Dolæus upon the cure of the gout by milk-diet

SECT. 2

All those who have other Distempers complicated with the Gout, as the Scurvy, Leprosy, bad Habit of Body, Stone or Gravel, Hystericks, the Pox, or other Distemper arising from the Impurity of the Blood, too great a viscidity or acrimony of the Juices, or a known or latent Acid in the Blood, are first to use Absorbent, Diuretick, Sweetening or other Medicines, proper to their particular Distempers, till the Acrimony or Tenacity of the Blood and Humours be corrected, the Acid expelled, and such complicated Disorders overcome, and then apply this noble Remedy of a Milk-Diet to the Cure of the Gout alone, from which they may certainly promise themselves Success: But if while the Body is ill prepared, or full of vitiated Juices, the Milk-Diet should be preposterously brought into Use, they will not only be disappointed in their hopes of Relief, but bring certain Destruction, and Increase of their Disorders; as actually happened to the Count de Perlebourgh, and a Lubech Consul in this Neighbourhood, who having a Complication of Distempers, made an improper Trial of a Milk-Diet.

SECT. 3

The Milk in which the Cure of the Gout consists, ought to be excellent in its Kind; the Animal from whence it is taken, as described by Waldsmid, should be an Heifer, or Cow of a middle Age, of a good Habit, either of Red or a Black Colour, (though this need not so strictly be minded) neither fat nor lean, nor pregnant, and kept separate from the Bull: In Winter fed upon good Hay, Barley, Bran or Straw; in Summer at good Grass, and led in a Collar like an Horse. If any one can keep a Cow for their own Use, it is best, and they may more safely rely upon help from it; but if not, the Milk as the Milkmen sell it will do; taking Care however that the Cow be of a good Habit, well fed, and not too old.

SECT. 4

As to the Quality and Quantity of the Milk, it is to be observed, that as soon as it is milked it should be warmed, but not so as to boil it. Let the Vessel full of Milk be put into boiling Water, and when it is so hot as to be conveniently supped, or at least so warm as when it came from the Cow, let it be taken after the Manner of Tea or Coffee. The Times of taking ought to be, two Pints in the Morning, some four or Five Hours before Dinner, as much about Noon, and as much about Seven in the Evening; but the Quantity cannot be exactly determined, because the Weakness or Strength of the Stomach must give a Rule in this Case; or let so much be taken as the Stomach can bear without Inconvenience, and the Patient may increase the Quantity daily till he comes to about forty Ounces. If the Stomach be weak, he may take it in a smaller Quantity, four or five Times a Day; if four Times, let two of them serve for Dinner and Supper, with some of the finest wheaten Bread; and a Draught of Milk may be repeated every four Hours; if the Milk be taken at five Times, it may be so ordered as to let three Hours intervene; those who are of more robust Constitutions, may be content with three Meals of Milk a Day; and it will not be amiss to take every Morning a Dose of Crabs-Eyes, or some other absorbent Powder: I usually take about twelve or fourteen Ounces of Milk in the Morning, Twenty four Ounces with Wheat Bread at Noon, and about Twenty Ounces at Night, half with Bread, and the other half drank as common Drink. Some allow the Use of white Meats at Dinner, lessening the Quantities by Degrees, and making up the Deficiencies by Food of Milk and Eggs, so that by Degrees the Milk and Eggs are entirely substituted in the Place of the Flesh Meat, and then by diminishing the Eggs daily, Milk becomes entirely substituted for other Food: This Method seems to me, entirely agreeable to tender Constitutions, and such as dont well bear sudden Changes. Some who have strictly adhered to Milk for fourteen Weeks, have indulged in the Use of poached Eggs without Salt, Barley boiled in Milk, fresh Butter without Salt, Custard and other Milk Foods; and in Summer, some Kinds of Fruits, as Strawberries, Peaches, &c. tho’ in my Judgment improperly, especially such Fruits as are cold, or seem to have a latent Acid, or such as weaken the Bowels. On this Head it may be observed in general, that the less whatever be used for Food differs in its Nature from Milk, it may be more freely ventured upon in the Milk-Diet; but the Prudence and Care of the Physician is to be relied on, according to the Diversity of Circumstances that may happen in different Constitutions.

