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in proportion to the violence of the preceding exercise.
546. It is also to be observed, that the exercise of gestation, though considerable and constant, if it be entirely without bodily exercise, will not answer the purpose in preventing the gout. For this end, therefore, the exercise must be in some measure that of the body; and must be moderate, but at the same time constant, and continued through life.
547. In every case and circumstance of the gout in which the patient retains the use of his limbs, bodily exercise, in the intervals of paroxysms, will always be useful; and, in the beginning of the disease, when the disposition to it is not yet strong, exercise may prevent a paroxysm which otherwise might have come on. In more advanced states of the disease, however, when there is some disposition to a paroxysm, much walking will bring it on; either as it weakens the tone of the lower extremities, or as it excites an inflammatory disposition in them; and it is probable, that in the same manner strains or contusions often bring on a paroxysm of the gout..
548. Abstinence, the other part of our regimen (540) for preventing the gout, is of more difficult application. If an abstinence from animal food be entered upon early in life, while the vigour of the system is yet entire, we have no doubt of its be. ing both safe and effectual; but, if the motive for this diet shall not have occurred till the constitution shall have been broken by intemperance, or by the decline of life, a low diet may then endanger the bringing on an atonic state.
549. Further, if a low diet be entered upon only in the decline of life, and be at the same time a very great change in the former manner of living, the withdrawing of an accustomed stimulus of the system may readily throw this into an atonic state.
550. The safety of an abstemious course may be greater or less according to the management of it. It is animal food which especially disposes to the plethoric and inflammatory state, and that food is to be therefore especially avoided; but, on the other hand, it is vegetable aliment of the lowest quality that is in danger of weakening the system too much, by not affording sufficient nourish. ment; and more particularly, of weakening the tone of the stomach by its acescency. It is therefore a diet of a middle nature that is to be chosen; and milk is precisely of this kind, as containing both animal and vegetable matter,
As approaching to the nature of milk, and as heing a vegetable matter containing the greatest portion of nourishment, the farinaceous seeds are next to be chosen, and are the food most proper to be joined with milk.
551. With respect to drink, fermented liquors are useful only when they are joined with animal food, and that by their acescency; and their sti. mulus is only necessary from custom. When, therefore, animal food is to be avoided, fermented liquors are unnecessary; and, by increasing the acescency of vegetables, these liquors may be hurtful. The stimulus of fermented or spiritous liquors, is not necessary to the young and vigor: ous; and, when much employed, impairs the tone of the system. These liquors, therefore, are to be avoided, except so far as custom and the declining state of the system may have rendered them necessary. For preventing or moderating the regular gout, water is the only proper drink.
552. With respect to an abstemious course, it has been supposed, that an abstinence from animal food and fermented liquors, or the living upon milk and farinacea alone for the space of one year, might be sufficient for a radical cure of the gout: and it is possible that, at a certain period of life, in certain circumstances of the constitution, such a measure might answer the purpose. But this is very doubtful; and it is more probable that
the abstinence must, in a great measure, be con tinued, and the milk-diet be persisted in, for the rest of life. It is well known, that several persons who had entered on an abstemious course, and had been thereby delivered from the gout, have, however, upon returning to their former manner of full living, had the disease return upon them with as much violence as before, or in a more irregular and more dangerous form.
553. It has been alleged, that, for preventing the return of the gout, blood-letting, or scarifications of the feet, frequently repeated, and at stated times, may be practised with advantage; but of this I have had no experience.
$54. Exercise and abstinence are the means of avoiding the plethoric state which gives the disposition to the gout; and are therefore the means pro. posed for preventing paroxysms, or at least for rendering them less frequent and more moderate. But many circumstances prevent the steadiness necessary in pursuing these measures : and therefore, in such cases, unless great care be taken to avoid the exciting causes, the disease may frequently return; and, in many cases, the preventing of paroxysms is chiefly to be obtained by avoiding those exciting causes enumerated in 504. The conduct necessary for avoiding them, will be sufficiently obvious to persons acquainted with the doctrines
of the Hygieine, which, I suppose to have been delivered in another place.
555. A due attention in avoiding those several causes (503, 504) will certainly prevent fits of the gout; and the taking care that the exciting causes be never applied in a great degree, will certainly render fits more moderate when they do come on. But; upon the whole, it will appear, that a strict attention to the whole conduct of life, is in this matter necessary; and therefore, when the predisposition has taken place, it will be extremely difficult to avoid the disease. .
556. I am indeed firmly persuaded, that, by obviating the predisposition, and by avoiding the exciting causes, the gout may be entirely prevented: but as the measures necessary for this purpose will, in most cases, be pursued with difficulty, and even with reluctance, men have been very desirous to find a medicine which might answer the purpose without any restraint on their manner of living. To gratify this desire, physicians have proposed, and, to take advantage of it, empirics have feigned, many remedies, as we have already observed. Of what nature several of these remedies have been, I cannot certainly say, but of those which are unknown, we conclude, from their having been only of temporary fame, and from their having soon fallen into neglect, that they have