6. Diluting liquors, such as are prescribed in common inflammatory fevers, should be given in such quantities as to dispose to a gentle perspiration.
7. Abstinence from wine, spirits, and malt liquors, also from such aliments as afford much nourishment or stimulus, should be carefully enjoined. Sago, panada, tapioca, diluted milk with bread, and the pulp of apples, summer fruits, tea, coffee, weak chocolate, and bread soaked in chicken water or beef tea, should constitute the principal diet of patients in this state of the gout.
8. Blisters are an invaluable remedy in this disease, when used at a proper time, that is, after the reduction of the morbid actions in the system by evacuations. They should be applied to the joints of the feet and wrists in general gout, and to the neck and sides, when it attacks the head or breast. A strangury from the gout is no objection to their use. So far from increasing this complaint, Dr. Clark and Dr. Whytt inform us, that they remove it[63]. But the principal advantage of blisters is derived from their collecting and concentrating scattered and painful sensations, and conveying them out of the system, and thus becoming excellent substitutes for a tedious fit of the gout.
9. Fear and terror have in some instances cured a paroxysm of this disease. A captain of a British ship of war, who had been confined for several weeks to his cabin, by a severe fit of the gout in his feet, was suddenly cured by hearing the cry of fire on board his ship. This fact was communicated to me by a gentleman who was a witness of it. Many similar cases are upon record in books of medicine. I shall in another place insert an account of one in which the cure effected by a fright, eradicated the disease from the system so completely, as ever afterwards to prevent its return.
Thus have I enumerated the remedies which are proper in the gout when it affects the blood-vessels and viscera with great morbid action. Most of those remedies are alike proper when the morbid actions are seated in the muscular fibres, whether of the bowels or limbs, and whether they produce local pain, or general convulsion, provided they are of a violent nature.
There are some remedies under this head of a doubtful nature, on which I shall make a few observations.
Sweating has been recommended in this state of the gout. All the objections to it in preference to other modes of depletion, mentioned in another place[64], apply against its use in the inflammatory state of the gout. It is not only less safe than bleeding, purging, and abstinence, but it is often an impracticable remedy. The only sudorific medicine to be trusted in this state of the disease is the Seneka snake-root. It promotes all the secretions and excretions, and exerts but a feeble stimulus upon the arterial system.
Many different preparations of opium have been advised in this state of the gout. They are all hurtful if given before the morbid action of the system is nearly reduced. It should then be given in small doses accommodated to the excitability of the system.
Applications of various kinds to the affected limbs have been used in a fit of the gout, and some of them with success. The late Dr. Chalmers of South-Carolina used to meet the pain of the gout as soon as it fixed in any of his limbs, with a blister, and generally removed it by that means in two or three days. I have imitated this practice in several cases, and always with success, nor have I ever seen the gout thrown upon any of the viscera by means of this remedy. Caustics have sometimes been applied to gouty limbs with advantage. The moxa described and used by sir William Temple, which is nothing but culinary fire, has often not only given relief to a pained limb, but carried off a fit of the gout in a few hours. These powerful applications may be used with equal advantage in those cases in which the gout by falling upon the head produces coma, or symptoms of apoplexy. A large caustic to the neck roused Mr. John M. Nesbit from a coma in which he had lain for three days, and thereby appeared to save his life. Blisters, and cataplasms of mustard, had been previously used to different parts of his body, but without the least effect. In cases of moderate pain, where a blister has been objected to, I have seen a cabbage leaf afford considerable relief. It produces a moisture upon the part affected, without exciting any pain. An old sea captain taught me to apply molasses to a limb inflamed or pained by the gout. I have frequently advised it, and generally with advantage. All volatile and stimulating liniments are improper, for they not only endanger a translation of the morbid excitement to the viscera, but where they have not this effect, they increase the pain and inflammation of the part affected.
The sooner a patient exercises his lower limbs by walking, after a fit of the gout, the better. “I made it a constant rule (says Mr. Small) to walk abroad as soon as the inflammatory state of the gout was past, and though by so doing, I often suffered great pain, I am well convinced that the free use I now enjoy of my limbs is chiefly owing to my determined perseverance in the use of that exercise; nor am I less persuaded that nine in ten of gouty cripples owe their lameness more to indolence, and fear of pain, than to the genuine effects of the gout[65].” Sir William Temple confirms the propriety of Mr. Small's opinion and practice, by an account of an old man who obviated a fit of the gout as often as he felt it coming in his feet, by walking in the open air, and afterwards by going into a warm bed, and having the parts well rubbed where the pain began. “By following this course (he says) he was never laid up with the gout, and before his death recommended the same course to his son if ever he should fall into that accident.” Under a conviction of the safety of this practice the same author concludes the history of his own case in the following words: “I favoured it [viz. the swelling in my feet] all this while more than I needed, upon the common opinion, that walking too much might draw down the humour, which I have since had reason to conclude is a great mistake, and that if I had walked as much as I could from the first day the pain left me, the swelling might have left me too in a much less time[66].”