SECT. 5

This Diet ought to be so long continued, until the whole gouty Matter be discharged forth of the Body, which is to be computed by the Degree and Length of the Distemper, and Observations upon the Cure in others. The longer it is continued, the more perfect Cure is to be expected; those that are over-run with the Distemper, are always to use it, others for an Year, and others for an Year and an half; some Persons who have, upon continuing it only for half an Year, thought themselves perfectly cured, and have returned too soon to their former Method of living, have so far exceeded, as to be seized again with the Gout, but returning to the Diet, have been cured; some more prudent, have continued the Diet for an Year, and then returned to their ordinary Manner of living by Degrees, always taking about sixteen Ounces or a Pint of Milk every Morning, and have thus for many Years been free. The best Time of Beginning the Diet is in the Spring, and that from the Beginning of May, to the End of April in the succeeding Year.

SECT. 6

Some have in the Continuance of this Diet been seized with Oppressions and Difficulty of Breathing, Weakness in their Limbs, Coughs and Phlegm; but these Symptoms either vanish of themselves, or quickly give way to Elixir Proprietatis without an Acid, Spirit of Hartshorn succinated, Sal volatile oleosum, or any of the more fixed absorbent alkaline Medicines.

SECT. 7

For those who are oppressed with an abundance of Humours, whose Bowels are full of Flatulencies, or are constipated, let them once in every Month or Six Weeks take a gentle Purge of Rhubarb, or of the Arthritick Pills, or half a Scruple of Pill Ruffi, or of Sylvius his Gum Pills: But if the Body be open, and the Milk passes too quickly through, it may suffice to take twenty Grains of Rhubarb; or if the Body be bound, take twenty Grains of Rhubarb in the first Draught of Milk, drinking the rest of the Quantity after it, or else in the Evening take twenty Drops of the Essence of Rhubarb with the Milk, and repeat it as often as there may be Occasion; but for the general, if it can be conveniently done, the purging Medicines should be used in the Decrease of the Moon.

SECT. 8

If the Milk should occasion a Looseness, let it boil before it is used, adding a Grain of Salt and so supping it hot; if it do not succeed the first Time, try it a second Time, and a third; but if it doth not do then, take a Dose of Crabs-Eyes, Unicornu fossile, or Terra sigillata.

SECT. 9

If the Milk should heat the Body, let a third Part of Barley Water, made with Raisins, be added to it; or if it occasion Thirst at any Time, Barley Water with Raisins; or in case of a Cough, the pectoral Decoction may be used between the Intervals of using the Milk.

SECT. 10

If the Stomach be weakened by the Use of the Milk, the Patient may be allowed Sugar Biscuits, sopped in Spanish, Italian or Burgundy Wine, or any other that is neither Acid nor Foul; and if necessary, even a Glass of those Wines: Thus the Stomach will be fortified, and more easily perform its Office; if there should be a Necessity for it, some of the warm aromatic Powders may be brought into Use.

SECT. 11

After this Diet hath been used twelve or fourteen Months, the Patient may begin to use Flesh Meats of easy Digestion, avoiding sharp, acid or salt Meats, but using such as we mentioned before, drinking Milk still, or small Beer well wrought, neither stale nor turbid.

SECT. 12

The Cure being thus absolutely finished, it will be still necessary to take every Morning a Pint of warm Milk, and to be constantly cautious about your Diet, avoiding every thing acid or sharp.

SECT. 13

To prevent the Milk from cruddling, some Sugar may be mixed with it, or even a little Salt, thus the Acid is prevented from gathering; but this should be done but seldom, and upon the most urgent Necessity.

SECT. 14

Though there should not follow an immediate or sensible Change upon the Use of the Milk for some Time, yet the Patient ought not to be disheartned; for if these Rules be strictly observed, and the Patient be otherwise in a good Habit, the Pains will vanish by Degrees, and a due Strength and Tone return to the Limbs.

