.

For this purpose he chose the urine of a healthy
man, in whose family there never was the smallest
suspicion qf the e^ristence of a hereditary calculous
labes, nor in himself had there ever been any sign of
a latent calculus observed.— r He put this urine dis-
charged when the man was in full health, tweh^e
hours after a copious meal, and most profound placid
sleep, i^to a cylindrical glass vessel six inches long .
and about the diameter of the^ middle of the thumb.
Whilst it continued warm, it was of a citrine colour/
pellucid, and every where homogeneous, neither in
the transparent bottom of vhe vessel, nor in any
other place, could he discover by the assisance of the
microscope the smallest particle of heterogeneous
matter.

He placed this vessel in a degree of heat equal to
72 of Farenheit*s Thermometer^ in the open air, and

119

only covered the orifice with paper to keep out
the dust.— In about a quarter of an hour he examin-
ed it with a microscope, when it appeared full of
corpuscles iike flocks of wool without any equal or
polished surface, which corpuscles seemed to be
agitated with rapidity backwards and forwards,
equally moving upwards and dov^n wards, so as to
maiuftain a kind of equilibrium, ascending and des-
cending by turns. A little after this something
whitish appeared in the urine, with striae like far,
resembling the appearance of spirit of wine poured
into water before an intimate mixture takes place,
this tatty matter was somewhat like eels, and w^hilst
this new phenomenon was accurately examined by
the microscope, clouds formed out of those fatty
stri-je, pendulous at first through the whole cylinder,^
which gradually receding from the sides of the ves-
sel gathered together towards its axis: those floc-
culi which before moved about, began to disappear,
and were collected into the cloud : — which becom-
ing thicker every minute, began to descend, and at
length to settle within the distance of half an inch
from the bottom of the vessel, and the upper part
of the cloud rested within about one inch of the
surface of the urine. All this cloud appeared by
the assistance of the microscope to contain every
where \yithin and without, minute shining concreted^

pai;ticles, and similar particles began to adhere to
the sides and bottorr^ pf the vessel, at the same time.
These particles, at first white, b^,game reddish
in, half an hour; from hence they turned redder, and
in two houra wem of th^ same colour with that uri-
nous sand, generally deposited on the sides and bot?
toHijof the vesseJa in which urine is left a consider-
able tiiifi|2. Nevertheless thiese rudinienis of nascent
calculi remained enveloped in the cloud:, and did
not. fall; ta the bottom, of the vessel, but appeare4,
suspended in the fimdinthe form, of a yellow cloud.
By decrees however some of these particles increased
inb raa^nittule ^d fell to- the bottom ; and, at the
s^me time, sevecai other molicles generated on the
sur/^e which wajs contiguous to the a;r, which by
^M^ shakmg the vessel fejl also to the bottom.
And these molicles. on the. sides of the vessel, alsa
mcm^s^d in hi^)h and in twenty four, hours equalled
oa^stai^d s^od m si^e. These, were of a rhomboidal
6gitm^ wath the opposite angles obtuse and equaU
mter^ixed with p^r4llelopiped moHcle^ much red-
d^C in colour, ^d krger in siz^ than the rest. Some
square grains wexe interspersed but tl^ose were few
int number.'«"None of thes^e molicles generated in
^e Gl<>ud became so large as thp&e which formed
Oil th< sides and boUom of the cylinder; and those
stiefcing ga tfee sides appeared to bo composed q/

121

six otliers similar in figure^ by whose mutual adhe-
■sion the size was increased.

I shall le^ve you to follow Vans wieteti through th-e
conclusions he formsfrom this curious experiment, as
it would be taking up too much of our time in this
Letter. I shall only observe/that the most natural in-
ference to be drawn from it is; that the urine of a
healthy person, appears to be loaded with solid rirattets
in astate otf solution^ whenit is excreted : and the^emat-
ters seem to be earth salt^ and other animal matterg^i
tvhich, on the decompositioti of the mixture by, I
suppose, the escape of the volatile principlej by th€
means of which the fluid held them in a state of so-
lution, the solid particles thus let loose, attract each
other and form new combinations in d crystalline
form, which lay the foitndation of cakuli. Thefe-
fore we may suppose that urinary calculi are formed
of the earthy matter of the bones, -salts, and abta-
'sions of the soft parts, Whit*h having become effete
and recrementitious, are secreted from the blood as
useless, and ordained by the la>ws of the animal eco*
nomy, to be excreted hy the urinary passages: and^
that this will always be the case when they are held
in solution in a watery fluid.— The bladder being
the reservoir of the tarine secreted by the kidneys,
very considerable quantities are very often detained
there for many hours in a quiescent state : during

123

tliis time that principle, let it be fixed air or wl^at
it will, which held these solid, earthy, and Oiber
matters in a state of solution, may have time to se-
parate from them and perhaps form some new com-
bination, we guess it may be fixed air, because the
urine is found by experiment to contain a great deal
of that principle. We find however that there is
certainly a decomposition takes place, that there is
actually a separation of the component parts, and
that the more solid precipitate, and by attracting
each other, sand or gravel in smaller or larger mas-
ses are formed, arid lay the foundation for calculi.
That in healthy people this seldom happens, unless
some foreign adventitious matter^ should be met

. with in the bladder, which may form a nucleus, to
which the calculi may adhere.

Vanswieten observes that the sabulous concre-
tions, arising as before related, in the urine of the

.mostiiealthy men, was of a red colour, in some it
w^as yellow, others ash coloured, w^hite, and some-
times, though rarely, black: and adds, that some

- think, they are the worst kinds of calculi, which
arise from sand of any other colour than red. He

. says calculi are formed by granulation or crystaliza-
tion, not from different principles in the body or a

-confusion of humours, but by the application of
similar eleraentSc

125

It has I iDclieve, often beeti said, that red gtavel
never forrlis calculi: that this opinioti is however
erroneous, the following instance will prove^ and
many more no doubt have appealed.

A. C. a young worrian aged 2 1 , at Westvvinch, in
this neighbourhood, was cut for the stone in Aprils
I7o6j and a flat, dblbng, brown stone near 3 inches
long, i ^ broad, and 1 thick, weighing two ounces
ind three quarters, was extracted : that end pre-
senting to the urethra, was rounded off like the end
of a flat potdto«i and was of a solid firm texture, the
other was covered aiid elongated by means of an in-
crustation of transparent, beautiful crystals, very
much resenlbling browri sugar caridy^ some of the
crystals were large ahd others small, and seemed t0
be an addition endwise of a late formation, covet-
ing the other extremity of the solidj I m^y say pri*
mitive, stone, which seemed tb have been blunted
and rounded off like the other end, visible through
the transparent crystalization, of the late creation.
Those crystals were of different figures, as well as
dimensions, some rhomboidal others square.

In the course of the cure stony incrustations from
the urine which constantly drained off, formed daily
upon thelipsand edgesof the Wounded parts, which
were not small, as the cutting gorget was used to divide
the urethra: and the operator finding the incision too

R

i24

small for the stoiie when in forcTps, cliose to tlit
^pon it in the extraction to enlarge tlic aperture
rather than lacerate the Joarts, as it ^as so large.
— These incrustations sloughed off In the course
6f digestion, and hung in a chain together by the
membranous parts in large quantities; biit after the
wounded parts healed so far that she could retain her
Water ten minutes or a quarter of an hour, and no
urine passed involuntarily, no more crusts formed.
She was perfectly well in less than two months, and
although the great quantity of sabulous and stony con-
cretions, which formed and were discharged during
the cure, seemed to indicate a constitution very much
disposed to the disease, she never afterwards had
any symptoms of calculus.

Here we have an instance of liot only red crysta-
lizations forming the stone of the bladder, but even
stony concretions forming on the wounded parts after
the urine was out of the bladder. We have many
instances of extraneous bodies forming nuclei for
calculi, recorded in surgical writers, memoirs of so-
cieties, medical essays, &c. as for instance, ivory
bodkins, needles, pieces of wood, &c. It would be
impertinent to give you here a detail of them y Van-
swieten has collected a number, and to him I refer
you. I will however mention three extraordinary
facts; two are experiments, and the other a blunder*

1^5

Nuck (adenographia p. ) tells us that he Inserted
a small ball of wood ia(:o the bladder of a dog-,
throi^gh a wound made into it for that purpose^ and
proper care 'was taken of the wound. The animal
spenied to be iy\ pain two days, but his appetite and
alacrity soqn returned, the oiily disagreeable sy^ip^
torn remaining was a frequent irritation to mak^
water. A few weeks afterwards, he dissected the
dog before his. pupils, ^n4 extracted the ball of wood,
which appeared to be incrust^d with calculous crys-
talizations, not unlike white sugar ca^dy: hence
he concludes, that a §m^ll calculus formed in th^
kidney, by descending into the bladder, may form
the nucleus of a ^tone, which may by degrees in-
crease to an enormous sizej and s^lso that, any ex-
traneous body n>ay forr^ a nucleusj the 'truth of
which as befoipe observed is proved by the annals of
inedicine.

The blunder is thus related by Tulpiqs (observa-
tiones medica? lib. iii. cap. 9,.). A rash young man
in hunting a buffalo in India, was gored by that
^uin\al, and his horn penetrated into his (the hun-
ger's) bladder. — ^An incautious surgeoq put a tent
into the \fyp,und, without a thread affixed to It, the
ponsequence \^as ^he ^ent slipped in^o the bladder.
The wound however healed, but the patient was
afflicted with a difficulty of naajcing water, and pus

R 2

196

passed with his urine for some time: from hence he
became afflicted with symptoms of the stone, and ii^
process of time lithotomy was performed and a
stone extracted the size of a man's fist f but of a tri-
able texture, which had for its nucleus in the cen-
ter, the tent which the surgeon h^d so carelessly let
slip into the bladder. The young man, however,
fortunately got well. Hence Tulpius takes occasion
to w^arn surgeons, always to fasten threads to the
dossils which they may be induced to apply tp
wounds in the cavities of the abdomen, thorax, &Cc

The other experiment is one quoted from Mr.
Sheldon's absqrbent system and shall be related
afterwards.

Preternatural ossifications have frequently been
discovered by dissection to have formed, in the cur-
vature of the aorta, valves and ventricles of the
heart, in tendinous fascios and many other parts of
the human body. Calculi of different textures,
some friable either like sand or in larger concrete
masses, others more compact, and more nearly re-
sembling bone, are to be met with in every hollow
viscus, and every cavity j I have seen the inner coat
of the pericardium incnisted with a sabulous lining.
The kidneys and bladder are the most common re-
ceptacles for them, even the veins and arteries are
not exempted from their formation. But the ab-

1^7

sorbent system and lymphatic glands are more often
affected; and the salivary glands, in whose excre-
tory ducts calculi are frequently found: all which
niay be referred to the same origin, the earth of
bones: to which ^Iso we may add those concretions
deposited from the saliva on the teeth, forming hard
incrustations upon them, which if suffered to grow
too large are very inconvenient and troublesome.
Fansvvieten rneniions an instance of a young woman
who suffered these hard incrustations to increase
from the dread of having them removed by an in-
strument, to such a degree that the teeth were buried
totally under the frightful mass; which by pressing
^nd ulcerating the gums, distressed the poor crea-
ture exceedingly and caused a very disagreeabJc
foetor. put the load, which was extremely hard,
being removed by means of a steel chisel, and
kaden mallet, iri the hands of a dexterous and skil-
ful surgeon, her mouth washed ^nd cleaned, her
teeth were cleared of the deformity and foetor.

