I have sometimes seen good effects from cream of tartar in this disease. It promotes the discharges by stool and urine, and will at least palliate, if it does not perform a cure. The patient may begin by taking an ounce every second or third day, and may increase the quantity to two or even to three ounces, if the stomach will bear it. This quantity is not however to be taken at once, but divided into three or four doses.
To promote perspiration, the patient may use the decoction of seneka-root, as directed above; or he may take two table-spoonfuls of Mindererus’s spirit in a cup of wine-whey three or four times a-day. To promote a discharge of urine, the following infusion of the London hospitals will likewise be beneficial:
Take of zedoary-root two drachms; dried squills, rhubarb, and juniper-berries bruised, of each a drachm; cinnamon in powder, three drachms; salt of wormwood, a drachm and a half; infuse in an English pint and a half of old hock-wine, and when fit for use, filter the liquor. A wine-glass of it may be taken three or four times a-day.
In the anasarca it is usual to scarify the feet and legs. By this means the water is often discharged; but the operator must be cautious not to make the incisions too deep; they ought barely to pierce through the skin, and especial care must be taken, by spirituous fomentations and proper digestives, to prevent a gangrene.
In an ascites, when the disease does not evidently and speedily give way to purgative and diuretic medicines, the water ought to be let off by tapping. This is a very simple and safe operation, and would often succeed, if it were performed in due time; but if it be delayed till the humours are vitiated, or the bowels spoiled, by long soaking in water, it can hardly be expected that any permanent relief will be procured[[138]].
After the evacuation of the water, the patient is to be put on a course of strengthening medicines; as the Peruvian bark; the elixir of vitriol; warm aromatics, with a due proportion of rhubarb, infused in wine, and such like. His diet ought to be dry and nourishing, such as is recommended in the beginning of the Chapter; and he should take as much exercise as he can bear without fatigue. He should wear flannel next his skin, and make daily use of the flesh-brush.
CHAP. XXXVIII.
OF THE GOUT.
There is no disease which shews the imperfection of medicine, or sets the advantages of temperance and exercise in a stronger light, than the gout. Excess and idleness are the true sources from whence it originally sprung, and all who would avoid it must be active and temperate.
Though idleness and intemperance are the principal causes of the gout, yet many other things may contribute to bring on the disorder in those who are not, and to induce a paroxysm in those who are subject to it; as intense study; too free an use of acidulated liquors; night-watching; grief or uneasiness of mind; an obstruction or defect of any of the customary discharges, as the menses, sweating of the feet, perspiration, &c.
SYMPTOMS.——A fit of the gout is generally preceded by indigestion, drowsiness, belching of wind, a slight head-ach, sickness, and sometimes vomiting. The patient complains of weariness and dejection of spirits, and has often a pain in the limbs, with a sensation as if wind or cold water were passing down the thigh. The appetite is often remarkably keen a day or two before the fit, and there is a slight pain in passing urine, and sometimes an involuntary shedding of tears. Sometimes these symptoms are much more violent, especially upon the near approach of the fit; and some observe, that as is the fever which ushers in the gout, so will the fit be; if the fever be short and sharp, the fit will be so likewise; if it be feeble, long, and lingering, the fit will be such also. But this observation can only hold with respect to very regular fits of the gout.