CHAP. III

I Have now delivered the Directions I proposed, partly from the Authors before-mentioned, and partly from my own Experience; by a due Observation of which many Persons have been perfectly relieved from this grievous Distemper; of which I shall give some Examples. D. Sorbait, p. 741, tells us, that he knew several Persons, by the Use of the Milk-Diet, either perfectly cured, or their Gout so much overcome, that their Pains were dwindled to nothing. John Pilus, the Emperour’s Surgeon told me, that tho’ he frequently had Fits of the Gout, and almost lost the Use of his Limbs, so that he was in a very miserable Condition, yet for these three Years past, by the Help of this Diet, he hath been perfectly free from Pain, his Countenance is now become fresh and healthy, he hath had several Children, and appears as if he were born a-new. Count Coningseck, his Imperial Majesty’s Counsellour, found the same Benefit by this Diet; and Count S. Hillario of the Emperour’s Bed-Chamber; several others, who were almost worn out with the Gout, grown pale and wan, have in a manner become young and florid again by this Diet. The Bishop of Wallendorf, tho’ quite impotent by the Gout, was cured by Milk. Three noble French Refugees, the Marquess de Bongi, Monsieur de Chamar, and the Counsellour de Talo, have been now many Years free from the Gout, as appears by the Letter before inserted. I am told that a Consul, and several others at Hambourgh, are now using this Diet with Success. A Counsellour of Oldenbourgh, the Sieur Van Velden, hath used this Diet this last Winter with very wonderful Success; for tho’ he could neither use his Hands nor Feet, he uses both now readily and perfectly well. A Miner here in the Neighbourhood hath used Milk for these six Months past with great Benefit; he was almost a cripple, but now walks very well to the Mines. All the World knows that the famous Prince of Conde was cured of the Gout in France by Milk-Diet. There are two Citizens of Hambourgh, one of which, tho’ he hath had the Gout fifteen Years, is well recovered by the Use of Milk, and the Knots in his Joints are quite wore away. Colonel Haste hath used Milk for six Months, and been free from the Gout; and tho’ he hath left off the Use of it, the Fits are much easier than before. There is no Occasion to multiply Examples; many more may be found in Sorbait, Sacks, Greizel, Waldsmid, Authors already named. I have experienced the great Benefit of this Diet in myself; I was so cruelly handled by this Distemper, that I almost lost the Use of my Limbs, and at last had a Fit every Month or Six Weeks; I was at the same Time violently afflicted with the Stone, and difficulty of Urine; but now that I have confined myself to this Diet for an Year and upwards, I have not only been free from any Fit in that Time, but the Strength of my Limbs is returned, the Dysury is abated; and what is wonderful, the Stone in my Bladder is lessened and dissolving, so that I now hope I shall get the better of the Gout, having been in a manner free from it an Year and an half; I have had some Fits indeed, but very mild ones. I take Milk to be a Medicine beyond any yet discovered for the Stone, since within the Space of one Year, the Stone in my Bladder diminished an Ounce, as I judge from the Bits I have voided and collected in that Time; and since I have left off the Cure, I have not voided one Bit. I am of Opinion, contrary to most Physicians, that Milk doth not breed the Stone in the Bladder, but only a viscid kind of Phlegm in that or any other Part.