The deposition of this concretion on the teeth
from the saliya, we may suppose to be much quick-
er in its formation than calculi any where else, the
bladder and kidneys perhaps excepted; because
the solutiori of the osseous earth secreted with the
saliva, is more exposed to the air, which, with the
heat of the mouth, will, more speedily dispose the

I@8

aerial acid to escape, the decomposition to take
place, ai>d allow thq earth thus separated, to be dcr
posited froxn the saliva, and gather in the form of ^
thick fqr on the teeth, but particularly about the
roots, where the gum has left them and vyher^ the
enamel does nqt reach, as if the naked, |>.ony, part
of the teeth, from containing the same materials^,
invited the adhesion qf it ; and where it is soon con-
solidated into the stone lik^ concretion.

The quickness of the fQrnr\atio,n of this calcarious,
(If I may so pall it) incrustatiQp on the teeth^ appears,
the more eviderit, when we co^nsi^er that ^he masti-
cation of our food at rneals, must abrade aad carry
off, great part of that already fo,rnied, as well as p^e^
vent the accumulation of it in hard qi^sses ; whicl^
with the pains that many people t^ke to, clean, thcii;
teeth, renders it surprizing that this crust forms at all.
Notwithstanding which, it forms so quickly that^
those ladies and gentleman > who are pa,rticularl3f
nice about their teeth, are obliged to have frequent
recourse to the dexterous hand of the surgeon dentist,
to remove this extraneous covering. By whicl>
species of luxury, you know thart the artists most in
repute of this ingenious class of men, add conside-
rably to their large income in London ; son\e I an^
told enjoying from their industry and reputation not
less than one thousai^d, and froni thence to up^wards

129

of three thousand pounds per ^nnatn.— But the enio*
lument arises to those great sums from the addition-
al assistance of the other branches of their operative
profession. The fair of both sexes, axe not only
obliged to the raccommodeurs des dents, for clean-
ing (ca^Ied scaling) extracting, transplanting, in-
grafting, &:c. of teeth, but also to the ingenuity of
these useful gentlemen, for supplying from the jaws
of the Elephant, but more especially those of the
Hippopotamus, the Sea Horse, {because the ena-
mel of his teeth is thicker and harder, and of a
purer white colour than ivory) the ravages of time
committed on those useful and ornamental parts of
the mouths ot the beaux and belles in the fashion-»
able world: giving as natural and youthful an ap-
pearance to those adventitious teeth, as the Rouge
and Blanc gives to their complexions. Nature is
said to do nothing in vain, it is therefore a query
with me, whether, even this collection of incrusted
earth on the decayed and exposed bony part of the
teeth, although from a recrementitious origin, may
not be designed, for their protection from the exter-
nal air, and the prevention of their more speedy decay ?
You may, my friend, observe in old people almost a
demonstration of this matter : an incrustation forming
upon the surface of the decayed stumps which not
only protects the nerve from the influence of the ex-

ISO

ternal air, but the angular points arc covered ^nd
blunted by its accreObn, the soft parts, viz. the
checks and toriguc prevent^ed from being wounded;
and somuch firmness given to the slumps th?.t they
actually perform in a great degree the office of sbund
teeth in masticiition !^ — This the dentists will say is
a strange doctrine, can an excrementitious foetid
matter like this be designed by nature to cover the
teeth, which occasions foul breath, &c ? It is not
this earth that causes the putrid halitus^ the gums
are the principal seat of itj small ulcerations, there,-
discharge fluids liable to corrupt by the heat of the
mouth, and send forth foetid effluvia y yet this fcetof
frequently depends upon carious teeth and often up-
on injured lungs.— But the foetor attending large
collections of this incrustation, will depend upon the
injury the gums sustain by its extension, which ir^
ritating the softer texture of their edges will produce
Ijlcerations and a discharge from them.

Large collections of this sort may always be pre-
vented by a moderate use of sugar. — This calcarious
matter is entirely soluble in acids, so is the enamel
and earth of the bone of the teeth. They are there-
fore dangt^rous applications. But sugar you will
say contahis an acid, and it has always been ob-
served that people addicted to an immoderate use of
sweets^ soon have their teeth destroyed; — sugar

131

therefore contaias an acid on which this destruction
depends.— This is certainly true in an immoderate
nse of sugary and the acid of the sugar will actu-
ally dissolve this crust of adventitious calcaneus
matter and expose the uncovered part of teeth to
the air, it will also attack the* enamel, and upon
rhese circumstances depends the injury which an
immoderate use of sugar, always present in the
mouthj occasions. But I know from experience
that a moderate use of sugar, will have a contrary
effect; a small piece of white sugar candy or even
double refined loaf sugar dissolved in the mouth
once or twice a day, will keep the breath sweet (as
far as that depends on the teeth) and prevent tfie
too great increase of this incrustation, that is, pre-
vent its becoming either hurtful or inconvenient,
and render the scaling of the teeth, as it is called, if
not totally unnecessary, at least less necessary than
is commonly imagined: — and w^ill be found a far
less injariQ'Js dentirrice, than many a composition
that goes under that name, which generally con-
tains a fossile acid material, of a far more active
and destructive nature.

The ingenious Mr. Sheldon page 30 of his ab-
sorbent system, says that if a calculus be formed in
the uiinary bladder of an animal wdiose bones are
coloured with madder (which can be effected by

152

\he introduction of any extraneous substance into
that organ), — the earth which composes the calcu-
lus will be of a red colour similar to that of the
dyed bones. If we suspend for a time the feeding
of the animal with madder and then (e^d him again
with the same substance, and proceed alternately in
this manner, upon cutting the stone through either
in a perpendicular, or horizontal section, streaks
of red wull be found intermixed with others exhi-
biting the ordinary colour of the urinary calculus. *
This phenomenon cannot be otherwise explained
than (he tells us) by supposing the earth of the bone
to be absorbed by the lymphatics, and by them con-
veyed into the sanguiferous system, where, being
secreted by the emulgent arteries from the blood
with the earth of the urine, it is afterwards attracted
by the nucleus introduced into the bladder. Some
years ago, from observing some phenomena in the
human body, the idea first suggested itself to me,
(says Mr. S.) that the earth of the bone was conti-
nually changing by the deposition of new matter and
absorption of old. f He had a conversation with

* Query — -Did Mr. Sheldon ever try this experiment f or is this ?.n ia-
duction drawn from reasoning, by analogy, from the experiments of th!=
kind on bones oi' animals ? A matter of this importance ought to be clear-
ed up.

t It seems to appear from this passage that Mr. Sheldon was totally ig-
norant of the many beautiful experiments in proof of this curious, fact
made by Herissant, Du Hamel, th« French acadeiuiciahs, Haller, Storck,

133

Mr. J. Hunter who informed him, fliat he had fed
himself with madder: I immediately (says Mr, S.)
asked him, if the earth of his urine was tinged with
madder? to which he answered, that the earth at-
tracted by the sides of the vessel in which the urine
was made, was of a red colour.| Vide Sheldon's;
absorbent system page 30. & 3lo

I am informed that the ingenious Mr. J. Hunter,
and some other physiologists are of opinion that the
waste of the osseous, &c. matters, which require a
perpetual renovation, is performed entirely by the
absorbent system, and that this system has the
power of absorbing the most solid parts of bone, car-
rying them into the course of the circulation, froni
whence they are secreted and expelled by the emunc-
lories. — Mr. Sheldon, after mentioning the extraor-
dinary case related by Mr. Cheston in the Philoso-
phical Transactions, vol, 70, part 1 1, page 323, of
the Thoracic duct of a man he dissected, being found
entirely plugged up with ossific matter from imme-
diately above the receptaculum chyli, — says, this is

&c. (mentioned "m the extract frora Tanswieten.} many years before h«
was a professional man : which is a little extraordinary in the writer of a
system of absorption, and teacher of ai^atomy.

X The Earth in form of crystallized sand, deposited on the bottom, and
attracted by the sides of the vessel in which urine is made, in different
people, xery often exhibits, a red, sometimes a pink colour, although no
maddsr has been taken,

s2.

134"

a proof of calcaneus matter being absorbed, and
found in the lymphatic system. There certainly Js
not a doubt of the fact^ the question is was it in a,
state of diffusion and suspension in a divided forni
-of minute^ solid, particles in the chyle and lymph,
or was it in a state of perfect solution in a fluid ? —
If the earth of bones is to be taken up in a solid form,
from the bone itself, as by implication we may be-
lieve it supposed to be, as no other mode seems to
to be hinted a^. I must confess I am under much
difficulty in being able to comprehend^ the nature,
indeed the possibility of such a process : it is giving
a power to the mouths of lymphatics, of abrading,
comminuting, and dividing this the most solid part
of the body; for which by their structure they are
by no means adapted. There is no such thing as a
solvent property given by those gentlenien to the
fluids in the system, which may alone be capable of
effecting this purpose. Although totally ignorant
of the w^onderful means which nature employs to
remove the effete and useless parts of the solids in
our sysfem, I cannot think it possible, that such a
process can be effected without the intervention of
such a medium, or rad^ier menstruum, as is able to
reduce them to a perfect state of solution : and wd:y
may not this power reside in mixture with the finest
part of the lymph? It cannot be a comminuticpi

135

of the soVi J matter and Its mere suspension in the
fluids ; because this could never pass the secretory
organs without forming concretions everywhere by
merely subsiding, as this earth must be specifically
heavier than tl\e fluid it is suspended in. Fine argil-
laceous earthy or any impalpable pow^der specifically
heavier than water, is capable of remaining diffused
through it and suspended in it whilst the fluid is in
constant agitation ; yet the fluid is ahvays turbid,
and the particles of the powder are easily detected
in it by a lens of a small magnifying power, cr even
the naked eye, and will immediately subside, when
in a quiescent state.— Far different is this from the
state of secreted fluids which hold the calcarious
earth in solution ; upon their immediate secretion,
they are limpid and diaphanous, and not a particle
of earthy matter is to be seen in them by the best
micjToscope till long after their secretion, and after a
decomposion of their principles takes place : as al-
ready mentioned in Boerhaave's experiment.

Mr. J. Hunter in his Treatise on the venereal
disease says (page 7-) that in ulcerative inflamma-
tion, the action of the absorbents superadded to the
action of the arteries, will remove solid parts and
even the arteries themselves. — What I should un-
derstand by this doctrine is, that the parts destroyed
in the process of ulceration and digestion^ are dis-

136

solved in the matter, and partly removed by it on the
dressing, if the ulcer is external, or absorbed again
into the system : — but perhaps this is not the author's
meaning.

When boHes are destroyed, they are, I believe,
always exposed to the action of some fluid matter,
which we may presume to have been the instrument
of their destruction, and the most solid bones of the
body have been known, to have lost their solidity
and become porous and soft and even altogether
dissolved under such circumstances. And that this
has been the case whether the bone has been ex-
posed to the action of blood, lymph, serum, sanies,
or pus, without being subject to the influence of the
external air is well known to every surgeon : and
many instances of this kind are upon record in the
annals of physic and surgery. — The destruction of
the texture of carious bones thus exposed, and the
softness they incur, seems to be owing to the loss
of the calcarious or earthy matter, which appears to
have been dissolved and carried off in a state of so-
lution. .' It may be asked what is this solvent princi-
*ple, which seems to be diffused in those several fluids,
and has this peculiar property of uniformly produc-
ing the same effect,having a similar elective attraction
to the earth of bones, and forwarding its dissolution
in those different menstrua ? In 1773, I sent an

137

account to the Philosophical Society of Edinbur^^h,
of an encysted dropsy of the right thigh, with a disso-
lution of the bone, in a lady* who died tabid in
1767 : as the case was a curious one I will give you
a short abstract of what appeared on dissection.

