It is now proper to apply what hath been hitherto delivered, to the Distemper we are treating of, that from thence the Powers of Milk in the Cure may more clearly appear. We have shewed before how the Mass of the Blood becomes impregnated with a saline Acrimony, more or less Acid, from a sharp and indigested Chyle, and the Powers of Digestion weakned and impaired; whence is easily explained how the Lymph and acrid Serum is communicated to the mucilaginous Glands, and the smallest Branches of the Arteries, so as to infect and coagulate the Mucilage, in Proportion to the Quantity of Salts they contain. The Fibres of the Membranes and Tendons are vellicated by the Acrimony of those Salts, so as to occasion intolerable Pain, and affect the Nerves to a very great Degree.
SECT. 2.
From the Diversity of Pains and other Symptoms in the Gout, it appears that these saline Particles are sometimes salt and pungent, sometimes more volatile, sharp and burning. That the mucilaginous Humour is frequently acid and corrosive in the Gout, appears from hence, that this Liquor is neither so easily coagulated, nor acquires so great a Degree of Viscidity by any other Mixture as with austere Acids, and from the Obstinacy and Duration of the Pain. It is frequently observed, that upon the Approach of a Fit, People complain of sowre Belchings, Wind, and vomit acid Humours, so that hypochondriac People, and such as are subject to the Gravel, are most apt to be seized with this Distemper; this may afford a good Reason why not only the drinking of acid Wines bring on a Fit in gouty Persons, but originally occasion the Gout in such Persons as frequently drink them. The Mixture of Wine with the Mucilage plainly evinces, that the acid Particles of the Wine give a Disposition to the Distemper, for it caused a greater Coagulation of the Mucilage than Oyl of Vitriol, whence easily appears what Mischief it may do to gouty Persons.
SECT. 3.
How this sharp acid Humour comes to be secerned in the Glands, seems to want Explanation, and this I judge to be in the following Manner. The Blood being first imbued with a sufficient Quantity of these saline heterogeneous Particles, which it receives from the corrupted Chyle, is by Degrees disturbed in its Motion, and the Fibres of the Nerves begin to be sensibly irritated, so as to cause irregular Motions of the animal Spirits. The Blood itself is thickned, because these saline and viscid Particles get into the small Ramifications of the Arteries, and occasion Obstructions there; by this Means the natural Functions and Secretions of the Humours, especially in the Glands, are disturbed, and proceed slower; and accordingly for some Time before the Fit, we find Complaints of Crudities in the Stomach, a swelling and Heaviness of Body, and Weakness and Numbness of the Limbs, which increase daily till the Fit is formed. At length the Blood, by continued Irritations, being put into more violent Motions, drives these saline heterogeneous viscid Particles through the obstructed Capillaries into the glandular Vesicles, whence without doubt the Juices there secerned, especially that of which we are speaking, viz. the Mucilage in the Glands in and about the Joints, is not only plentifully stored with these acid corrosive Salts, becomes more viscid and ropy, but also very corrosive and poignant; and while it irritates and corrodes the adjoining Membranes and Tendons, not only causes violent Pains, but also since by the Contraction of the Nerves the Blood cannot move so freely through the smallest Vessels, the Fibres are distended, and an inflammatory Tumor frequently succeeds.
SECT. 4.
The Reason why the Gout affects particularly the Hands and Feet, and not all the Joints together, where Glands of the same Nature are placed, seems to be this: The Blood vitiated in the Manner before explained, propelling these saline Parts into the Pores of the Glands, from the inequality of its Motion in the Time of a Fit, does not impel those Salts with an equable Force, but chiefly into such Parts (especially the Feet and other pendulous Members) where the Pressure and Impulse lies heaviest; so dilates the Cavities of the smallest Canals, till at length it deposits Part of such Salts, with other viscid Humours, upon those Glands. Thus being partly freed from those Salts, the Gout does not seize other Parts with the same Violence; for frequently a large Quantity of such vitiated Humours are secerned by Urine, Sweat, and other more open Passages; and it even often happens, that Persons whose Juices are much corrupted, have avoided the Distemper by the Laxity and Openness of their Vessels; yet these very Persons, when the Blood becomes oppressed by these saline Particles in so great Degree, as not to be readily discharged by the larger Passages, they affect the Mucilage in the Glands and occasion the Gout.
