Out of the fit, it is in the patient’s power to do many things towards preventing a return of the disorder, or rendering the fit, if it should return, less severe. This however is not to be attempted by medicine. I have frequently known the gout kept off for several years by the Peruvian bark and other astringent medicines; but in all the cases where I had occasion to see this tried, the persons died suddenly, and, to all appearance, for want of a regular fit of the gout. One would be apt, from hence, to conclude, that a fit of the gout, to some constitutions, in the decline of life, is rather salutary than hurtful.
Though it may be dangerous to stop a fit of the gout by medicine, yet if the constitution can be so changed by diet and exercise, as to lessen or totally prevent its return, there certainly can be no danger in following such a course. It is well known that the whole habit may be so altered by a proper regimen, as quite to eradicate this disease; and those only who have sufficient resolution to persist in such a course have reason to expect a cure.
The course which we would recommend for preventing the gout, is as follows: In the first place, universal temperance. In the next place sufficient exercise[[139]]. By this we do not mean sauntering about in an indolent manner, but labour, sweat, and toil. These only can render the humours wholesome, and keep them so. Going early to bed, and rising betimes, are also of great importance. It is likewise proper to avoid night studies, and all intense thought. The supper should be light, and taken early. All strong liquors, especially generous wines and sour punch, are to be avoided.
We would likewise recommend some doses of magnesia alba and rhubarb to be taken every spring and autumn; and afterwards a course of stomachic bitters, as tansey or water-trefoil tea, an infusion of gentian and camomile flowers, or a decoction of burdock root, &c. Any of these, or an infusion of any wholesome bitter that is more agreeable to the patient, may be drank for two or three weeks in March and October twice a-day. An issue or perpetual blister has a great tendency to prevent the gout. If these were more generally used in the decline of life, they would not only often prevent the gout, but also other chronic maladies. Such as can afford to go to Bath, will find great benefit from bathing and drinking the water. It both promotes digestion, and invigorates the habit.
Though there is little room for medicine during a regular fit of the gout, yet when it leaves the extremities, and falls on some of the internal parts, proper applications to recal and fix it become absolutely necessary. When the gout affects the head, the pain of the joints ceases, and the swelling disappears, while either severe head-ach, drowsiness, trembling, giddiness, convulsions, or delirium come on. When it seizes the lungs, great oppression, with cough and difficulty of breathing, ensue. If it attacks the stomach, extreme sickness, vomiting, anxiety, pain in the epigastric region, and total loss of strength, will succeed.
When the gout attacks the head or lungs, every method must be taken to fix it in the feet. They must be frequently bathed in warm water, and acrid cataplasms applied to the soles. Blistering-plasters ought likewise to be applied to the ancles or calves of the legs. Bleeding in the feet or ancles is also necessary, and warm stomachic purges. The patient ought to keep in bed for the most part, if there be any signs of inflammation, and should be very careful not to catch cold.
If it attacks the stomach with a sense of cold, the most warm cordials are necessary; as strong wine boiled up with cinnamon or other spices; cinnamon-water; peppermint-water; and even brandy or rum. The patient should keep his bed, and endeavour to promote a sweat by drinking warm liquors; and if he should be troubled with a nausea, or inclination to vomit, he may drink camomile-tea, or any thing that will make him vomit freely.
When the gout attacks the kidneys, and imitates gravel-pains, the patient ought to drink freely of a decoction of marsh-mallows, and to have the parts fomented with warm water. An emollient clyster ought likewise to be given, and afterwards an opiate. If the pain be very violent, twenty or thirty drops of laudanum may be taken in a cup of the decoction.
Persons who have had the gout should be very attentive to any complaints that may happen to them about the time when they have reason to expect a return of the fit. The gout imitates many other disorders, and by being mistaken for them, and treated improperly, is often diverted from its regular course, to the great danger of the patient’s life.
Those who never had the gout, but who, from their constitution or manner of living, have reason to expect it, ought likewise to be very circumspect with regard to its first approach. If the disease, by wrong conduct or improper medicines, be diverted from its proper course, the miserable patient has a chance to be ever after tormented with head-achs, coughs, pains of the stomach and intestines; and to fall at last a victim to its attack upon some of the more noble parts.