The tumour was very large, of a pyriform shape,
and extended from the spine of the ileum, and ar-
ticulation of that bone with the os sacrum, possess-
ing the whole thigh to within about three inches of
the joint of the knee: on plunging a knife into it,
about six quarts of a fluid were discharged, the first
quart of which was yellow and without smell, the
rest a bloody sanies. In ope ning the tumour by cru-
cial incision, many ossifications in the soft parts
•were broken asunder before the knife would pass.
It was now discovered that the fluid had been con«
tained in a cyst, between whose thick coats, many
preternatural ossifications of various shapes, thick-
nesses, and dimensions, uniting with one another, and
forming a kind of reticular coat, of plates of boue_^
were every where spread. The muscles of the
thigh were emaciated, and so united that distinction
wab lost, and appeared like a thin fleshy mem-

* The case of this lady is given tit large in the Author's ** Observation.^
<m Scrophulouj AfFeclions." page 93, &c. The abov^ is merely an abstract
of the dissection, inserted here to illustrate the opinion entertained ia this
work of the solvent priad^le coataiiied ia morbid aiil!na,T fiuUs,

138

brane covering the cyst. A considerable quantity
of white medullary like substance and seven or
eight ounces of grumous blood, were deposited witli-
in the cavity, and its internal surface was studded
with fungous^ hemispherical excressences of various
dimensions. — But the most wonderful circumstance
VN'as that the whole solid os femoris was wanting
from the acetabulum coxendicis to the lower end ot
the tumour: where its remains projected a small
matter upwards, without any covering, into the cyst!
three fourths of this solid bone being dissolved and
annihilated. The acetabulum coxendicis had the:
upper and posterior part of its cartilaginous brim
destroyed; there was a roughness at the bottom of
it and a small ridge extended downwards through
its cavdty. — The remaining fragment of the femur
was soft and yielding to the knife, of a dark blue
inclining to black colour, its naked extremity was
exposed to the action of the fluid in the cyst^ its
cavity was obliterated, and gqiug plates of bone ap-
parently of recent production, shot oui; from the
edges ©f it fashioned to the shape of the cyst.

The operations of nature in this case are truly as-
tonishing, here we see a total destruction and annihi-
lation of some parts, and at the same time new com-
binations and arrangements in the formation of new
ones; es if by these means she attempted to restore

1S9

^ case of bone, to give some stability to the limb
thus robbed of its bone by disease.

How is this very extraordinary business to be ac-
counted for ? was not the bone's texture destroyed
by the action of the fluid ? did not the fluid contaiij
some principle, which rendered it a menstruum of
adequate power to dissolve this solid bone ? and if
soj did not this solution enter the system by absorp-
tion ? and was not the whole carried off" by secretion ?
or does it appear more consonant to probability and
tlie laws of Nature, that all this should be performed
by the absorption of solid matter as before noticed ?
I shall leave you, my friend, to decide this question,
I know what my own opinion is.

But whence came the origination of the new bony
arrangements? I believe I must refer that to the sup-
ply of bony mate rials furnished daily from the aliment,
and conjecture as there was no access to the space
lately bone, ihey might be diverted to another situa-
tion and form bone in the parts where they were
found : perhaps upon the same principle that ossifi-
cations are forme? d in the tendinous parts in old peo-
ple, as the materials are not required in their bones*

140

LETTER VII.

Dear Sh\

I shall next come to the treatment
of this very extraordinary distemper.

There is no disease incident to the human body,
irfthe treatment of which there has been more whim^
more caprice, and more quackery introduced than in
the gout. This distemper being deemed an oppro-
brium medicorum, every one thinks he has a right
(particularly in an age when quackery is rendered
lawful, by raising a scanty revenue at the expense of
population, and every smatterer and superficial reader
pretends to more knowledge in medicine than the
professors of it) to offer his opinion, and a method a(
curing this incurable distemper. Accordingly we
have had a succession of nostrums obtruded on the
w^orld as infallible in the cure of the gout j and the
credulous arthritic prompted by his distressing feel-
ings has grasped at the delusion and forwarded the
interested view^s of successive impostors, Erery one
mast remember the famous I.e Fcvr^> who some

141

years ago gulled some people of distinction out of
more than a^5000, in a very short time, under pre-
tence of an absolute cure, which he cunningly made
them believe could not take place in less than a
fifteen months' course of his powders : he received
his money, and left the credulous patients to discover
the cheat at their leisure. His patients, appeared, I
am told, somewhat relieved at first ; but they soon
found that the disease returned with aggravated
symptoms, (as it was supposed to be an arsenical
preparation it destroyed the remains of their debili-
tated constitutions) and many died victims to their
credulity, and had their lives shortened by this dan-
gerous experiment, as I have been credibly informed
by several people concerned, and I liave seen some
of the victims myself. Yet I am told that this
powder (if I am not mistaken) is sold under the
name of the Liege medicine to this day. It would
be endless to give you a catalogue of these healers
of the gout, which would begin with that empi-
ric, Paracelsus. It will be sufficient to notice
that the credulous patient has always found himself
disappointed,' and that the gout has returned after
tlie boasted cure was declared to have been per-
formed, and the only certainty which remained after
his delusion was the expense it cost him.

But in answer to this it may be said that there

T 2

142

are many undoubted testimonies upon record in
proof of the gout*s having been cured. One of
these is the story which Hildanus relates (page 393)
of a very ill tempered arthritic, who used to be con-
tinually reviling and calumnating his neighbours.
A wag he had thus maletreated, took the opportu-
nity, one evening when his attendants were absent
to enter his chamber,, blacked, and disguised like a
negro, and approaching his bedside with a solemn
pace, without uttering any answer vO his questions,
seized on hi$ gouty hands in the height of a parox-
ysm, threw him on his back, and carried him in
that manner below stairs, with his feet dragging on
the stairs from step to step. When he arrived in the
hall, he set him down terrified and speechless, on
the pavement, and, retreating during his consterna-
tion, instantly disappeared. The arthritic who.
could not move a limb before, even upon plain
ground, much less go up a stair, instantly found the
use of his feet, and, fled with great agility, above
stairs, where, having gained bis chamber, he alarm-
ed all the neighbourhood by clamorously calling out
at the window. When the neighbours came, they
found him breathless and almost lifeless from fear.
All he remembered was.thathe had been pulled out
of bed by a spectre, who carried him out of his
chamber, and cruelly dragged him dov/n the stairs ;

1 43

and that if he had not groaned out the name 6f Jesus
he must have been destroyed. Every one was
filled with astonishment, but especially at perceiv-
ing a person who^ just before, had been deprived of
theuseof his limbs, able to escape up the stairs,and
now standing upright upright before them. **' What
was the cocsequence? (says the writer to Hildanus)
He perfectly recovered, and never afterwards was
afflicted with the gout."

Credat Judcsus appella— non ego.

That a violent agitation of the mind, from an
attention to a particular object; for instance, when
a person in a dangerous situation, requires immedi-
ate assistance, will suspend the pain of the gout, I
well know from my own experience irr more than
one instance : and from an exertion of an energy of
mind, by an attention to one distressing object,
which engrossed all my faculties, I have from a crip-
ple, been enabled to set my foot to the ground ; in
a short space of time, been capable of walking with
the assistance of a stick only, and very soon after
without it. I have more than oncebeen sent far hv
patients in dangerous sit nations, when confined to my
bed with the gout> with great torture have gotten up,
and gone down the stairs, sitting on one and sliding
from that to the next, till I arrived at the bottom*
I have slidden along in this manner or beea carried

;144

tQ the chaise which was to convey me. I once par-
ticularly was thus circumstanced, being obliged to
go a short journey to visit a patient; with much dif-
ficulty I was helped into the house: I immediately-
sat down on the bottom stair, and slipped up back-
wards step by step to the landing, which as my right
foot was well I ^could do. I was helped into the
chamber in extreme pain: but the idea of the
lady's* danger, it being a midwifry case of an
alarming kind, in an instant suspended my pain.
The difficulty and danger of the state I found her
in, immediately occurred to me; and my presence of
mind was instantly exerted to relieve this lady in
her perilous situation, in which I happily succeeded.
In short this exertion of my mind suspended all
pain, and in ten minutes or a quarter of an hour at
most I was able to walk with ease about the room
with a stick: only, and very soon after, without it.
I perfectly recovered from that time, but was not
so fortunate as the subject of Hildanus*s case, for
ray paroxysms still continue to return.

The same author, pag. 58. and 59. gives an in-
stance where the torture had the same effect on an-
other patient, that terror had in the case above re-
lated. A certain nobleman, afHicted with the gout,

* Mrs. Wm. F. of South Wootton,

145

hemg suspected of holding a correspondence with
the enemy, was impiisoned and put to the rack,
whiibt under a paroxysm of the disease. He bore
the torture with fortitude, and his innocence being
manifested, he was set at liberty. To recover from
the injury sustained from the torture, he went to
the warm baths, where he was cured of the hurts
he suffered by his cruel punishment, and his gout at
the same time: and although eighteen years had
elapsed since he was put to the torture, he never
had the gout afterwards, but was as firm and erect
upon his feet as any man of his age.

Happy would it be for gouty people if adventi-
tious pain w^ould always have the effect related by
Hildanus of this nobleman, but unfortunately we
poor arthritics find that sudden and continued ap-
plication of cold, particularly to the extremities,
blows, hurts, bruises near the joints producing ex-
cruciating pain the instant they are inflicted, sprains,
&c. are frequently sure to bring on a fit of the gout
out of the common course. The relation of these
apparent facts of the gout's being thus cured by ac-
cidental causes is certain in other authors of undoubt-
ed credit, besides Hildanus, but with regard to the
facts themselves I must confess my infidelity : be-
cause as I have before observed the gout is a heredi-
tary disease^ so intimately blended with the very es-.

U6

sential matenals of our existence, from the first or-
ganization of the f(£tus, even in the formation of
our most soltd parts, that I cannot think it possible
to remove it without the constituent partsof our bo-
dies were disunited and resolved into their first prin-
ciples, a process in compatible with our existence:
therefore it cannot in the nature of things be a cura-
ble disease. Vanswieten gives some instances, I
have heard of some myself of cures by a milk diet
of a very long continuance; but I believe on a strict
investigation that all those pretended cures, which
have been adduced in proof, of the efficacy of cer-
tain nostrums, and certain regimens, are no other
than an apparent mitigation of t>ym.ptoms arising
from a debility superinduced in the system, which pre-
vents an acute paroxysm from taking place, at the
usual periods, but they carry indubitable marks of
inactive gout remaining in the system under a
chronic form.

From this exordium, you may suppose that J
have no nostrum, and no method of cure to offer
in this distemper. You may be right in your suppo-
sition, and may ask, what have I to offer that can be
■worthy of attention in the treatment of a distemper
I have declared to be incurable ? I flatter myself
however that I have some observations and some facts
to relate, which will ooint out the means of miti-

147^

gating the distressing inflammatory paln^ lessening
the periods of the paroxysms, and preventing the
rigidity and distressing lameness which remain in
many arthritics in the intervals of those paroxyms.
Desiderata, I conceive^ of no small importance to
gouty people.

