Of the Gout/Part 1
Sir HANS SLOAN, Bart.
President of the
College of Physicians London,
CURE of the GOUT,
By Oyls externally apply'd.
Read before the Royal Society, Feb. I.
22 Jan. 1732-3.
IPPOCRATES says well, that the humane body is pervium & perspirabile quid. We in this moist, northern island find it so, to our prejudice, too often; when raw vapors are imbib'd thro' the pores, and assimilating some humor to themselves, cause colds and catarrhs so frequent with us. Perhaps the rheumatism and gout among many other distempers, partly owe their origin to this spring; perspiration being thereby slacken'd and disproportionate to our plentiful way of living. These are diseases so obstinate, and have so long baffled the medicinal art, especially the gout, that we now seem to have given over all quell for a remedy, and sit down contentedly to bear the cruel torture. 'Tis certain that the gout is a crisis of nature, and the many unsuccessful and fatal attempts upon it, have altogether discourag'd the professors, from countenancing even enquiries after a cure. Nevertheless 'tis agreed that many other distempers are but crise's; still they admit of medicin and a happy solution thereby. Even a fever, as Dr. Sydenham well defines it, is no other than an endeavour in nature, to relieve her self by exterminating with all her power; the morbific matter, This in few words is but a crisis: And should any one say; that physicians cannot assist in the case, and even cure a fever; they would think it an unworthy treatment. Therefore my self who have suffer'd many years under an hereditary gout, cannot still judge any otherwise, than that we ought not to despond of finding a remedy for it: which is, to assist nature in making that crisis more easy and truly salutary, as doubtless she designs it. 'Tis plain, by throwing the morbific matter upon the extremities, she saves the individuum: relieving the whole by punishing a part. And the patient (as he may justly be call'd) after a fitt well solv'd, finds himself perfectly in health for a considerable time, and till the next fitt. Still it must be confest, that the returns of fitts accelerate in a proportion cruel and uncomfortable, as years advance: and safely we may pronounce, as a great author of the faculty does on another occasion, than when we have got a fitt over, we escape ὡς διὰ πυρὸς. And the fitts, especially when they begin to return frequently, so incapacitate our limbs for action and necessary exercise, that the health and habit of the body and constitution suffer extremely, and grow every year worse and worse: they bring one nodose joints, as well as gravel, stone and other diseases, the consequents of Inactivity, that at best we maybe said, only to labor under a continual disease, which kills us by a more unkindly blow, because protracted.
Hence I cannot excuse my self from endeavouring to serve the publick; in notifying after this manner, what I have hitherto observ'd, in a remedy lately try'd with us at Stamford, and in all appearance with great success, and without any ill consequences, which are so much dreaded in the case.
Dr. Rogers an eminent apothecary and licensed practitioner in physick at Stamford, has for above two years last past, used a warm oyly composition, which he prepares, to anoint the part affected with the gout. He has try'd it upon himself in many fitts, the severest that can be imagined; when seiz'd in both feet, knees, hands, and shoulder all at once, and separately; and it has never fail'd removing the fitt, rather taking it quite off; without any ill effect ensuing. And 'tis a distemper he has been obnoxious to from his youth. He has likewise try'd it upon several other patients in the like case, and with the like success; the thing is notorious among us. I likewise try'd it upon my self; in three different affections of the same distemper, the latter ends of the year past. One was a sort of ganglioform swelling below my left knee, upon the lower tendon of the patella and the tendons of the great muscles of the thigh, where they are inferred upon the tibia. This swelling I have had several times before, and have no reason to doubt of its being gouty; and that in time it would probably become an encystid tumor or chalky node, as usual in such cases. The second was a black spot on the joint of the great toe of my left foot: the spot was as broad as a sixpence, and black as a hat. It came, I suppose, by a bruise in walking, immediately after a fitt of the gout in that part. The third was upon the joints of the tarsus , in my right foot, when affected with the gout. I anointed all these, and the event was, that it cured them all, and there was no ill consequence attending, even to this time.