SECT. 2

These Things premised, I shall next examine how it comes to pass that Milk is endued with this mighty Power; but it is necessary first to enquire concerning the genuine Cause of the Gout. All the Symptoms testify the first and nearest Cause to be some viscid, sharp Liquor, endued with some acid or lixivial corrosive Salt, more or less fixed; this Salt indeed occasions such a singular smart Pain, that it seems to be specifick. I think it not only acid, but also somewhat austere, from the different earthy, cheesy Particles it contains. Hence it fixes its sharp stiff Points in the Membranes, Tendons and Nerves, and more readily thickens and coagulates the lymphatick Juices. Where and how this Liquor that causes the Gout is generated, I shall explain in a few Words. First then the Stomach and Bowels, whether from too great an use of Wine or Women, or from too sedentary a Life, and want of due Exercise, or from the particular Disposition of the stomachick Juices, or from bad Diet, become so affected, that by Degrees the Digestion or Dissolution of the Food is lessened; the Chyle thence produced, becomes more thick and viscid than formerly; so that this Chyle, thus delivered into the Blood, renders its Mass thicker, and of Consequence the several Secretions of the Humours, as the Lymph, animal Spirits, the mucilaginous Juices about the Joints are more slowly performed; thus the Stomach and Bowels become more tainted, the stomachick Juices and those separated by the Glands of the Intestines become more viscid, and the Difficulty of Digestion is increased; Part of the Food turns to Flatulency, and viscid sharp Slime in the Bowels; Part of the Chyle becomes infected with a corrosive acid Salt thence produced, and being again thrown into the Blood, the Lymph and other Juices become infected with the same acid Salt, which gives Birth to many Distempers. It is observable these viscid Juices, thus stopped in their Progress, and infected with this noxious Salt, so as to be more liable to an intestine than a progressive Motion, are the most subject to Corruption of any in the Body, and to contract a Thickness, and Inaptitude to Motion. Such an Humour is the Lymph, and more especially the mucilaginous Juice separated in the Glands of the Joints, in order to keep them moist and smooth for Motion. If therefore a sufficient Quantity of these acid Salts be brought into the Mass of the Blood, or the Humours impregnated with them, be lodged about the nervous or tendinous Membranes, and there acquire so extraordinary a Tenacity or Sharpness, as to be coagulated, the Gout thence arises, as is evident both from Reason and Experience. That this may more evidently appear, I shall next explain the Figure, Situation and Structure of these Glands.

SECT. 3

These Glands, as described by Dr. Havers in his new Osteology, and as they discover themselves upon Dissection, are of two Kinds; some are small and thickly interspersed in the Membranes of the Joints, and with very few Exceptions of an equal Bigness, so as to render the Membrane perfectly Glandulous: In some Parts of the Membrane, in the Joints, and in the Furrows of the Bone, these Glands are so united as to form very remarkable and large conglomerate Glands. In some of the large Joints there is but one, as in the Hip Joint; in others, as in the Knee, four or five; they are of a red Colour, which is communicated from the blood Vessels; as to their Substance, soft and papillary, tho’ not tender and friable; they are in their Structure Conglomerate, consisting of divers Membranes, wove one within another, interspersed with small round Vesicles, which are not only contiguous, but adhere closely one to another, as the Membranes also do. By the Pores of these little Vesicles a mucilaginous Liquor is strained and secerned from the general Mass of the arterial Blood, and thence by the excretory Duct, with which all these Glands are furnished, is shed into the Interstices of all the Joints.

SECT. 4

These Glands have a sufficient Number of blood Vessels, they dont come out of them in right Lines, but are observed to have many Convolutions, Windings, and Insertions; there seems to be a very particular Reason, from the Nature of the Liquor to be separated, for this Obliquity of the blood Vessels; for since that Liquor is to be viscid and mucilaginous, its Parts should proceed slowly, and not without Difficulty, through the glandulary Pores; and therefore the Vessels are contorted in the Manner we see, that the Motion of the Blood may be retarded, and more Time and Leizure given, both for the separating Particles of such a Nature, and for their Admission through the Pores of the Glands.

SECT. 5

These Glands are of different Shapes, so as to fit the Furrows and Cavities where they are placed; some are long, others conical, broad at their Base and grow narrow towards the Top, so as to terminate in an Edge; some have a broad Base, and rise into a sort of Cone; some are like little Ridges; some like Fringe; some are broad and pretty flat.