On being attacked by the gout myself I was na-^
turally led to examine what authors had said of that
distemper, especially in relation to the treatment of
it: but finding so much contradiction and so much
whim, and nothing absolutely founded upon prac*
tical facts, I was dissatisfied^ and the disappointment
I repeatedly met with in following the advice of
the best, in the first five years I was affiicted with
this distemper, disgusted me so much that I laid
them entirely aside, and began to study th^ course
of the distemper as it appeared in myself, and from
my own feelings and the evidence of my senses to
regulate my conduct in the treatment of it accord-
ingly.

From the most accurate investigation of It in my
own person, it appear-ed evidently to me that every
attack was accompanied withsymptortis of a highly
lafiammatory distemper, and during the commence-
ment of the paroxysm was as much so as pleurisy,
peripneumony, acute rheumatism, or any other phlo-
gistic distasej indeed it resembled the inflammatory

148

rheumatism more than any of the other. Here was
intense pain, great heat, violent inflammation, so
great as even to render the vasa minima almost im-
pervious to the blood, fever and strong, full, pulse :
such a pulse as, Huxham says, in treating of an-
other disease, he would bleed for, aye even if it was
in the plague. Under, such symptoms why not
bleed here? does not common sense with a very
slender degree of medical knowledge, point out
the necessity of it? will it not help to lessen the
impetus of the blood, and prevent the violence na*
ture often suffers in overcoming the resistance, the
obstruction of the capillaries, as much as in pleuri-
sy, &c. and by assisting to abate the general inflam-
nation In the part, contribute the sooner to render
the vessels pervious and restore the freedom of the
circulation ? But authors say it is wrong, it is dan-
gerous, it may cause a retrocession of the disease f
a disease which must be left entirely to nature, and
she must not be disturbed in her business! so it has
been said of exanthematous diseases, as small pox
and measles; bleeding and evacuations, and cold
air were destructive, they would occasion a retroces-
sion of the eruption, and endanger the life of the
patient. But the boldness of the Suttons pointed
out a happy improvement in the treatment of the
small pox by inoculation, which entirely overturned

149

the old practice and showed it was founded in error
and continued from prejiadice : however humiliating
it might appear to the pride of regular professors.
This happy discovery forms a remarkable era in the
practice of physic ; as it laid the foundation for a more
rational and successful treatment of fevers of every
denomination, as well as the small pox: which
every honest and humane physician not only acknow-
ledges but practises. If prejudice in favour of old
customs, had so fatally ?nisled practitioners in the
treatment of the small pox, why may we not con-
clude that the same attachment to what had been
recommended by ancient authors, and early writers
on this disease amongst the modems, might mislead
practitioners, in such an extraordinary, versatile^
distemper as the gout. We find them talking of the
danger of a retrocession of gout, from bleeding and
other evacuations, but there does not appear, that
I know of, a single proof of it upon record. The
gout is so variable in its appearapce, ^nd so extraor-
dinary in its shifting from place to place, that I do
not hesitate in saying that the natural progression of
it in subjects loaded with an uncommon quantity of
disease, might easily be mistaken. for the effect of
the treatment: and indeed there is so much contra*
diction in opinions respecting the treatment, that a
man that would wish to regulate his practice byres-

V ^

150

pectable authorities, is so much bewildered that he
does not know \vhich to choose.

Those very authors who condemn bleeding and
other evacuations in the gout in the extrerhities,
gravely tell you if it attacks the head, lungs, fee.
that blood must be immediately taken away: as
this is confessedly to alleviate the inflammation, why
may it not be done 'with equal advantage when it
is violent in the extremities ? From this view of the
matter I was strongly prepossessed with an opinion
that this practice must be attended With the best
effects, I therefore lost blood in a quantity propor-
tioned to the degree of inflammation, and state of
the pulse, and always with great relief, and I declare
most sincerely that I never felt any thing like a rcr
trocession of gout after it, although I have used this
practice eighteen years y and can safely affirm the
same with regard to some of my friends ; one gen-
tleman in particular who loses generally twice, some-
times thrice the quantity that I do, by repeating the
operation, indeed I have sometimes thought im-
prudently: he is of a plethoric habit, and can bear
it better on that account, and suffered no debility
from it ; he however never had any retrocession of
gout, but always reaped great benefit from this prac-
tice and that which is the subject of the next para-
graph. Some, medical authors tell you that a single

151

c^athavtic or breathing a vein will often bring an a
fit of the gout iminediately ; but further, (mark, my
fflcnd, the dreadful sentence!) if either is attempted
in the fit its^lf^ it will throw the gout all over the
constitution, and the greater the evacuation the more
dangerous the event ! — I can only answer, that if
I may speak from my own feelings, I do not believe
a single word of the assertion : it is from mere con-
jectural theory and not from facts 1 I have taken
mercury, 8cc. and have lost blood repeatedly during
the paroxysm, perhaps I have done this more than
any man living, notwithstanding this dreadful ana»
thema, not only without feeling a single inconve-
nience, but on the contrary the greatest benefit, and,
my friend, you as well as others know that my fits
are no trifling ones : therefore I must infer that this
, opinion is founded on false theory, and consequently
erroneous,

Upon the same principle that I used bleeding (the
lessening the inflammatory diathesis) I was induced
|o try the effects of calomel* and opium. Ycfu, my

* The ipader is referred to a paper by Dr. Hamilton, upon the Effect* of
Mercury in iriflammatory disease*, published in the 9th Volume of Dr<.
Duncan's Medical Commentaries, for an account of his reasons for the ap-
^licatiori of it in those case?, from an opinion of its antiphlogistic propel-
ties ; and his success in the trials he made of it, in contradistinction to the
g-^neral opinion tntertained of its stimulant powers. The author left a
panuscripf Second Part to the aboye pap^r^ which has net yet beeja
published. ■ ■

. 152

friend, and many of our medical acquaintance, have?
long seen the great benefit derived from the use of
calomel and opium in every kind of inflammatory
disease, with the occasional addition of tartar emetic
and camphlre, as circumstances pointed out : and
you know that it has been marked with such a series
of success, that it has become a general practice
within our circle of acquaintance.

From a series therefore of successful experience,
I was determined to try it in another inflammatory
distemper, which I have already said a paroxysm
of the gout appeared to be. I have taken them
myself in every fit, and always obtained great relief
from their exhibition, as have many of my friends,
in particular the gentleman before mentioned. Not-
withstanding the prohibition of purgatives by authors
of great respectibility, as detrimental in the gout,
I could not help thinking, that as it was founded
upon the same principle, the danger of a retrocession
of the disease, there must be a mistake in the ratio-
nale of it: and indeed the very directions of the same
authors to administer earth artics, when the gout
attacks the head contents, of the thorax and abdo-
men, most undoubtedly with a view to abate inflam-
mation, forms such a contradiction to the general
principle they would inculcate ^ that I cannot help
thinking it must be founded in error. I do not

153

know a single instance that is adduced in proof of
this retrocession, and from the same reasoning that
inflammation is lessened in the head, lungs, and
contents of the abdomen, by the exhibition of
cathartics, it must hold good in violent inflammati-
on on the joints. The following consideration will
howerer point out the necessity of administering
them, if the inflammation did not exist. Most
gouty people are of a costive habit, at least if they
were not so before they were attacked by the first
fit, they become so afterwards : certainly this dispo-
sition is augmented by degrees ^ and the want of
exercise, when tolerably free from the disease, and
the almost total rest during the paroxym, with the
increased secretions of sweat and urine, greatly con-
tribute to it. Must not the retention of putrid foeces
be injurious in any disease with febrile symptoms ?
Will not an absorption of putrid sordes, from the ca-
vity of the intestinal tube, increase the distemper ?
These are questions common sense must resolve !
Clysters are recommended, but they reach but a small
way into the intestinal tube, and in general only
empty the rectum. Something more then is neces-
sary, the whole canal wants to be cleansed, and an
eccoprotic is plainly indicated for this purpose, as
before observed : and we know not but medicines
of this class are pointed out by nature. The diges-

154.

tion, t)efore the Ht, is generally very indifferent,- th^
appetite lessened; there is sometimes great sick-
ness and a loathing of food : when this is the case,
the alimentary process cannot be canied on in a re-
gular and salutary manner, crudities v/ill arise in the
primal viae, vitiated chyle must be taken into the
blood, the habit will not be nourished, and a mor*
bid affection in the system will be induced. From
these circumstances does it not appear probable that
the cause of the gouty paroxysm, about to make its
appearance, is accumulating at this period in the
first passages, a^id, from thence is diffused through
the habit, and excites the latent gout into action by
its stimulus ? This is rendered more probable from
a spontaneous vomiting sometimes relievirig the pa-
tient, and a spontaneous diarrhoea coming on some-
times at the going oiFof the most violent symptoms of
the paroxysm, from which I have known very great
i'eiief received. This evacuation I observed did not
diminish the natural discharge by sweat from the
parts affected, which continued notwithstanding:
and the great benefit received from it convinced me
that a great deal of gouty matter was evacuated by
this spontaneous diarrhoea. This circumstance may
certainly be adduced in favour of occasional cathar-
tics, during the paroxysm of the gout, and will go
some way to overturn the opinion of its being a

155

4(angerous practice; since experience is the basis on
which I may found it, and facts cannot be contro-
verted An inference of some consequence natu-
rally arises from consideiing the foregoing circum-
stance ; would it not be of use to attempt to prevent
an indigestion, and the abovementioned supposed
accumulation, w^ich I am strongly induced from
jjiy own feelings to believe takes place, by adminis-
tering an emetic and cathartic as soon as the appe-
tite begins to fail, and strengthening the tone of the
viscera by chalybeate waters, bitters, and the bark |
I never have tried the experiment here suggested,
but as I believe it may be attended with advantage,
and not with prejudice, I certainly shall : although
emetic^ have a very disagreeable, indeed painful
effect upon mc, by inducing a spasn; oi^ the upper
orifice of my stomach, which entirely prevents their
operation. The painful sensation occasioned by
them has naade me decline taking any medicine of
that kind, upwards of twenty years.

The cathartics which I have generally employed are
the cooling eccoprotics, in the inflammatory stage, or
warmer aloetics, as Tinct. Sacr. on the decline of the
paroxysm ; arid I can safely aver with considerable ad-
vantage. I therefore without hesitation declare, that
I think cathartics are not only attended with safety in
their exhibition, but with very beneficial effects in the
gout* W

156

Medical writei*s recommend the application of
blisters and symaepisms to the extremities, wheij
the gout seizes the head, chest, stomach, &c, with
a view to make a revulsion from the parts affected.
Having repeatedly seen the application of blisters
attended in those distressing cases with the most
happy consequences, I paid particular attention to
their effects, and observed that in proportion as an
inflammation ^yas excited on the skia by the blister,
the pain and other symptoms abated, and as the
blisters rose and the discharge increased, they went
gradually off.