Were I to pretend, to give a rationale of the gout, in few words, it would be thus. In people that live plentifully, have a good stomach, and drink strong liquors, if they don't use a proportionate degree of labor or exercise; in a gouty constitution, they must expect to be visited by that irksom guest. If nature cannot form a fitt of the gout, they suffer worse, perhaps by some violent or fatal distemper. For health consists chiefly in a due proportion, between the intaking and expending. Hence people of fortune and those of a studious, contemplative life, are most liable to it. Laborers that fare hardly and work daily, are sure to be free. Women are so, for the most part, because nature in them has it in her power, better to regulate the quantity and abate of a surcharge, than with us. And, thereby they remedy the inconveniences of a sedentary life. But men are design'd for action, which breaks in pieces the blood, scours all the glands, promotes every secretion, preserves the equilibrium between the solids and fluids; and next to food, is the conservator of the animal life. A rich state of blood loaded with salts, sulphurs, and spirituous particles, at length kindles up a certain fiery phosphorus, which nature exterminates into the extreme parts, and out of the bounds of the circulation. And this relieves her by a fitt of the gout,
It is contriv'd by our most wise author, that round about the the commissure of all our joints, ad upon the insertions of the tendons of the muscles, there should be plac'd many glands, to separate an oyly matter, wherewith to lubricate the joints and tendons in action; as we grease coach-wheels, and for the very same purpose. The great joint or ball of the great toe must have larger glands of this kind than any other toe, as 'tis the principal opponent if that great joint the ancle, in walking. The of the great toe is the most distant large joint in the body, from the center of circulation, the heart. Witch good reason then, does the gout there begin its first attack. The mode of a fitt if the gout, I apprehend to be this. The matter of it is a certain fiery drop, like liquid phosphorus, a caustic animal salt dissolv'd in a rectify'd spirit of animal juices, which being disagreeable to the animal œconomy, is thrust out by nature, into the glands that separate the oyl abovesaid, in order to extinguish it there; like putting a piece of hot iron or live charcoal into a vessel of oyl. It extinguishes the iron or coal, but sets the oyl on fire, which causes all the symptoms of the gout. The pain and heat, by degrees derive a vast flux of blood and humors which distend all the circumadjacent vessels, in order to quench the incendium. The struggle between this heat and the humour, rends open the extremitys of the vessels and continues the racking pain, till they are sufficiently distended. But these symptoms I shall not be particular upon. They that feel it, know them too sensibly, and compare them to the gnawing of a dog, to an actual fire at the same time, and to whatever is most direful and torturing.
By frequent fitts, all this oyly matter of the joint and tendons thereabouts, becomes deflagrated, and the glands that secrete it, so spoil'd in texture, that they cannot furnish a due quantity, either to lubricate the joint in walking, or to extinguish the matter of another fitt. Then nature is oblig'd to remand it to the next joint, the ancles. After that has sufficiently satiated its fury, the knees succeed, or perhaps the hands, elbows, shoulders or hips. She takes in a much compass as is necessary to her purpose. Sometimes, it will seize upon the very great gland serving the head of the os femoris, lying on the backside of it; and this causes prodigious torment. In short, by continuance of time, it quarters itself upon every join of the spine, and at length, every joint and tendon of the body: till for want of proper objects, it reverts upon the stomach, brain and noble parts, and compleats the fatal tragedy. Hence in time, it calcines the ends of the bones devoid of periosteum into nodes and chalkstones, or fills up the tubular vessels there with sabulous matter. Hence walking will bring on a fitt of the gout, without any other predisposition, for want of sufficient mucilage. The action heats the joints, and sollicits the lurking humor out of the blood, before its time. Hence it emaciates the limbs and burns up all their fat, as a sacrifice to its rage. And at best the podagric, when in health, is but a criple, the joints being defrauded of due unction. Hence the cure of the gout, by our artificial oyls, analogous and succedaneous to the natural.
Use legs and have legs is a common proverb, and no doubt it holds good of those limbs as well as of all other, which become firmer and stronger by exercise; the muscular fibres in action gathering strength, as well as the glands of the joints pouring out their juices more plentifully, the more they are irritated. Just as the glands of the mouth throw out spittle in smoaking and chewing. But podagrics find by experience, this proverb holds not good in their case, much walking is prejudicial, a sure sign that the joint-glands have been spoil'd by former fitts, and that there is the seat of the distemper.