SECT. 6

As to their Situation, they are differently seated in the several Joints; in some they stand over-against the very Interstice of the Bones, and run in a little way between them, where the Ends of the Bones towards that Side are not contiguous, but so formed as in their Conjunction to make an Interstice, and these are commonly in the Manner of a Fringe; some are seated in some Sinus or Cavity, others planted upon the Membrane, which immediately covers the Articulation: In general they are so seated, that they cannot be injured by a Compression from the Bones; and yet there is this Contrivance, that the Bone does, either in the Inflexion or Extension of the Joint, lightly press upon them, so as to promote the Excretion of the Humour, which they separate into the Joints, when they are moved and stand most in need of it; and by this Means it seems to be most plentifully supplied, when there is occasion for the greatest Quantity of it, and to be proportioned to the present Exigence, according to the State of Rest, or the several Degrees of Motion in the Part when it is moved. And it is no small Security to these Glands, against the Obstructions which the mucilaginous Quality of the Liquor that they separate does naturally dispose them to, that they are solicited, and the Liquor expressed out of them by the Motion of the Parts where they are seated: The same sort of Glands are placed about the common Membrane of the Muscles, and about the Tendons.

SECT. 7

The Liquor that is separated from these Glands is a Mucilage, not unlike the White of an Egg, tho’ not always so clear and pellucid; when pure it is very like it. In some Animals it is of a Colour inclining to Yellow, and is composed of watry, saline and slimy Particles; it is supposed that the earthy Particles may be about a two and thirtieth Part. The Nature of this Mucilage seems nearly to approach to that of the Serum of the Blood, separated from the grumous Part upon being exposed to the Air, and exhibit much the same Appearances upon Trials by Mixture with other Bodies, only the Serum is not so mucilaginous. The Serum is coagulated upon being mixed with Spirit or Oyl of Vitriol, Spirit of Salt, Oyl of Sulphur, and other acid Spirits. The Serum, upon being held in a Spoon over the Fire, becomes a thick Jelly, and at length a sort of friable Glew; on the contrary, the Mucilage grows thinner, upon the same Application, throws up a slight thin Film at Top, and produces but a slight Coagulum. After the aqueous Parts are evaporated, there remains scarce a thirtieth Part of the whole Mass.

SECT. 8

The principal Use of this Mucilage is to lubricate the Joints, and to render and preserve the Extremities of the Bones, at their Articulations, smooth and supple, for the easy Performance of animal Motion. Besides this mucilaginous Liquor from these Glands, there is an oily medullary kind of Substance transmitted through the very Bone into the Cavity of the Joints: These two Liquors are mixed by the Motion of the Joints, the Mucilage contributes to make the Oyl more slimy, and the Oyl preserves the Mucilage from stiffening into a Jelly. This Mucilage further serves to prevent the Extremities of the Joints from being burnt up in the Gout. In the same Manner the Muscles and Tendons are lubricated and kept in Vigour by the Liquor supplied from the same kind of Glands placed on their Membranes.