From these observations, I imagined that as blis-
ters certainly allay inflammation, for that reason arq
used with success in pleurisies, peripneumonies, &c.
and proved of such benefit in removing the gout
from the parts abovementioned, they must be of use
to abate the violence of the inflammation in the ar^
ticulatlons, of the feet and knees for instance, and
contribute to discharge the gouty matter. Impress-
ed with this idea I applied them, to my feet on the
instep near the ankle, on and near the knees when-
ever those parts were attacked. The benefit I re-
ceived from them greatly overbalanced the temporaiy
pain they occasioned. If I applied them ovej night
ihe intenseness of the pairt and inflammation was
gone by the morning, and-as the blisters discharged,

167

entirely went off; but as many small fits that daily
return in different parts compose what is called by
Sydenham, the grand or cardinal fit, I have been
obliged to repeat the application to different parts,
as the former blisters dried up, so that during the
whole paroxysm or cardinal fit, several are repeatedly
applied, and indeed so great is the relief I receive
from them, that as soon as the pain begins to be in-
tense, i«^irh ther concomitant inflammation, I directly
have recourse to my certain friends, the blisters: I
hare used them in my own case upwards of eighteen
years. I had long put this method of practice into
execution on myself before Dr. Stephenson's pamph-
let fell into my hands, which contains much good
matter on the subject of blisters in the gout, mixed
with much eccentricity. Their effect upon me is:
very extraordinary : about the second day after their
application, when the discharge is very great, the
inflammation is also intense where the vesications
were^ and when I put my legs out of a horizontal
position, as for instance in sitting on the bedside^
the throbbing pain is prodigious in the site of the
blister, and is exactly similar to the same sensation
I used to have in the diseased joints of my (eet^
w^hilst the gouty inflammation remained in them,
when I put them out of bed; and it contiques for
a minwte or two and then gradually declines exacts

w 2

158

iy in the same manner, whilst the diseased joints
themsefes remain perfectly free from pain, and this
ha opens when the blisters are applied at a dis-
tance from the joints either of the feet or knees; from
which ciixumstance I generally now place them at
a distance. If the foot and knee are affected at the
same time, I place the blister above the ankle on
the inside df the leg, on the part where they are ge-
nerally put in fevers: and this place I find more eli-
gible than any other, being fully efficacious in re-
lieving both the foot and knee. On this spot the
throbbing pain abovementioned takes place with the
gouty inflammation: but it is not felt unless I hang
my legs in a sitting posture, or when I get up to
walk> when I must pause a little till k abates and
in a short time it leaves me. This pain is not alike
in all blistered parts, but chic% confined to those to
w^hich the greatest quantity of g.auty matter is de-
termined> and blisters there are generally the best
applied, i have had two on each leg open at once,
but in succession : three gave no pain, and the last
seemed to have absorbed all gouty pain. The sen-
sation on getting out of bed continues several days.
After the blisters have discharged two days there Is
something like pus appears upon their site; then it
is that the peculiar smell takes place in the discharge
fromthem^ which the gouty efSuvia from thespon*

159

taneous discharge of sweat from the feet, so strong«
ly exhibits on the decline of a paroxysm; a smell
which there seems nothing like on the face of the
earth: though I have lately thought that it bears a
faint resemblance to that of dry human bones, as a
«kull for instance, which is emitted after rubbing it
with a dry hand. The inliammation and pain on
the blisters, abovementioned, and the peculiar smell
of their discharge, are sufficient demonstrations that
a great part of the gout is translated from the joints
to the blisters, and is there discharged, and are suf-
ficient evidences that the disease depends upon fluid
matter, sui generis^ which here finds an artiiici^
cutlet.

Besides the relief from pain, and abatement of in-
flammation afforded by the discharge of the blisters^
thi^f discharge is attended with another great advan-
tage the batement of tumour occasioned by the infiltra-
tion of a serum or other watery part of the blood into
the cellular membrane of the diseased part : the absorp-
tion of this fluid is certainly promoted by their effects,
and great pain is discharged at the vesicated surface.
This is rendered pretty clear not only from the lessen,
ingof the swelling whilst the blisters run, butfromthis
diminution stopping, when the discharge from them
stops. Another advantage is obvious ^ the great ac-
cumtilation from this extrar^ation about the joints

160

is prevented, and that stiffness^ from the inspissated
stagnant fluid, about the ligaments, &c. in a great
measure obviated, at least I find it so in myself, my
joints being perfectly free in thdr motion? when t
am clear of the paroxysm. May v^^e not infer froni
this that a discharge thus pfocurcd of th^ stagnant
fluid in the cellular membrane, may be in some de-
gree the means of preventing chalky concretions ?
Dr. Stephenson ^ems to have entertained this ideay
and I believe he is right.

It has been alleged that blisters ^re liable to occa*
sion a retrocession of gout : — this I believe io be ill
founded, from the very nature of the effects of these
applications 5 however the facts above related are
presumptive evidences' to the contrary : besides I
never felt the least symptom of a retrocession, and I
really believe that some of those instances of a«up-
posed retrocession which so we often hear of> are no
other than varieties of it, different parts being affect-
ed in the progression of the disease in subjects loaded
with a superabundant quantity of it (as before ob*
served) of which there are many instances in the
world.

16\

I.ETTER VIII.

Dear Sir,

The spontaneous sweating from
the feet and other parts affected by gout, which
takes place on the decline ot a paroxysm has been
considered as the only outlet by which nature carries
off the morbific cause of tlie disease: and the pecu-
liar smell which attends it seems ta confirm the
conjecture. — I am convinced from experience that
although it is the principal, yet, it is not the
ONLY discharge by which the crisis of the parox-
ysni is cpn^plpted. First, because a spontaneous
^iarrhpsa frequently takes place at that period (as
.already notice4) and also an increased secretion of
"firine, \yhich is the more remarkable, as it is very
large on the decline, and very sparing during the
paroxysm ', and these increased discharges are attend-
ed with manifest relief: and secondly because I
have known ^Iso a large discharge from the salivary
glands continue for some days, and not unfrequent-
Jy a large expectoration^ both with and without a

^63

cough, of a mucns of a very peculiar and disagree^
able flavour, and this also continued through the
whole of the decline of the paroxysm, without any
apparent diminution of the sweating froni the feet ;
which leads me, as I have attended particularly to
these circumstances in repeated instances, to bc-»
lieve that all the emunctories are eniployed by na-
ture, in discharging the morbific matter, the acci^r
mulation of which was the cause of the paroxysm.

But the sweating from the parts affected is attend-
ed with so peculiar a smell, and continues such a
length of time, that this discharge has been regarded
as the only critical evacuation, both by medical
people and arthritics. For this reason, the gouty
man, the moment he is attacked, wTaps himself In
flannel, confines himself in bed covered with a load
of blankets, whose weight he contrives to keep
from the parts affected, weltering in heat and sweat
for many successive days and even weeks ; breath^^
ing the filthy atmosphere of his own steams, in a
close chamber, with his bed curtains drawn close
round htm, and a free circulation of that salutary
principle, fresh air, denied admission, lest by the
influence of cold a retrocession of gout on some of the
noble parts should take place. This I am sorry to
say has often been the language of doctor and pa-
tient : but a seasoned arthritic thinks himself com*

I6S

pefent to the business Without the assistancef of the
doctor, and wc see him coridemn himself by this
preposterous treatmer>t to suffer real evils, to shun
imaginary ones;; till when the pain is gone, at the
end of eight or ten weeks' confinement, he is drag-
ged out of bed an exhausted, miserable cripple, un-
able either to stand or go. This is by no means an
exaggerated picture, but di^awn from life : several
of my acquaintances have obstinately persevered in
this plan till they have destroyed good constitutions,
and readered themselves ten times lamer thari they
would othervv^ke have been; and it cannot but be
so. — Every surgeon knows, in the cure of fractares
of the leg, especially compound ones which require
long confinement, in persons otherwise of good con-
stitutions, that by the tnere want of motion, the
knee and ankle joints as well as the toes become so
rigid that many months, sometimes years, elapse
before they recover their motion, and sometimes in*
deed they nevef recover their usual freedom at all:
this is supposed to be caused by the inspissation of
the synovia; but whatever the cause may be, the
fact is SO- If therefore, this is the case, where ^he
joints labour under no disease, and that mere want
of motion will produce this effect, how much more
may we expect it to be so if we add to the want of
motion the most violent gouty inflammation round
the joints^ with intense heat, a heat artificially kept

164

up by double yea quadruple wrappers of thick Man-
uel, under the false notion of bringing on a sweat,
and preventing a retrocession of the disease? i say
a false notion^ because it is impossible a sweat can
take place until the inflammation abates, the very
effect of which inflammation is a stoppage of the
pores from the compression of the distended vessels
on the excretory ducts, and the crisping up and
parching of the cutide by the intense heat, which
tenders it impervious to the perspirable fluid: and
when such pains are^ taken to keep up this heat by
the surrounding. flannel, the inflammation cannot
speedily abate: I have on the contrary felt the in-
fiammatory heat and pain augmented by this mis-
management. When I first had the gout I did like
my neighbours, wrapped the diseased feet in flan*
nel, and adopted the fashion soon after invented of
covering them over the flannel vi^ith the oiled silk
bootikins, with a view to confine the heat and sweat-
ing, and form, as it was called, a kind of warm
vapour bath: this was said to be attended with the
best consequences; but the distressing torment I
felt in the height of the inflammation, which was
highly aggravated by the confinement of intense
heat, soon forced me to lay flannels and bootikins
aside and to acjopt another and more cooling plan,
with great advantage.

The sweating process has however been univcr-

i<ally adopted, (notwithstanding the mischief it has,
done by being carried to the extreme) upon the
hypothesis of sweating being the only evacuatiou
which efFectuates the crisis of the paroxysm. This
has given rise to many inventions to bring on this
evacuation prematurely, and push it to the utmost,
under the delusive but flattering hope of obtaining
a perfect cure of the gout, and we may readily be-?
lieve these were grasped at with avidity by the suf-
feiing arthritic. Some niodern medicines of this
kind I believe have not escaped your memory. I
will however recal some of thern to it, and first the
celebrated quack Dr. Ward's sweating powders: the
first of which as the process of its preparation stands
in Mr, Page's pamphlet, consists of ipecacuanha
and opium, &c. and is nothing more than Dover's
powder, only with a parade of deflagrating the
nitre after the ingredients are mixed, which certain-
ly n;iust rather injure the ipecacuanha by burning,
on which and the opium the virtues of the com-
pound unquestionably depend, and therefore the
medicine is the worse for it. The second has white
hellebore instead of ipecacuanha, and a fifth less of
opium, the other ingredients are in fact the same,
although a parade of a different process is rnade^
Another I shall name, which made some noise in
the fashionable arthritic world, was a medicine 5n-

X 2

166

vented by a Mrs Dutton (I think her nama v/as'.
at Henley upon Thames, who piet^ndcd to perform
cures by a particular sweating process: the corapo-
sition of her medicine was kept a secret, but it ap-
peared to be no other than a strong balsam, guajac.
The patient took this, in certain doses, and was
sweated naked between blankets, with a load of
covering, in a bed closely surrounded by the cur-
tains to keep in the steam, and thus lay weltering
in a mass of corrupted, perspirable matter, and
foul sir, for the space [X am told by one of the suf-
ferers) of a week: at the expiration of \yhich he came,
out exhausted;^ fr^e f(Qm pain, bpt not from decre-
pitude ; and most certainly not from the distemper,
which notwithstanding all this severity, returned
again at the usual periods.