Should I go about to recite the medicins that have been try'd inwardly, for cure of the gout, many volumes would not contain them. Nor can one out of the infinite number be selected, that will contribute towards it. 'Tis no new thing to use external applications herein. They too have been innumerable. Camphorated spirits of wine, oyl of turpentine, oyl of amber, foments, heated bricks, blisters, oylskin. At other times cold baths, cabbage leaves, and the contrary regimen with a thousand more inventions have been try'd. Frequently they repell the malady from one joint to another, which is doing nothing: sometimes to the noble parts, with danger or death. Seldom we hear of any succeeding, or that but by accident: and none, that I know of, so constantly and uniformly as our oyls. The common intention in many fancyed remedys, is to sweat the part, and make the humor perspire outwardly, as they imagine. And this indeed is the most frequent solution of those that have discours'd in conversation, upon the operation of the oyls. But we do not find that this can well be performed: nor in the general usage of wrapping the part up in flannels, can we discern any sighs of sweating, nor does heat relieve it apparently. Nor do I account for our oyls curing it by this kind of operation. Thus I apprehend the cure is performed.
Right reason will inform us, the surest method of finding out a cure for distempers, is carefully to observe nature's steps, and discover, if we can, what method she takes for her own relief. To oppose her directly, is generally dangerous, but to assist her, safe and necessary. If then our foregoing theory be right, these oyls seem well calculated for this purpose. They are of a very warm, volatile, penetrating nature, and as much as we can conceive, in substance and use, like the oyly mucilage of the joints, of nature's own providing. From Hippocrates we at first; observed, that the human body is very pervious. These oyls then actually insinuate themselves to the part, and supply the use of the natural, by extinguishing this fiery drop, which gives the onset of the distemper. And probably nature imbibes and attracts them greedily, for her relief. We may consider that the drop which begins the prelude, is like that drop which is the poison of the viper, of a mad dog, the pus of the small pox with which they inoculate, or other deleterious substance; which being of a genius immensely fermentative, rages far and near, and draws by contagion a great quantity of the humors; to partake of its own quality. So that beginning with our oyls upon the first attack, extinguishes the spark, before it makes the conflagration extensive. In an ordinary fitt of the gout, we observe plainly, it takes several hours to raise the pain and swelling to a considerable height. And those who have succeeded with the moxa, let out at first this fiery and contagious drop, and thereby cut off its beginnings. And this must be done in using the oyls. Whether these oyls act further beneficially, after having deaden'd its violence, by carrying it back into the habit, and thence forwarding its extermination, thro' the cuticular glands of the whole body; we may perhaps not without reason imagin: for the very breath and the pores of the body shall smell strong of them, after properly using. Or perhaps it may prepare that matter to be sent off by the excretory ducts of the kidneys in urine. But if this use of them does not act by promoting any sensible or insensible excretion, only by extinguishing the matter of nature's crisis pro hac vice tantùm: therein it differs not from the mode of operation, which we observe in the famous peruvian febrifuge. It performs the cure without any apparent evacuation, and for one turn only. These oyls may possibly, as the bark, prepare that critical matter for a beneficial and salutary evacuation, which we cannot at present account for: tho' this seems to be the intention desired in the case, by such as with other methods attempt to cure it. A small matter critically applied will drive off distempers; as a fever is sometimes cured with a fright, a fancy, a charm. And manifestly, when nature thus makes a discharge of the arthritic matter upon the solid parts, she makes a false crisis, and 'tis a dreadful remedy to prevent a worse present inconvenience. But this among many other matters, necessary or expedient to be considered, in the affair, must be left to a further judicious tryal and observation. What I know of it at present, I was willing to recite, if but to stir up an endeavour of mitigating, at least, this untamable evil.
The operation of the moxa, and application of an actual cautery to a venomous bite, illustrates and confirms my way of reasoning, for they destroy the texture or essence of the poison, before it gets head. So likewise the application of the fat of venomous creatures, in the bite, as us'd by the Indians, seems strongly to plead in our favor. They seek the fat of the viper, perhaps other fat may do as well, unless that of the creature be of a more volatile nature than others; and perhaps our oyls would supply its place. Surely the fat can act no other way, than by its unctuousness, which invelops and sheaths the fiery spicula of the poyson, and so do the oyls with the matter of the gout, according to my assumption. And with the same view has lana succida been usefully applied to the gout; 'tis an imperfect way of administring a volatile oyl. But I was unwilling to be tedious in discourflng on a recent subject, and which requires much experience and maturation, before one can pretend to make a regular treatise upon it.
