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been either inert or pernicious, and therefore I make no inquiry after them; and shall now remark only upon one or two known remedies for the gout which have been lately in vogue.

557. One of these is what has been named in England the Portland powder. This is not a new medicine, but is mentioned by GALEN, and, with some little variation in its composition, has been mentioned by the writers of almost every age since that time. It appears to have been at times in fashion, and to have again fallen into neglect; and I think that this last has been owing to its having been found to be, in many instances, pernicious. In every instance which I have known of its exhibition for the length of time prescribed, the persons who had taken it were indeed afterwards free from any inflammatory affection of the joints; but they were affected with many symptoms of the atonic gout; and all, soon after finishing their course of the medicine, have been attacked with apoplexy, asthma, or dropsy, which proved fatal.

558. Another remedy which has had the appearance of preventing the gout is, an alkali in various forms, such as the fixed alkali, both mild and caustic, lime-water, soap, and sorbent earths. Since it became common to exhibit these medi. cines in nephritic and calculous cases, it has often happened that they were given to those who were

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at the same time subject to the gout; and it has been observed, that under the use of these medicines, gouty persons have been longer free from the fits of their disease. That, however, the use of these medicines has entirely prevented the returns of gout, I do not know; because I never pushed the use of those medicines for a long time, being apprehensive that the long-continued use of them might produce a hurtful change in the state of the fluids.

559. With respect to preventing the gout, I have only one other remark to offer. As the preventing the gout depends very much on supporting the tone of the stomach, and avoiding indigestion; so costiveness, by occasioning this, is very hurtful to gouty persons. It is therefore necessary for such persons to prevent or remove costiveness, and by a laxative medicine, when needful; but it is at the same time proper, that the medicine employed should be such as may keep the belly regular, without much purging. Aloetics, rhubarb, magnesia alba, or flowers of sulphur, may be employed, as the one or the other may happen to be best suited to particular persons.

560. These are the several measures (from 542 to 559) to be pursued in the intervals of the pa

roxysms; and we are next to mention the measures proper during the time of them.

561. As during the times of paroxysms the body is in a feverish státe, no irritation should then be added to it; and every part therefore of the antiphlogistic regimen (130 to 133) except the application of cold, ought to be strictly observed.

Another exception to the general rule may occur when the tone of the stomach is weak, and when the patient has been before much accustomed to the use of strong drink; for then it may be allowable, and even necessry, to give some animal food, and a little wine.

Dr.

562. That no irritation is to be added to the system during the paroxysms of gout, except in the cases mentioned, is entirely agreed upon among physicians: but it is a more difficult matter to determine whether, during the time of paroxysms, any measures may be pursued to moderate the violence of reaction and of inflammation. Sydenham has given it as his opinion, that the more violent the inflammation and pain, the paroxysms will be the shorter, as well as the interval between the present and next paroxysm longer; and, if this opinion be admitted as just, it will forbid the use of any remedies which might moderate the inflammation; which is, to a certain degree, uñ,

doubtly necessary for the health of the body. On the other hand, acute pain presses for relief, and, although a certain degree of inflammation may seem absolutely necessary, it is not certain but that a moderate degree of it may answer the purpose and it is even probable, that, in many cases, the violence of inflammation may weaken the tone of the parts, and thereby invite a return of paroxysms. It seems to me to be in this way, that, as the disease advances, the paroxysms become more frequent,

563. From the last considerations, it seems probable, that, during the time of paroxysms, some measures may be taken to moderate the violence of the inflammation and pain; and particularly, that, in first paroxysms, and in the young and vigorous, blood-letting at the arm may be practised with advantage: but I am persuaded, that this practice cannot be repeated often with safety; because blood-letting not only weakens the tone of the system, but may also contribute to produce plethora. I believe, however, that bleeding by leeches on the foot, and upon the inflamed part, may be practised and repeated with greater safety; and I have known instances of its having been practised with safety, to moderate and shorten paroxysms: but how far it may be carried, we have not had experience enough to determine.

564. Besides blood-letting, and the antiphlogis tic regimen, it has been proposed to employ remedies for moderating the inflammatory spasm of the part affected, such as warm bathing and emollient poultices. These have sometimes been employed with advantage and safety; but, at other times, have been found to give occasion to a retrocession of the gout.

565, Blistering is a very effectual means of relieving and discussing a paroxysm of the gout; but has also frequently had the effect of rendering it retrocedent.

566. The stinging with nettles I consider as analogous to blistering; and I think it probable that it would be attended with the same danger.

567. The burning with moxa, or other substances, I consider as a remedy of the same kind, I have had indeed no evidence of this proving hurtful; but neither have I had any proper evidence of its having proved a radical cure.

568. Camphire, and some aromatic oils, have the power of allaying the pain, and of removing the inflammation from the part affected: but these remedies commonly make the inflammation only shift from one part to another, and therefore with

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