The fanious Buzzaglio's method is upon the. same,
sweating principle, J ^m told, as far as the imposed
secrecy on the patient has allowed it to transpire,
but conducted in a different, and so far more serv
sjble, manner, because exercise constitute^ part o(
the plan j this however is s?iid to be carried to the
e:^treme, and therefore mi^st be hurtful.

The mischief wh'^gh ensues whet\ the sweating,
whether spontaneous or artificial, is carried to excess,
seenis to be this : the intense inflammation leaves the
parts, when the sweating is established, in a state of

167

great debility, much swelled by tbc infarction of the
cellular membrane, and the joints incapable of mo-
tion at this period, without great exertion by the
patient. But no exertion is made, and he acqui-
esces in their torpor and lies motionless in bed,
sweating most profusely, with the parts surrounded
by flannels. The synovia for want of motion will
thicken, and the intense heat will increase the spis-
situde The extravasated, lymphatic fluid in the
tela cellulosa will also thicken, a«d the finer parts
being evaporated, the heat will increase the spissltude
of this also ; and as the tela is not o«ly interwoven
in the texture of the ligaments and tendinous
aponeurotic expansions about thejoints, but surrounds
^hem as the universal, connecting medium, the cre-
taceous matter, in this state of rest, will be deposited
j^nd add to the calamity ; these parts therefore must
particularly suffer, and become of course rigid and
Ipse their action ; and, in short, whilst the heat is
thus artificially kept up, the evaporation of the fine^
parts will go on through the pores, and the whole
mass of inspissated fluid, become as it were baked
by the intenseness of it ; and every successive fit, by
the same maletreatrpent will increase the rigidity,
lentil the joints lose their motion entirely, and become
as it were anchylosed, and the cretaceous matter in
them will be hardened.

168

This- you will say, my friend. Is a terrible picture j
I am afraid however it will be found to he a true
one, and I could point out some cases now existin*^,
which on examination will confirm it, I am per«
suaded myself from experience that this mischief
would be wholly prevented by a different treatment ^
and in all things I here assert experience is the cri-
terion by which my practice is directed: for you
may be assured that all the appearances and effects
of this distressing disease menlioned in these letters^,
except where the worst of the latter have been pre-
sented by my mode of treating it, and the course of
treatment recommended from an attentive observa-
tion of them, have been experienced in my own
person as well as in those I have attended. When
thus profusely sweating, were the coverings of the
bed made as light as the patient could bear them
without feeling any pain from cold, no flannels
wrapped round the joints, but only a thin, cotton
or worsted, gauze stocking, such as is worn under
silk, drawn on to lie in, to prevent friction from the
sheets, when the limb is moved 5 the inflammation
would be less, would sooner abate, and the sweat-
ing would sooner appear :— -for, there is a certain
period or acme to the inflammatory stage, generally
from the fifth to the seventh day, before which, it is
not found by experience that the sweating can take

169

place. That this period is protracted by the pre-
posterous increase of heat, from that heat's being
confined by the thick flannels, and the load of blan-
kets in the bed, is beyond a doubt, I have known
by experience^ By this increase of heat, the cuticle
becomes parched and dried, and denies the transu-
dation of prespirable matter through the contracted
rigid pores : and when this is the case, the sweat-
ing is not fully established until the parched cuti-
cle cracks in many places, relaxes, and is actually
pushed off and separated, by the moisture underneath,
from the true skin : and much time is lost, and much
does the patient suffer ere thishappcns. But— aproper
degree of exposure, with a light covering, to cool
air, instead of preventing the sweating — a circum-
stance so much dreaded by arthritics invalids, on
,the contrary, by allaying heat and inflammation^
actually promotes it. This I have repeatedly expe-
rienced in myself: it is my constant practice to leave
my bed. as soon as I can put my feet to the ground,
and to keep up as long as I can bear it, without
fatigue, or increase of pain. This practice instead
of checking the perspiration, appears to promote it.,
and it continues under the vicissitudes of exposure
to cool air, until tlie symptoms of gout cease: which
does not take place till many wrecks after my w^alk-
in g abroad^, on my professional avocations: and I

170

always find that too warm covering on the bed brings
on .heat and pain in the night, which leave me
when it is removed. Here I cannot help mention-
ing a circumstance which happens to me and I ap-
prehend to every arthritic : when I am in a con»
yalescent state, I observe when I get up in a morn-
ing, that my joints are feeble, stiff, lame, and not
without pain, and I make a very bad progress ia
wilking; but, after I have used a little exercise,
those symptoms gradually disappear, and In the
evenings I can walk extremely well, and nearly with-
out lameness. I al^ find that by sitting long, even
in s^ chaise, although there is motion, but more es*
pecially by sitting at a table to read or write, for any
length of time, my joints become stiff and lame,
which sensation soon goes off by walking: and I
find likewise during this convalescent period, my
stockings wet in the ieet, and my feet in a full pers-
piration at night when I go to bed ; which are not
so when I am well, as I have in health dry feet.
All this may, I apprehend, be adduced as no small
proof of what I have been endeavouring to show,
that a confinement in bed, and heat, most undoubt-
edly render the disease worse, and that a propensity to
indulgence with a view to relieve pain, by sweating
fo excesf^, lays the foundation for an incurable lame
ness^ as 3iu-t appear from the facts related^

171

I find from experience that extremes of every
kind are prejudicial; that extreme heat or extreme
cold never fail to excite spasms and often a fit j that
too much exercise, so as to fatigue, or extreme in-
dolence are equally hurtful. I am confident that
extreme intemperance will produce, and extreme
debility will protract a paroxysm : and am convin-
ced that a happy mediocrity of conduct and diet
which avoids extremes of every kind, is one of the
best preservatives from, and affords the readiest mean^
of eluding, the most distressing consequences of the
disease.

The popular method of treating the gout was to
attack the enemy with fire and faggot, and force
liim vi et armis from his strong hold in that viscus to
the extremities, this was thought to be best done by
strong drink of every kind, from the strongest wines
to spirits simple and compound of every denomina-
tion, and the stronger and more above proof they
were it was thought they w^ere the better for this
purpose : that this was inconsistent must appear
from considering the nature of the attack ; and the
consequences proved it to be so and in the end fatah
since it superinduced a complication of maladies
whicb involved the arthritic in destruction. The
effect of ardent spirits used in the gotit in the sto-
mach is, that taken in a moderate quantity the dis-

y

17S

ease is increased — in a large quantity by means ot
their sedative power, the nerves are rendered torpid ;
and their use too often occasions the bad habit of
dram drinking, which terminates the victim*s hfe by
jaundice and dropsy. All this might be prevented
by opiates, stimulatmg the extremities, emollients
and eccoprotics, and calomel with alkaline salts ; the
contrary is not only an er|:oneous practice, but is de-
duced from mere traditionary example, not from
common medical knowledge : I am therefore sur-
prised at Professor Culien*s inculcating thi^ practice.
The celebrated Dr. J. Brown pretends to remove a
paroxysm of gout by what he calls stimulus direct : he
$ho wedhis pupils this in himself by drinking abottle of
wine before them. Tiiis artificial energy may be
$ometimesright,but, Icannotthinkitrightforamanto
get drunk when he feels a fit approaching, with a view
to remoYp it : he may be deceived and bring on a
worse disease, apople:^y. This was probably done
from the supposition that gout is caused by debihty,
but as it certainly is phlogistic and its consequence
debility, first let the phlogistic diathesis be removed
by mercury, opiates, and cathartics, and then the
stimulus may com.e in for its share in restoring ener-
gy and health !

ns

LETTER IX,

fyi^ai^ Sir;

I shall in this letter give yoii ati
Abstractive concentration of my opinions and con-*
elusions on the original cause and nature of goiit^
deduced from facts, and reasonings from those facts^
recorded in the foregoing letters and which are there
given in detail. Should I appear to be guilty of too
much repetition, you may believe it is from a con-
viction of the importance of the subject, the relief of
a distressing distemper : to attain which I think
that a just idea of it cannot be too deeply impressed
ilpon the rtiirid.

From the following abstractive arrangement of
triy opinions and conclusions, the processus integra?
podagrse inay be easily understood ; I shall cori-
elude my letter with concentrated directions for the
treatment of this disease, according to the principles
I have laid dowri ; and with that shall close a ecr-
tespondence which was pleasing at its commence-
ment from the hope of its affording some hints to

Y 2

174

relieve your pain, and as in its progress it has grown
to a volume, from the various digressive remarks it
has occasioned, I shall conclude it with additi-
onal pleasure, in the hope of its becoming of gene-
ral utility: since I intend now to offer it to the
world ; though with some diffidence of its recep-
tion from its militating against received opinions.

The opiniofis and conclusions I have formed, from
the facts and reasonings recorded in this series of
letters, are the following.

1 . That the gout is hereditary, and that descent
fifom parents is the only cause of its origination and
continuance in the human species : but we are ig-
norant how it entered the human system, unless we
allow of its existence in tlie species from the
creation.

2. That the materia morbifica of the gout appears
to be an extremely subtile fluid, sui generis, and that
itis coeval with our existence, orrather existedbefore
it, blended in the materials of it in a fluid state, and
therefore is the first and only cause of the disease*
But as it existed thus in the origin of the first fluids,
and as the whole of the animal was originally in a
fluid state, it must in a manner enter into the com-
ponent parts of the texture of the solids, with the
materials of their formation : and hence the gout
becomes a disease of the fluids and solids together.

175

and cannot be separated from the latter but by re*
turning again to a fluid state, and ia this form being
evacuated from the system, during the resolution of
the paroxysm ; and this becomes obvious to the
senses by the smell of the discharge during the par-
tial dissolution of the solids, in the general waste
sustained during the decline of a paroxysm. Yet
from the very nature of its intimate mixture with
the whole of the component parts of the fabric, it is
impossible it can be wholly discharged, unless a total
dissolution of the body were to take place, which is
incompatible with life, and therefore the goat can
never be exterminated from the habit, and of course
is an incurable disease. But how this subtile matter
first originated, thus to be entailed on posterity, is
a problem never to be solved.

3. The solids therefore and particularly the nerfes
are secondary causes, that is the instruments which
receiving the stimuli, excite the morbid fluid into
action and produce a fit: for if it was not present in
the constitution no such consequence would happen^
as appears evident in those who have no gouty sta-
mina from descent: as excessive exercise, extreme
cold^ blows, strains, hard drinking, crapula, ScCh
are known to excite no such consequences in peo«
pie of this descriptian; but complaints of a very
different nature, and merely dependent oti the na*
ture of accidental stimulus. w

I/O

4. Therefore all stimuli ^b infra et nh exlrn, afV?
not original causes predisposing the habit to receive
the gout; but only exciting causes of rousing into
action the gouty virus latent ab origine in the consti-
tution: for if it were not there^ a man might drink
hard, catch cold^ &c. with hnpunity as to thegouf,
as "is obvious to common observation every dav.

5. Tliat it is an extremely acrid, subtile principle^
to act with such extraordinary rapidity as to excite
the pain m such succession from joint to joint: but its
modus operandi is a mystery never to be solved.

Tliere seems to be a singular, peculiar, sympa-
thetic regularity in this progression of its activity
daring the paroxysm. One part for instance of the
foot is attacked, it removes. successively to others,
gradually leaving the first parts affected; the other
foot is seized exactly in the same parts and in the
same succession ; presently one knee, generally on
l^hQ same side with the foot which was first affected ;
it goes round that in a progressive way, and then
ceases, upon the other knee's being seized exactly
in the same manner. This is called by some metas-
tasis; they may call it what they will, but 1 think
it is the regular progression of tlie distemper.