It was with some difficulty, that I persuaded the preparer of these oyls, to send some bottles up to Town. Who represented that his only aim was to give case to himself and such of his patients as thought fit to make use of them, without any view of having them made publick. He rested himself well pleased in doing some good. But as I laid my Injunctions upon him (as he writes to me) to make it known in a more public manner for the benefit of mankind, he will discharge his duty in the faithfulness of its preparation: and has sent up bottles of it, to be sold at Mr. Rogers's a hatter, the corner of Chancery-Lane, Fleetstreet, his son. The method of using, is to heat some in a spoon over a coal, and to rub it on as warm as may be, for some time. Then wrap the part up in flannel, and the sooner this is done, the better. I have only this to add, and it seems perfectly obvious, that it is very necessary for arthritic constitutions, to use more than common temperance, if they expect relief from this or any other method. Too great a quantity of the arthritic matter may overcome this and all other methods. 'Tis apparent this cannot alter the constitution, it cures it but for the present fitt. And the method; hitherto try'd, of dieting, milk, vegetables, &c. have indeed alter'd the constitution, frequently to bring in a worse mischief; or more expeditious death. And if we suppose the whole mass of blood intirely chang'd, still the same solids remain, and will produce in time the same constitution as before; if after a long intermission you return to your former way of living. Or if you proceed in that poor way of living, 'tis doubted whether, a better constitution is obtain'd, than the first.
We may with much reason recommend to arthritics, the use of milk, and that frequent. I have known during a fitt of the gout, a milk diet immediately enter'd upon, has taken off all the pain. I believe, in a fitt where there is much gouty matter, white-wine posset-drink with spirit of hartshorn prudently introduc'd for sweating, and the oyls us'd upon the part affected at the same time, will have a happy event. I look upon it as a sure axiom in the affair we are treating of, that by all possible and safe means, the matter of the gout ought to be hinder'd from spending its self upon a joynt: for it certainly leaves an irreparable stroke thereon. It so spoils the texture of the oyl-glands that they never recover themselves intirely. A frequent use of milk must needs be good, for the oleous particles that abound in that fine animal fluid, sheath and subjugate the fiery particles of the gouty matter, much as our oyls are suppos'd to do.
It does not appear in history, that the old Romans were much troubled with this distemper after luxury became universal among them. And it seems owing to another practice, which prov'd a remedy introduced by the same luxury, the frequent custom of oyling their bodies. And those oyls were used immediately after bathing, which open'd the pores and admitted them thro' the skin. The oyls likewise were impregnate with the virtues of hot barks, spices and herbs, such as cinamon, marjoram, lavender, florentin iris, warm and volatile like our oyls. Galen in his book De tuenda sanitate particularly recommends the use of them to students. And the Greeks in their athletic games practis'd oyling very much, which shews that they actually do penetrate to the joints; Thus the West-indians who will run 30 or 40 miles a day, anoint themselves all over at night with bears grease. It is recorded in the memoirs of the society, that oyl of cinamon has been apply'd in the gout, with good emolument. And they that sell oyl of mustard-seed in town, affirm the like of it. Both which preparations seem,to participate of the nature of our oyls. But by frequent use of milk internally and oyling externally, we may promise our selves, as it seems to me, great success in the gout: and nearly accomplish the regimen of Romulus Pollio, Augustus's host, who being ask'd by the emperor, how he had maintain'd for so great an age his health and vigor, being above a 100 years old: he answer'd, intus mulso, foris oleo. Plin. XXII. 24. From whence we may well conjecture that old and tartarous and french wines are prejudicial in our distemper., and the like aromatics. So that they must be very
We may reasonably think, that 'tis not in the power of oyls and milk to overcome a high degree of the gout, where persons will not confine themselves to a very sober way of living and use exercife: tho' they may allow a moderate use of all the comforts of life. Nor can we prescribe any other bounds than prudence and experience. We may retrench till we find the desired purpose accomplish'd. Health and long life are generally the mark of a good deal of prudence. Practice makes good customs easy. But what can be more easy, safe and pleasant than temperance, when health, when natural dictates, when religion require it? What greater encouragement, than that you probably may find with it and our prescribed method, a constant relief from the gout. And as gouty constitutions have commonly the soundest vitals, we may by these means, with some little inconvenience, avoid the pain and arrive at a vegete old age.