very melancholy accidents. Of these truths a case which occurred to me some months since affords an excellent illustration. A gentleman, who had led a somewhat licentious life, contracted a sore, concerning the nature of which the surgeon who attended him unfortunately doubted till it assumed a very threatening aspect. At this time it was decided, in consultation, to use mercury with great freedom, in order to arrest fastspreading mischief. The consequence was a very severe ptyalism; but accompanying it was the most intense pain of the occiput and nape of the neck. I have already pointed out this as one of the most distressing forms of the gouty attack. But the absence of all other symptoms of the disease, and the presence of great inflammation of the gums and fauces, made the real cause be overlooked, till a very painful explosion took place in the foot. This was the most complete case of ecchymosis I ever saw. The whole foot, from the ankle downwards, was literally a bag of blood, and its colour varied from the darkest hue to a purple blush. This gentleman is unfortunately an unsteady patient, and in his wanderings from doctor to doctor has repeatedly been rudely handled. I am imperfectly acquainted with the subsequent details of his case; but I saw him not long ago, in a very pitiable plight. But a year

ago he was a man of great strength, of powerful limbs, and seemed destined to long life. He is now wasted to a shadow of his former self, has a haggard and miserable look, and speaks of himself as a dying person.

Since the above sentences were written in the first edition of this book, this unfortunate man has sunk under the combined effects of gout, syphilis, wine, and mercury. Had he been treated steadily and reasonably for any one complaint, I believe his life might have been preserved, but this he would not permit.

CHAPTER XIII.

TREATMENT

OF REGULAR GOUT- MORGAGNI

AND SYDENHAM'S

OPINION-QUACKS AND IMPOSTORS-BLOODLETTING-PURGATIVES

-ALKALIES AND ANTACIDS-TONICS-HYDROPATHY-COLCHICUM -MINERAL WATERS.

THE popular distrust of medicine in gout should only stimulate to exertion, but it is discouraging to find the opinions of very eminent physicians so heavily pronounced against the utility of remedies in this disease. Morgagni writes : "Most of them have either never been at all useful, or at least very little to most persons, and some of them have thrown patients into very great danger, or been the cause of their death.' (Epist.' lvii, § 9.) Sydenham dissuaded from the use of remedies during the fit. So far, indeed, was he from having any desire to abridge it, that he expressly declares, "quanto enim magis aegri dolores lenit, tanto magis humorum concoctioni adversatur; quantoque claudicationem arcet, tanto materiae morbificae expulsioni officit." (Op. cit., p. 443.) "Et fidenter assero, multa et longa observatione suffultus, maximam partem eorum

qui Podagra periisse putantur, non tam ipso morbo quam sublesta atque indebita medicatione fuisse peremptos." (Op. cit., p. 448.) When these things are considered, it clearly appears that Sydenham's opinion did not fall far short of that of Morgagni. In combating the opinions of two such men, I am comforted by reference to their practice. It does not appear that they refused to employ remedies in the cases of which they have left us a record.

A host of authors, and the daily experience of practitioners, must suffice to set aside such hopeless maxims. I have already expressed my own opinion, that, in the whole catalogue of chronic diseases, there is not one which is more amenable to treatment, and which receives greater relief at the hands of the physician than this. It is indeed illogical to hope for its removal while the cause is permitted to remain; but the resources of modern medicine have established great mastery over the fit, and I have already shown how much the diathesis and morbid tendency may be obliterated. There is this consideration, too, to confirm our faith in the use of curative means for the relief of gout, that our practice in these days should be rational and not empirical. The time is doubtedly arrived, when the light which has been shed on pathology by the discoveries of physiology and chemistry should regulate our practice,

un

and for ever separate the physician from the quack. This is probably more true of gout than of other diseases; and yet of none could it be less seriously affirmed in former days, which is perhaps the reason why remedies, dangerous in themselves, and used without guide or principle, were rejected by the wise and great men whose opinions I have quoted. We find, indeed, scattered through the writings of the older physicians, the most painful regrets concerning the mischief done by impostors in this disease. Such will ever be the case while the wealthy and self-indulgent are its principal victims. Van Swieten has well expressed the reason of this: "Empyrici soli, qui audacter adeo de corio humano ludere solent, jactant, se suis arcanis vel radicatissimam podagram funditus tollere posse. Cumque ditiores præcipue infestet hic morbus, undique advolant ut ingenti sæpe pretio nugas suas vendant credulis." But these days are not exempt from the like evils. In the course of the last century, a French quack, of the name of Lefevre, extorted large sums of money from a few individuals with more wealth than understanding. He cunningly promised them a cure after many months' use of his remedies, but, having secured his reward by anticipation, he left those who had listened to him to discover the cheat at their leisure. Yet we are now surrounded