The acme of every single paroxysm of gout is
from the fifth to the seventh day : after that it de-
clines, What I mean by a single paroxysm is that

177

in the simple part attacked; for instance the ball of
the great toe. This goes the period stated, but,
when the gout is at its acme there, the symptoms
decrease in that part, and _as the gouty commotion
is excited, but does not expend itseli there, it ap-
pears in the neit^hbourhood; perhaps in the heel,
sole of the foot or otitside of it> the ank!e or the
knee. Thus it goes on, till its coarse is finished,
first in one extremity then in the other, and some-
times in the loins, hips, shoulders, elbows and
wrists: and this complication of individual fits forms
a compound aggregate of one; although the attack
and progress of the disease in each part may bie
considered as one in that part.

6. That gout is an inflammatory disease in the
early periods of its attacks; it may remain latent in
some constitutions of not sufficient powers to deve-
lop it, and which therefore cannot produce a regu-
lar fit: yet wandering pains will declare the pre-
sence of the enemy, and persons of such constitu-
tions, though it remains inert in them, may convey
it to their posterity. The various distinctions of au-
thors with regard to the appearances of gout may
therefore be reduced to two, the acute and the
chronic: and though it is a disease of a highly in-
flammatory nature in its acute form, not caused by
debility, but producing it on the decline of a pa«

178

roxysm, its repeated attacks and the gradual advance
of life occasion it at length to appear principally in
a chronic form, sometimes earlier, but, mostly in
old age.

7. That tophaceous concretions are probably
caused by the earthy matter of the bones, being
whilst in a state of rest, deserted by the aerial acid
which held itjn solution in the fluids: that calculi
in the kidneys and bladder are owing to the same
cause, and as a course of Bewley*s* julep is found
to dissolve calculi ; the same may in the intervals of
paroxysm, prevent the accumulation of, if not dis-
solve, the chalk stones.

* Made by completely saturating a solution of Salt of Tartar, in water,
with fixed air, in Nooth*s glass machine, improved by Parker ; in the
common -way from chalk and vitriol. The quantity of one ounce of Salt
of Tartar should be put to a quart of boiling water in a stone vessel, and
whan the liquor is cold, and the calcarious earth of the water precipitated
*o the bottom of the vessel, it should be carefully poured from the sediment
into the mi<ldle vessel of Nooth's glass machine. It generally takes up the
space of three days to saturate it completely with the aerial acid, when
twice the quantity of Sal. Tartar, is used (which is sometimes done, but
the above quantity is best) and four, sometimes five measures of the vi-
triolic acid and as many measures of chalk to effect it. When arrived at
the point of complete saturation, absorbing no more fixed air, which is
inown by the water in the upper vessel remaining stationary ten or twelve
kours, while no more air is Citricated from the chalk in the lower vessel,
it is time to-draw it off; which it is best to do into pint bottles, which
. should be corked well and placed with the necks downwards. It is better
Slot to swallow acids immediately after the julen, as the effervcsctnicc of

179

8. That as the gout Is incurabk^- the stories re-
counted of its being cured by terror, &c., though
told by authors of credit, cannot be believed, and
it may be inferred from all that has been there ad«
vanced that those authorsf could have Ho positive

the acid and alkali will occasion great part of the fixed air to escape by-
eructation, which otherwise would enter the habit, the effect intended by
taking the julep. This is a very wholesome antiseptic beverage, and may
help the constitution by sweetening the juices^ independent of its use in
dissolving calculi.

My friend Bewley says the alkali is so tenacious of the superadded quan*
tity of aerial acid, that he could not expel it by a boiling heat. I doubt he
was deceived in this matter, I am afraid the alkali retained but a very lit-
tle (if any) more than its natural quantity, which the fixed alkali, as it
is in a manner the child of fire, will retain even in a strong red heat. And
i find that every time I take the cork out of the bottle I have in use, there
is always a fresh quantity of air let loose in the intervals between my doses^
which has force enough even to explode the cork, if the bottle stood up-
right, and, as it is, with its neck downwards, and resting on the cork, the
spontaneous extraction of air from the mixture frequently forces the liquor
out by the sides or pores of- the cork. Therefore the aerial acid mnst be
separated from the saline liquor, by the heat of the atmosphere only.

t Even the respectful authority of Vansv/ieten is doubtful j as he does
not say that those people, in the instances he mentions, were never after->
wards afSicted with bad digestion, or wandering chronic pains : besides
Vanswieten follows the ancients and some moderns, in distinguishing the
Podagra, the gout affecting the feet only, from the arthritis, affecting all
the joints; jind from his account of arthritis being always attended by an
acute inflammatory fever, it would appear on comparison to be little differ-
(Tkt from the acute rheumatism, in short they seem, though treated under
di.-ji-nct headsj to be conroundcd togQther, He says the arthritis is cured
sometimes after one fit and never returns — Pkres emm vld'iy qui hoc inorho
^ra-Aier dccuhuci a:\i , ei ^•osiea ^initus mmunes vLycrur, V?.ns^vk'ten, Com. de
FciagTa, p£3;e 189, Tv)m. iv,

Z

180

proofs of its being so* In my own case I know
that an energy of mind exerted upon extraordinary
occasions, will cure a fit of it; but I also know by
experience that it cannot effect a radical cure of the
disease. Yet although the gout is incurable, it is
in the power of medicine to relieve and abbreviate
the distresses of the patient^ and by avoiding adven-
titious stimuli from hard drinking, or other irregu-
larities of conduct, exposure to extremes of cold or
heat, and external injury, as far possible, &:c., a fit
out of the regular course may be prevented : though
some of these exciting causes of gout it is impossible
to avoid, from the circumstances of human life it-
self; mental distress must be experienced by all; ex-
ternal injury cannot always be guarded against;
and the avocations of active life must necessarily ex-
pose men to vicissitudes of weather. Of these vi-
cissitudes every member of the medical profession
must come in for his share; which was one reason
of the remark in the first letter that no greater mis-
fortune could befal a medical man than such a
disease* He may be exposed in the pursuits of his
business to journey under a meridian sun in the
hottest period of summer, and to travel in the middle
of a snowy night in the severest part of winter. His
mental feelings ate likewise often hurt by the scenes
of distress he is obliged to witness, sometimes with-

184

out the power of relieving, when the patient la-
bours under a malady which must quickly terminate
in death. Having often experienced these sit-
uations, superadded to the disease which is the sub-
ject of my remarks, I know what effect such excit-
ing causes may have. To vicissitudes of weather
ihQ soldier, sailor, mechanic and husbandman must
also be unavoidably exposed: as far however as
these and every other exciting cause may be avoids
ed, they ought to be guarded against by the arth-
ritic sufferer.

The following is a concentrated view of the mode
of treating the gout, which from facts, reasonings
from those facts, and experience I would recom-
mend.

When the gout attacks a person of a full habit,
with symptoms of great inflammation, strong full
pulse, and intense pain, bloodj should be takea
away without hesitation, in a quantity proportioned
to the violence of the symptoms, and strength of
the constitution; and a dose of calomel, opium^
and tartar emetic, given in certain portions, accord-
ing to the state of the patient, and repeated accord-
ing tocircumstances; and if this medicine does not

X The ancients used venesection in the part itself. Vanderheyden ani
some moderns advised the same, and even by way of prevention, to open
^ vein in the great toe, the seat of the gout, twica or thrics a year.

z 2

182

open the bowels, which it generally does, at the
same time that it promotes perspiration and urine,
a suitable purgative should be given to answer the
purpose. But if the disease goes on, extending to
different parts in succession, for instance the feet
and knees, blisters should be applied, but not im-
mediately on the diseased part, but on the inside or
outside of the limb, between the aggrieved joints,
as much as possible upon the course of the large
lymphatic vessels: these are constantly attended
with the most beneficial effects, discharge prodigi-
ously, and the discharge has strongly that smell so
conspicuously peculiar to the perspiration of gouty
people, and evidently shows that a great deal of
gouty matter is discharged this way. Whilst this
is going on the opiate with calomel and tartar emetic
should still be taken, and a plentiful dilution with
weak wine whey, barley water with a little wine, or
any tepid liquor the patient may have a fancy for.
When the iniiammatory symptoms and pain abate,
and debility in the diseased articulations becomes
now distressing, wine should be used with greater
freedom and the diet should be more generous ac-
cording to the state of the stomach, and the peru-
vian bark given in full doses.

As the acute gout is certainly an inflammatory
disease, and should be so treated, though pracli-

tloners have been afraid of treating it in this way
under the notion of the danger of its retrocession,
those practices are erroneous which have been in-
stituted to prevent this, for instance wrapping the
diseased Wmh round with a load of double flannel,
which from undoubted facts arising from personal
experience of many years, is found by accumulating
heat in an extreme degree to aggravate every inflam-
matory symptom, and by inspissating the coagulable
lymph and synovia or jelly of the joints, and thus as
it were baking the limb, by thejntense increased
heat, leaves the joints rigid and contracted, and in-
creases that afllicting debility, consequent to re-
peated attacks of this distressing disease. If the
joint thus wrapped up sweats, the patient hopes it
is for his advantage, but the misfortune is that it is
©nly the finer fluid which evaporates, while the co-
agulable matter is rendered by these means thicker,
and aggravates the distressing lameness and rigidity
of the part, A thinner covering of bedcloths should
be used when the patient has the gout than at any
other time, he should leave his bed as much as po£«
sible, and there should be' a free circulation of air
through the room, no flannels should be worn on the
diseased part, and only a pair of thin gauze stock-
ings drawn on when the legs are blistered, to pre-
vent friction from the bedcloths ; though even these

184

I have found from exp€rience occasion so great an
accumulation of heat and pain, that I. am glad to get
rid of them. What then are we to think of the late
contrivance of fleecy hosiery? I am convinced from
my own feehngs that although it is necessary to pro-
tect the limb from the influence of too much cold^
yet the accumulation of heat which these stockings
must produce, especially during the fit, must do all
the mischief I have pointed out.

The doctrine of what is called retrocession in
gout is not founded on fact. All symptoms of
gout, wherever they appear, arise from one specific
cause, the universal prevalence of the constitutional
disease, which it is notorious lies dormant, and may
be excited to action in different parts, by an adven-
titious stimulus to those parts : hence the action of in-
digestion, acidity, or, any acrid matter internally, will
cause gouty symptoms in the stomach, &;c., and ac-
dental injuries exteraally will excite the gouty mat-
ter to action, which w^ill first appear on or near the
parr, where the injury was received, and afterwards
spread in succession, and it is remarkable, that the
violence abates in the part first attacked, when the
diseased action is excited in another, for instance,
one toot is first attacked, it soon appears in the knee
or the other foot, and gradually abates in the first as
it increases in the second.

To remove the gouty affection from the stomach,
S^c, it has been a practice to give very strong spiri-
tuous waters, tinctures, &c., a very dangerous one in-
deed, because they are without doubt acrid stimuli^
and will rather tend to increase than lessen the symp-
tom : certainly the most rational way of relieving
this is by exciting a greater stimulus in a distant
part, as by blisters on the extremities, and conse-
quently producing a greater action of the specific
disease at those parts and an inlet to some of the
matter: as nature actually teaches us herself in the
usual progress of the gout from one part to anothefo
It will at the same time be necessary to remove the
acrid matter, which excites this attack, from the
stomach and intestines, by purgatives, and to dilute
it and promote its evacuation by some bland inoffen-
sive liquor, as barley water, water gruel, or muci-
iage of gum arable and water, to which may be
added a small portion of fixed alkaline salt, which will
blunt its acrimony at the same time and render the
exhibition of anodyne medicines more efficacious.
Clysters may be likev^ise employed, though not so
useful as cathartics.