SECT. 9

This Mucilage is formed from the purer Part of the Lymph and the serous Parts of the Blood, and separated in these Glands from the Mass of the Blood. In order to have a more distinct Notion of its constituent Parts, and to know how it comes to occasion the Gout, the following Experiments of Dr. Havers may be very properly repeated in this Place. He made most of the Trials both when it was hot and when it was cold. Vinegar dropt into it, when it was hot, made a considerable Coagulation with a Serum; it must be observed that those Mixtures that were made with it cold, did produce the same Effect when it was warmed, namely a Coagulation with Acids and Stypticks, only in an higher Degree: And whereas the Coagulations, which were made when it was in one State, did only change it into a thick Jelly without any Serum, after the Manner of a Cheese when it is newly set, as they term it, which over the Fire afterwards exhibited two distinct Parts, a Coagulum and a Whey; in the other, that is, when the Mucilage was hot, the Mixtures which coagulated it produced an harder Curd, and a Serum distinct from it. By dropping in some of the Decoction of Galls into it, the whole turned into a gelatinous Mass, and it was all a Sort of Coagulum like a Skin, of a whitish Colour, and so tough as to hang all together when it was taken up with a Needle. This Coagulum or Jelly being laid in the Sun, and dried, the Parts of it stuck all together in one Piece, but was very friable and easily rubbed to a Powder, which was very much like fine Flower. The same Effect had the strong Infusion of Balaustia, red Roses, Pomegranate Bark, and the Peruvian Bark, although there was some Difference in the Coagulation, according to the different Degrees of their Astringency. With a few Drops of Aqua Fortis distilled upon it, the Mucilage was immediately coagulated, though the Coagulum, which was white, was so tender, that it would by Agitation be dissolved in fair Water, and make it of the same Colour almost like Milk; Spirit of Nitre made exactly the same Alteration in it as Aqua Fortis did, a Coagulum which was of a white Colour. Vinegar, Spirit of Salt of Vitriol, Oyl of Vitriol, and of Sulphur in some Mucilage which I tried it with, did not make any considerable Alteration when it was cold, but in some other it did more; when Aqua Fortis and Spirit of Nitre did produce in all the same Effects in the same Degree. It was mighty observable, that so strong an Acid as Oyl of Vitriol should have no greater Effect upon it to alter it not, so considerable as that of Vinegar, which would incline one to think that it is not always the high Degree of Acidity that works this Change. But there seems to be something particular in Wines, which disposes them to coagulate this Liquor, when any of them are made Use of; and those Parts of them, which are apt to act thus upon it, are cast into those Interstices where they have the Mucilage singly to work upon. And therefore we find how readily any Wines do procure the Paroxysms of the Gout, where the Tone of the Glands is weakned, and the Patient hath a Disposition to this Distemper; which agrees with those Trials I have made with some of them: For Claret, white Wine, and even Sack, but the Claret especially, did make a Coagulum like a Jelly; and it was not strange that Claret, which hath both an Acid and a Stypticity in it, should produce the greatest Coagulation. A mercurial Water made of Sublimate and Aqua Calcis, made a very considerable whitish Coagulation, and rendred it all a thick Jelly, which being held over the Fire, turned to a Curd and a Serum. A Solution of Roman Vitriol produced a Coagulation likewise; so did Allum dissolved in Water, but it made a greater Alteration in some than it did in others, though the Mucilages were taken from subjects of the same Species. Saccharum Saturni did inspissate it, which appeared to be a true Coagulation, because with the Fire they would turn to a distinct Coagulum and Serum. Salt of Wormwood made no sensible Alteration, only it seemed a little thicker, to which I put some of the Decoction of Galls, which immediately produced a Coagulation. Upon dropping in some Spirit of Vitriol, to see what would be the Effect of the Colluctation of the Salt and Spirit, and I found, after it was over, that the Coagulum and the serous Part were distinguished, and the Serum limpid like Water. I took some of the Decoction of Galls, and added to it Spirit of Vitriol, intending to make a strong Acid austere, where I observed that these two by themselves produced a strong Coagulation; and stirring of them together, to see if the whole might not be brought to mix by that Means, I found the Coagulum turned into a viscous Body, and a perfect soft Gum. Then I took out the Gum, and poured some Mucilage to the residuous Liquor, by which it was changed so as to assume a whitish Colour, but was not considerably coagulated; which it was the less, because the austere Parts were most of them, with some of the Acid, precipitated into the Gum which had been separated from the serous Part. But if the Spirit of Vitriol and the Mucilage are first mixed, and the austere Liquor be afterwards added, they make a very considerable and plentiful Coagulum, which will only be broken into smaller Parts, and not be dissolved in Water. Aqua Fortis, and the Decoction of Galls being both dropt into some of the Mucilage, made a white Coagulum, which likewise was not dissolved in Water, altho’ with oleum Tartari per Deliquium, and so with Spirit of Sal Ammoniac dropt into it, I presently dissolved it. I found likewise, that the Coagulum made with the Infusion of Pomegranate Peel, red Roses and Balaustia, being mixed with some of the Mucilage, to which an Acid had been put, made the Coagulum more firm, so that it would not dissolve in fair Water; but yet the Oyl of Tartar by Deliquium, and the Spirit of Sal Ammoniac, did the Business in all of them. The Coagulum of the Mucilage made with an Acid, and the Infusion of the Peruvian Bark and several other Astringents, I kept and dried, which when they were first put to the Teeth, seemed a little gritty, though after they were moist they were of a softer Nature. All the Mixtures made of the Mucilage with an Acid and an Austere, produced not only a plentiful Coagulation of a white Colour, but such a one as was of a thicker Consistence, and not Soluble in fair Water, as that was which was made with an Acid only.