SECT. 5.
That this Distemper comes by Fits, appears owing to this, that upon the Approach of a Fit much of the morbifick Matter is thrown upon the Glands by the Blood, so that the Blood thus freed from sharp and viscid Particles, moves easier and freer, till such Time as a sufficient Quantity of morbifick Matter is again generated in the Blood; which by separating again, a viscid and sharp Mucilage, the Symptoms of the Gout, are repeated in another Fit. The feverish Chilliness and Shivering that attends the Gout, is to be accounted for from the irregular Motion of the Blood, occasioned by the Salt and viscid Particles; and it is very likely that those very Salts themselves, irritating the Nerves, and occasioning inordinate and violent Motions of the animal Spirits, contribute to such a Fever; this Sharpness of the Blood, while the Salts are thrown forth by Urine or Sweat, remits till the Blood be again infected. We observe that the Gout often prevents other Distempers; for by this Expulsion of the corrupted Parts from the Blood, Distempers which might have arisen from them are prevented.
SECT. 6.
Because there is a great Difference made between the fixed and wandering Gout, I shall observe a few Things thereon. As to the wandering Gout, it is observable that the Mucilage of the Glands is often very differently affected from the viscid and saline Particles of the Blood; sometimes these Particles are mixed in different Quantities with the Mucilage, neither have the Salts at all Times the same Degree of Volatility or Fixity; so that the Mucilage may at some Times be only lightly infected, and the Infection be more Volatile, and consequently it may easily move from one Joint to another, or attack many Joints at a Time. The Points of the Salts are in a Manner lixiviated, become more volatilized, and of Consequence are with more ease protruded from the Blood into the Glands, and render the mucilaginous Juices sharper; whence the nervous Membranes are irritated and distended, and the gouty Pain generated.
SECT. 7.
The Reason why this morbid Matter is not long fixed in a Place, but is apt to wander from one Joint to another, I take to be this: These saline volatile Particles, when their intestine Motions are increased, are very easily dissipated, either through the Pores of the Skin in sensible Transpiration and Sweat, or by insensible Perspiration, and so the Pain ceases; other Glands, whose Pores are more open to receive this acrid volatile Matter, are for the like Reasons infected, the same Tragedy repeated, and the Particles in like manner dissipated. This is the Reason why the Pains in the Gout are not fixed and permanent, but rather wandring and uncertain, the morbid Particles being attenuated, and pushing to get forth by the Methods now mentioned, vellicate the Nerves in various Directions. It may be further considered, that when by the smallness of the Pores or glandulous Vessels, or any other Disposition, the morbifick Matter cannot be separated from them in sufficient Quantity, and the Secretion once begun is stopped, it recurs to other Glands of the same kind, and thus the morbid Matter is suddenly translated from one Joint to another, and from one Sett of Glands to others, so as to produce this Effect.
SECT. 8.
