be forgotten that they are only remedies for the fit. They who desire to prevent its recurrence, and still more they who look higher, and would eradicate all tendency to the disease, must let into their minds a larger and more philosophical idea of its nature, not see it in some partial, transitory, and material cause, and must not depend on the means furnished by pharmacy. Drugs, in this disease, only alleviate and shorten suffering. This, however, is much for men who cannot choose either their condition or position in this world, and who, in their pursuits and occupations, must submit to many a hard necessity, little compatible with health. Besides this compulsion of circumstances, it is, I believe, according to the experience of all physicians, that patients much more willingly swallow any amount of medicine, however nauseous, than relinquish longcherished habits. For my own part, I can truly say that I pass my days exposing the absurdities of custom, and preaching against the noxious lives of my patients.

But, before concluding, I would again warn the gouty against expecting too much from drugs. If the functions of the body do not preserve their respective relations,-if the balance of the machine be lost, disease of one kind or other must be at hand. It is in vain to expect to enjoy health

with erring functions, and it is a gross and imperfect view of the practice of medicine which sees disease only in substantial and tangible disorganisation of the body's structure. If too much food

be administered to the stomach while its assimilation is imperfect, if the primary function of digestion be active while the secondary and equally important one of assimilation is inert, health is impossible for any great length of time. Gout may not, indeed, be the result, unless that unknown something in the constitution, which is the real essence of the disease, be there. But disturbance of health, and possibly organic disease, must ensue.

We are too much accustomed to look upon the bowels as the only road for the excrements of the system. I believe it would be both more true and more wholesome to associate the skin, the kidneys, and the lungs, in this office, and to assign to each of these organs a parity of rank and equal influence in the depurating function. It is certain, however, that if the carbonaceous and nitrogenous principles be not freely and constantly expelled by their proper channels, they must find their way out by vicarious roads, or be retained to disturb the health. Purging is then a necessity for the indolent.

But how much better would it be for those persons to permit the offices of nature to go on in

the way which has been ordained for them, to limit their diet and increase their exercise, to take only the amount of food necessary for the sustenance of the body in vigour, and sufficient exercise to keep it in comfort, to direct the nutritious part of the food to the repair of the frame, and to permit the expulsion of all those matters which should go to waste.

CHAPTER XIV.

PARTICULAR APPLICATION OF REMEDIES-CATHARTICS-CHOICE OF REMEDIES-DIURETICS--COLCHICUM-LOCAL REMEDIES-CASES

AND

-CURE OF CHALKY FORM OF GOUT-CASES-TREATMENT OF IRREGULAR GOUT-HASTY INTERFERENCE CONDEMNED-CASES -ABUSE OF BRANDY AND CORDIALS-BENEFIT OF PATIENCE DELAY-CASES-FREQUENCY OF ORGANIC DISEASE-ITS NATURE- DIET-COLCHICUM PURGATIVES TONICS -GALLIC ACID-METASTASIS TO THE HEAD-BLOODLETTING COLCHICUM -LAXATIVES-DIET.

In the previous chapter, I gave a general account of the principal remedies useful in the cure of gout. I proceed now to treat of the manner of their application to individual cases, a task omitted in former editions of this book, on account of the lengthy and not very interesting details into which it must necessarily lead me.

When called to see a case of gout, three great considerations must take precedence of all others; the age of the patient, his constitution, and the period of the disease. These important circumstances control all our treatment. To use remedies in the indiscriminate manner recommended by Sutton and others, cannot fail to expose us, sooner

PARTICULAR APPLICATION OF REMEDIES. 349

or later, to sad accidents and reverses. I frequently see patients in whom I deplore the necessity of even simply evacuating the bowels, and when nature cannot accomplish her own work, proceed, with caution and apprehension by the mildest means, to supply her deficiency. Persons much worn by the disease and in whom it has taken the atonic and metastatic form must be very gently touched with laxative medicine. A watery stool may be death. Patients with wan cheeks, blue lips, perished muscles and feeble pulse, sink very quickly under diarrhoea. But even when more robust, if the pulse be intermittent and he have ever had any degree of syncope or lipothymia, the utmost caution is required in administering medicine. Without exhaustion of the sanguiniferous system by fluid evacuations such patients are extinguished at once by suspension of the action of the heart. It is probable that this organ is diseased, and it cannot bear the revulsion occasioned by the too great and sudden removal even of that which oppressed it. These ideas are wonderfully exemplified in the celebrated treatise of Sydenham. It was written at the extremity of its author's life, when disease had made great inroads on his strength, and on every page of it is imprinted the dread he had of purgatives. No doubt he felt exhaustion from every evacuation; and it is clear that he