From an attentive view of the matter I am in-
duced to think that acids are not even a proximate
or exciting cause of the gouty paroxysm : for ex-
cepting the acid vomiting when the gout- attacks

186

the stomach, the cause of which has been accounlcd
for from the impaired state of the digestive powers
occasioned by the superabundance of the gouty
matter, there is no appearance of acids; and as the
production of this acid is the effect of the disease
and not the cause of it, and happens equally when
that organ is affected with inflammation from, other
causes, it must be regarded as an adventitious pro-
duction. It was therefore an erroneous practice to
forbid the use of acids in the gout; which Iiiis been
inculcated under the supposition that they w^ere the
causes of it: from this idea physicians have de-
nounced th^ pains and penalties of a multiplication
of arthritic torments upon the gouty sufferer who
uses them> but as the existence of this cause w^as
imaginary, so was the prohibition wrong: nor can
I see any reason why the arthritic should, in the
febrile stage, be debarred from the use of cooling
acid drinks, when the gout attacks any other part
but the stomach. I certainly would preclude tiieir
use when the gout attacks the stomach, for the
same reason that the dilution and evacuation of tl>e
acid generated by disease at that time, were recom-
mended; because it would be absurd -to add to acid
already too redundant in that 'serisible irritable or-
gan; now rendered more so by the gouty infiaroma-
tion; indeed wine or any irritating fluid ought not

tt) be taken in this sta^eofit: but when tlie in-
Sammation is in the extremities, and nature points
out the necessity of the advantage to be gained by
their use, it would be cruelty in the extreme from a
false theory, to deny the afflicted the comfort of
quenching insatiable thirst, and correcting a mani-
fest tendency to putridity in the first passages, by
an agreeable acidulous beverage. Strongly impress-
ed with those ideas, I have always freely indulged
myself id theiise of vegetable acids, arid with con-
siderable benefit, not only during the paroxysm,
but, when in health and free frbm it, and have
strenuously recommended it to others. Far differ-
ent has it been with others, who, bigoted to erro-
neous opinions, have already rendered their juices
putrid; as appears evidently from the smell of their
, breath, &c., by the accumulation of more heat,
and denying themselves the use of acidulous li-
quors.

It is well known that the animal juices in the first
passages are disposed to be alkalized and putrid in
the advanced stages of fevers, in that state are ta°
ken up by the absorbent system in the intestines,
particularly the lacteals, are carried into the course
of the circulating fluids and increase the disease ?
indeed I believe that the nervous system is thus af-
fected, and coma subsultusand delirium are chiefly

A 2k

B8

owing to this cause. Providentnature, in that case>
raises a strong inclination in the sick, for cooling
acid liquors, to allay the thirst and heat, which li-
quors will absolutely destroy the cause of those af-
flicting symptoms, in destroying the alkalescent pu-
tridity in the stomach, Bic. The distressing heat and
thirst which the arthritic labouring under fever en-
dures no one can judge of but he who has felt them:
I ani fully competent to speak of this situation of the
gouty sufferer from many years' experience in my
own person. I am therefore fully persuaded that
acids so far from being the causes of gout are ex-
cellent remedies, in the inflammatory stage of it,
when the fever runs high: though certainly for obvi-
ous reasons when calomel is administered to the pa-
tien^t, acids must not be taken.

As gouty persons a.dvance into the vale of life,^
the inflammatory symptoms gradually decline in
every succeeding paroxysm, and the disease becomes
rather chronic, the rigid limbs- are distressed w^ith
debility, and frequently chalky concretions are found
in their vicinity. In this state the treatment must
differ: still however gentle doses of the calomel ano-
dyne become of great use in opening the secretions
at first, and blisters are of great utility. The pa-
tient should use wine liberally, camphire occasion-
ally, and large doses of musk, about thirty or forty

grains twice or oftener in the day. The musk has a
sedative as well as a neurotic and antispasmodic
power (spasm in this state of the disease being very
common and distressing) and if opium disagrees, or
induces a torpidness or stupefaction, which it some*
times does, musk will he found an excellent substi-
tute : and the bark must be given with freedom to
strengthen the tone of the viscera, with chalybeates
and bitters. It is of the greatest Iconsequence to
admit free air, and as soon as possible for the recover-
ing patient to use exercise. Horseback is excellent
if the patient can bear it, if not^ a carriage, and he
ought to walk, as soon as he can. The flesh brush
and dumb horse, have their utility in a reniarkable
manner in convalescence.

To prevent chalky concretions and stiff joints, I
have long used a medicated water strongly impreg-
nated with fixed air, and drink a pint daily with or
without wine. We have good grounds to believe
that the chalky matter is the earth of the bones,
which is constantly renewing and separating, in a
state of solution in our joints, andiii a healthy state
is carried out of the body^ but by disease may be
separated from the fluid in which it was dissolv-
ed, and detained in some deposite. Upon a sup-
position that fixed air is the principle which keeps
it in SQlutioa in the fluid, I have used this water^

Aa2

190

^nd have reason to conclude from my own fcclingt.
that niy suggestion was right: I may appeal to facts
in my own ease. I have no chalk stones, and after
my fits of the gout are over I have the free use of

yny joints.

With regard to regimen, much has been said by
authors upon the apparent cures of the gout by ob*?
serving a particular one. The reason of which nii-
tigation of disease niay be accounted for by the
theory of the contrary effect of the redundant earth
of the bones remaining in the habit, from the escape
of the aerial acid, which w'ould have held it in so-
lution in the system, till expelled by the emunctories.
The labourer and mechanic must certainly eat less ani-
mal food than their brethren in more opulent circum 1
stances in middle life: and therefore have less earthy
niatter of bpnes furnished, and of course less redun-
dancy of it to be carried off. Tlieir laborious exer-
cise superinduces a firmer tone of fibre, greater
strength and agility, and the animal functions are
consequently better performed; in particular the
glandular secretions : and hence that redundancy of
earthy matter which we have supposed to be in less
quantity, is more easily and fully carried out of the
constitution by the emunctories. So that if a
labourer has even a clairn to gout from his proge-
nitors, he has less of the presence of this, what may

191

be called, natural cause of exciting the latent
matter into action, than the other class of men.
For this reason if we take a view of the men in mid-
dle life, who have a claim to goat from descent,
we shall find their state the reverse of that of the
hard working man. The man of middle life, in
which may be included the three learned professions
of Divinity, Law, and Physic, the merchant. Shop-
keeper, and wealthy mechanic, &c., has generally
a plentiful table of animal food in its different vari-
eties, which, affording more delicacies than the ve-
getable kingdom, constitutes almost wholly his diet.
Of course more of redundant earth of bones is fur-
nished in his constitution than in that of the labourer,
and from his habits of life, and perhaps avocations,
he uses less exercise, and is more prone to indolence,
' he^is less athleticj and the animal functions are per-
formed with less regularity and ' order, and conse-
quently the glandular secretions must suffer; if there-
fore more earth of bones is formed, the redundancy^
having less chance of being carried ofFby the emunc-
tories, must accumulate in the habit and become
an exciting cause by its stimulus of rousing the
latent gouty matter into action and producing a
paroxysm. i uo.'

From the foregoing considerations it would ap-
pear that in order to relieve the arthritic man in

192

middle life, from frequent attacks of gout, he must
by regimen be reduced nearly to the condition of
the labourer. He must live temperately, abstain
Simost wholly from animal food^ drink of the limpid
s.tTeam:, or home-brewed new beer, and condemn
himself to laborious exercise in the field in the open
air, ior some hours in a day. According to our
conjecture his vegetable diet will afford less redun-
dancy of the earthy matter of bones, will also, with
Ms- fermenting beverage, afford him more fixed air
to keep it in solution, untilit is expelled, and his
labour will increase^ the vigour of the system and
rile secretions and anim.al functions in general.
From a view of our theory there is a possibility that
Ihe paroxysms of the gout might be thus suspended,
but the distemper would be by no means cured, and
upon any future deviation from this regimen would
make it-s appearance.

' Dr. M. Adair, in his cautions to invalid?, men-
lions an instance of an attorney, w'ho by regimen
of this kind escaped the gout for, I think, sixteen
years: but being persuaded that this long exemption
from it must indemnify him from future attacks? he
returned to a more liberal diet, and in six weeks af-
terwards bad a most severe Rt of the gout.* This

• This single instance is by no means sufficient to establish a theory upon.
Sach is ihe verfiatilliy of thi* Uiasase that fro^n some inexplicable cause this

is a proof that the gout remained dormant in the con-
stitution and only Waited for a stimulus to brin<'- it
into action. But the rigorous prosecution of such a
regimen could only take place in vigorous arthritics
of the middle age. Men of this description might
probably with advantage try this, but it mujit be
thought too dangerous an experiment for an aged
and infirm arthritic, who must require a nutritive and
generous diet to support a worn ouc debilitated
frame.

I shall conclude with observing that the thejorv
which has been advanced in these letters, has been
adduced from observations on what have appeared
to me to be facts. I am open to conviction if it
should be proved that I have been mistakea in my
conclusions. But of this from experience in your-
self, you, my dear Sir, if you live long enough
(which I hope will be the case, many years, as w^ell
for the benefit oi mankind, as your relatives) you
will be sufficiently enabled to judge. If the theory
fee erroneous, reject it^ but the practice is entitled

gentleman might have had this long interval between the paroxysms, if
he had not lived in this manner. I know several who live liber-ally and
some hard drlakersj who have intervals of nine or ten years j and again E
know many abstemicu? men affected with it severely, for some months^
in succession, or at very ehort interval- j, every year: yet ou.^ht hard drink-
ing to be avoided und regularity of conduct observed, as must be obvious to
common sen'^e

t0 more Indulgence; because it is chiefty founded
on results from the experiefice of many years in
my own person, — I therefore presume that can-
dour will give me credit for them, until they are
refuted by as long a course of experiment on other
people.

w^C^rNS3H0Binif(5S^^-«^>--n

Whittiiigham, Printer, Lynn-r

ERRATA.

Page 4, line 8, yj?r paying r^^^ pay.

28, 15, for to the fluid read io it.

45, 1 6j for this liver r^^^ the liver.

46, 1 5, yj7r saponeous read saponaceous.

55, 6, insteadofare not I believe predisposing causes^
read'is not I believe a predisposing cause,

7.5, 13, y<7r existing r^^<^ exciting.

80, 20, for prodagrs r^r^J podagras.

95, 26, /<?r Aquse r^'^^ Aqua.

93, 6, y^r experiment r^^^ experiments^

142, 5, /^r calurnnating r(?ij^ calumniating.

., 143, 6, dele upright.

152, 23, after head place a comma — dele the comma

1 60, IS, for so we read we so. [after contents.^

169» 16, yjjr arthritics rp<^^ arthritic.

17I» 12, after gout r^f^^^ in the stomach.

173, 17, /^r that r<f^^ them.

185, 10, yi^r inlet r<?<3^ outlet.
Error in the pages froai 42 to 49, read 43, kc*