while the energy of the brain still retains its vis gour, the vis medicatrix naturæ is excited to re store the tone of the parts; and accomplishes it by exciting an inflammatory affection in some part of the extremities. When this has subsisted for some days, the tone of the extremities and of the whole system, is restored, and the patient returns to his ordinary state of health (511).

534. This is the course of things, in the ordinary form of the disease, which we name the regular gout; but there are circumstances of the body, in which this course is interrupted or varied. Thus, when the atony (506, 507), has taken place, if the re-action (509) do not succeed, the atony continues in the stomach, or perhaps in other internal parts, and produces that state which we have, for reasons now obvious, named the atonic gout.

535. A second case of variation in the course of the gout, is, when, to the atony, the re-action and inflammation have to a certain degree succeeded, but, from causes either internal or external, the tone of the extremities, and perhaps of the whole system, is weakened; so that the inflammatory state, before it had either proceeded to the degree, or continued for the time, requisite for restoring the tone of the system, suddenly and entirely ceases. Hence the stomach, and other in

ternal parts, relapse into the state of atony; and perhaps have this increased by the atony communicated from the extremities: all which appears in what we have termed the retrocedent gout.

536. A third case of variation from the ordinary course of the gout, is, when, to the atony usually preceding, an inflammatory re-action fully succeeds; but has its usual determination to the joints by some circumstances prevented; and is therefore directed to an internal part, where it produces an inflammatory affection, and that state of things which we have named the misplaced gout.

537. We have thus offered an explanation of the circumstances of the system in the several states of the gout; and this explanation we suppose to be consistent with the phenomena of the disease, and with the laws of the animal economy. There are indeed, with respect to the theory of the disease, several questions which might be put; to which we have not given any answer. But, though perhaps we could give an answer to many of these questions, it does not here appear necessary; as at present we intend only to establish such general facts with regard to this disease, as may lay a foundation for the cure of it, so far as experience has enabled us to prosecute it. Proceeding, therefore, upon the several parts of the pathology given, as so many matters of fact, I shall now consider what

may be attempted towards the cure of the dis

ease.

538. In entering upon this, I must observe, in the first place, that a cure has been commonly thought impossible; and we acknowledge it to be very probable, that the gout, as a disease of the whole habit, and very often depending upon ori ginal conformation, cannot be cured by medicines, the effects of which are always very transitory, and seldom extend to the producing any consider. able change of the whole habit.

539. It would perhaps have been happy for gouty persons, if this opinion had been implicitly received by them: as it would have prevented their having been so often the dupes of self-interested pretenders, who have either amused them with inert medicines, or have rashly employed those of the most pernicious tendency. I am much disposed to believe the impossibility of a cure of the gout by medicines; and more certainly still incline to think, that whatever may be the possible power of medicines, yet no medicine for curing the gout has hitherto been found. Although almost every age has presented a new remedy, yet all hitherto offered have very soon been either neglected as useless, or condemned as pernicious.

540. Though unwilling to admit the power of

medicines, yet I contend, that a great deal can be done towards the cure of the gout by a regimen: and from what has been observed (498), I am firmly persuaded, that any man, who, early in life, will enter upon the constant practice of bodily labour, and of abstinence from animal food, will be preserved entirely from the disease.

Whether there be any other means of radically curing the gout, I am not ready to determine. There are histories of cases of the gout, in which it is said, that by great emotions of mind, by wounds, and by other accidents, the symptoms have been suddenly relieved, and never again returned; but how far these accidental cures might be imitated by art, or would succeed in other cases, is at least extremely uncertain,

541. The practices proper and necessary in the treatment of the gout, are to be considered under two heads: first, as they are to be employed in the intervals of paroxysms; or, secondly, as during the time of these.

542. In the intervals of paroxysms, the indications are, to prevent the return of paroxysms, or at least to render them less frequent, and more moderate. During the time of paroxysms, the indications are, to moderate their violence, and shorten the duration of them as much as can be done with safety to the patient.

543. It has been already observed, that the gout may be entirely prevented by constant bodily exercise, and by a low diet; and I am of opinion, that this prevention may take place even in persons who have a hereditary disposition to the disease. I must add here, that, even when the disposition has discovered itself by several paroxysms of inflammatory gout, I am persuaded that labour and abstinence will absolutely prevent any returns of it for the rest of life. These, therefore, are the means of answering the first indication to be pursued in the intervals of paroxysms; and I must here offer some remarks upon the proper use of these remedies.

544. Exercise in persons disposed to the gout is directed to two purposes: one of these is the strengthening of the tone of the extreme vessels; and the other, the guarding against a plethoric state. For the former, if exercise be employed early in life, and before intemperance has weakened the body, a very moderate degree of it will answer the purpose; and for the latter, if absti nence be at the same time observed, little exercise will be necessary.

545. With respect to exercise, this in general is to be observed, that it should never be violent; for, if violent, it cannot be long continued, and must always endanger the bringing on an atony