As to the fixed Gout, where the morbid Matter remains long in a Place, I take it that many acid Salts and viscid Humours contained in the Blood, occasion a greater Coagulation and Viscidity in the Mucilage about the Joints and the Tendons, than can be easily dispersed and evacuated; and on the contrary growing more viscid and sharp, it distends and vellicates the small Fibres of the Tendons and nervous Membranes, and occasions a Pain proportional to the Degree of Acrimony and Viscidity in the Mucilage about the Joints and Tendons, generally pretty sharp. The Mucilage is affected in the same Manner as it would be from the Affusion of Aqua Fortis, Spirit of Vitriol, or any other corrosive acid or austere Substance, whence it is manifestly thickned and coagulated. This affords a Reason why such a Gout is not only fixed in a particular Limb, but also why it long remains there. The ingenious Dr. Havers explains this Matter very well; he tells us that when the Matter happens to be thick and gelatinous, it is not to be expected that it should be easily and presently discharged out of the Interstices of the Joints, either by being resorbed or evaporated, when the Consistence of it renders it uncapable of insinuating itself into the minute Pores, and penetrating those narrow Avenues through which it is to pass. And according to the Degree and Nature of the Acid in the morbific Humour, it doth more or less coagulate the Mucilage, and the Part affected is sooner or later, with more or less Difficulty, freed from it, either by the Translation of it to another, or by the more happy Exclusion of it out of the Body. The same Author very elegantly explains the Cause of the Knots in the Joints, where he says that it seems to be no difficult Thing to account for that tophaceous Matter, which is sometimes found concreted in those Parts that have been afflicted with this Distemper. It hath been observed, that an Acid and an Austere, being both mixed with the Mucilage, did produce a plain, a notable and white Coagulation, where the Coagulum, though it was made when the Mucilage was cold, was not so soft and tender, nor dissolvable in Water like that which was made with Acids only; but though it would break, remained distinct in it, and being dried, was easily reducible to a fine Powder like Flower, or the fine Powder of Chalk. Whence he humbly conceives, that where-ever the Gout comes to be nodose, there is not only an Acidity in the preternatural Humour, which is separated by the mucilaginous Glands, and mixed with the Mucilage; but it is an Acid austere, which is no sooner thrown into the Interstices of the Joints and the Sinuses of the Tendons which are thereabout, but it produces a Coagulum in the Mucilage, and that such a one as is not easily attenuated and dissolved, so that it lies fixed and imprisoned there, and in Time, as the aqueous and moist Particles are by the Heat and Spirits carried off, the terrestrial and saline Parts concentrated come nearer together, and coming to be immediately contiguous, do mutually adhere, and are concreted so as to produce that Chalk or tophaceous Matter which is in some arthritick Cases to be observed. And as the Coagulum, which may be made by an Acid austere, seems apt to make a Concretion of that nature, so the Colour of the tophaceous Matter doth answer to that of this Coagulation, so as to seem generated in this Manner.
SECT. 9.
The same Author explains the Reason why the Hands and Feet are most subject to this Disorder. In the Hands, as was shewn before, there not only are considerable Glands in all their Joints, but the Tendons which are there inserted, especially those of the Musculi perforantes, have their mucilaginous Glands, so that Nature hath a convenience in these Parts to depurate the Mass of Blood, and they must receive the morbifick Matter, when the Blood in its Circulation obtrudes it upon them, and the Glands are disposed to separate it. The same Thing may be observed of the Shoulder and of the Knees. But of all the Parts none are so frequently afflicted with this Disease as the Feet, and it is plain why they are so. For besides, that they have many mucilaginous Glands in their Joints, and others about the Tendons which are inserted into their Bones, as the great Chord or Tendon of the Muscles which extend the Foot, and those of the Perforantes; I say besides this, they are the inferior and pendulous Parts, so that as their Glands make them capable of entertaining, so their Situation does conspire with the Effort of Nature, to bring down the morbifick Matter into them. Thus far Dr. Havers, whom I have chosen to quote, because he hath exceeded all Authors in treating of the Nature of this Distemper. It is not necessary to add any more upon this Head. What I have omitted for Brevity’s Sake, the Reader may find in my EncyclopÆdia Medica, where I have treated of the Cause of this Distemper, and evidently shewed how from the Glands and Lymphatick Ducts about the Membranes and nervous Parts of the Joints, a large Quantity of sharp Serum and other lixivial and acid Particles or other morbid Matter thickning and corrupting the Lymph, is secreted and deposited upon the Joints, where they corrode and vellicate the nervous Fibres. Upon the Addition of Particles more than ordinary acid, the Pains become more durable and fixed; insomuch as Salts of different Natures become jumbled together, and from the Agitation and Conflict of the Particles, the Membranes are vellicated and distended in a very painful Manner; neither doth the Pain abate till the Particles get forth of the Glands, or their Conflict being over, leave the Spirits at rest.
