Dolæus Johannes
Dolæus upon the cure of the gout by milk-diet
The best Way of curing the Gout, (if it may be allowed that Name) is to prevent it, that is, to hinder the Generation of this gouty Humour in the Body; this is to be effected no other way, that I know of, but by Diet: While the digestive Powers of the Body are in such full Strength and Vigour, as perfectly to assimilate the Food into its own Substance, and they be not oppressed with greater Loads than they are able to manage, the Choice of particular kinds of Diet will be of little Consequence; but these are always defective in gouty Persons, and these Defects are productive of different Habits in different Constitutions, which must be attended to in Rules for Diet in general, as well as in the Gout. Long Habits are not suddenly changeable with Safety; and after the Ætas vergens, the human Body doth not freely admit of Changes. A Body always supported in an high Manner, with Flesh Meats, and Wine, will not well bear a sudden Change to a low Diet; and on the contrary, a Body fed upon Water and Vegetables, will not well bear a sudden Change to an high Diet; sudden Repletions or Evacuation is dangerous, and therefore Celsus well advises, Nullum cibi genus fugere, quo populus utatur, interdum in convictu esse, interdum ab eo se retrahere; modo plus justo, modo non amplius assumere, but this is to be understood of People in Health.
Milk seems to be the best Medium of Diet, and yet from what was before said of it, there must be many gouty Constitutions it will not agree with; the same may be said of Turneps, which have been in their Day reckoned Specifick to the Gout as well as Milk; and the Truth is, that many Persons have suffered irreparable Damage, and some lost their Lives, by attempting particular Diets in improper Habits of Body. It is utterly disagreeable either to Reason or Experience, to fix any one general Rule of Diet that shall agree with all Constitutions, or even all gouty Constitutions. The particular Constitutions of gouty Persons are hardly reducible to general Rules, and nothing but Observations, and accurate Judgment, can determine upon them so as to direct a proper Diet. Lewis Cornaro, who is one of the strongest Instances of the force of Diet, in the little Account he hath published, tells us that he found several Particularities in his own Constitution, which his Physicians could no way satisfy him in. One Instance is much to our purpose, old Wine disagreed so much with him, that in the Months of July and August, in his later Years, he was forced to abstain altogether from Wine, this generally brought him to Death’s Door every Year with perfect Weakness; for though he had been gouty, and cured of it by Diet, he never refrained from Flesh Meat or Wine in some small Quantities, nor could he relish or digest his Food without Wine: So soon as the Grapes began to turn, even before they were full Ripe, he had Wine pressed out for himself, whence he was wonderfully restored, in two or three Days, to the Admiration of his Physicians, who could not conceive, that new Wine, before thorough Defæcation, should have so good an Effect. Cornaro describes himself, and his own Diet very honestly; but when he comes to give Rules for others, leaves the Kinds of Food to its Agreement or Disagreement to every particular Constitution; and concludes with this Maxim, which is undoubtedly true with Regard to Diet in general, That for such Persons, to whom no kind of Food is offensive, the Regulation of the Quantity, and not the Quality of the Food is principally to be attended to; in which this Rule is always to be strictly observed, that no greater Quantity even of the most proper Food, be taken at a Time, than the Stomach is very well able to digest.
Having premised thus much about the Regard to be had to particular Constitutions, in ascertaining a Diet in the Gout, we may very well enquire, what Diet is most proper to prevent the Collection of gouty Salts in the Juices of the Body? From what hath been already said, and from pretty certain Experience, we may conclude this to be the Milk of an healthy young Animal, fed upon Vegetables; the next eligible is a vegetable Diet; and if animal Diet be absolutely Necessary, (as no doubt, some Part of it may be to many Constitutions) the Flesh of such Animals, as feed upon Vegetables, is preferable to such as feed upon other Animals. I prefer Wines to vegetable Diet, because all fermented Liquors are produced from Vegetables; of these the softest and smoothest are always to be preferred to the harder and rougher, though none should be used farther than as an help to Digestion; for Water is the Drink proper to all Animals. To assign Reasons for these Assertions would be only to repeat what I have said before; for if that be true, these evidently follow from it.
But so it is, that through the Difference of Constitutions, or different Habits superinduced, many cannot bear a strict Attendance upon one kind of Food; it shall disagree with the Body, be nauseous to the Stomach, fail in giving proper Nourishment, or if too strictly persisted in, may Cure the Gout, and bring on some other more fatal Distemper, or bad Habit, and even this hath been the Case of Milk it self. It is not within the Compass of my present Design, nor indeed, I am afraid, within my Power to enumerate all the several different Constitutions of gouty Persons, and the different Modifications of Diet necessary for them: A Constitution that will bear living upon Bread and Milk, will no doubt be in an happier Way of being cured of the Gout, than one that cannot. But what will not bend, must not be broke; vegetable Food is too flatulent, and gives too little Nourishment to many Constitutions, who require Food already assimilated into animal Substance. Stomachs long used to Wine, require it in Digestion, and in many Cases and gouty Constitutions, even while a Cure is attempting by Diet, a little Flesh Meat must be allowed at certain Times, and the Powers of the Body kept up, by the Moderate use of Wine, chusing the easiest of Digestion, and the softest of each Kind; taking especial Care never to overload the digestive Powers, by too great Quantities; which is a Rule that will hold at all Times, and in all Constitutions; and is of so great Consequence, that if not attended to, it will invalidate the Force of any other Rules that can be given for Diet in the Gout, or any other Distemper.
The Necessity of varying from the strict Milk-Diet, in which the Cure of the Gout absolutely consists, according to the Unhappiness of particular gouty Constitutions; must be left to the Observations of the Patient, of the Agreement or Disagreement he shall have experienced of particular Kinds of Food, to his own Body; and to the Judgment and Advice of a skilful and diligent Physician.
CHAP. I
Before I explain this Method of Cure, I would have my Reader take Notice, that he is not to expect any thing perfectly new: I only propose to confirm, by fresh Experience, what hath been long enough known. The Method of Cure here advanced consists in the proper Use of Milk for a Year and upwards. Many will perhaps wonder at my Endeavours to revive a Method so long known and exploded by Physicians, as hurtful to gouty Constitutions, and shortening the Period of Life itself: But being fully satisfied from Reason, and certain Experience, that this most excellent Remedy is the Gift of Providence, for the Relief of Persons afflicted with this cruel Distemper, I could not help drawing up and communicating my Experience and Observations for the Relief of others.
Cornelius Celsus, the celebrated Roman Physician, speaking of the Pains and Evil that gouty People suffer, tells us of some Persons who entirely avoided this Distemper by a strict Adherence to the Use of Asses Milk, and of others that by abstaining a whole Year from the Use of Wine and Women, were never afterwards troubled with it.
Among the Moderns, John George Grezzell hath wrote a very learned Treatise upon the Cure of the Gout by Milk, wherein many curious and useful Observations are delivered; that excellent Physician Dr. James Sacks hath inserted, in the German Ephemeris, a Method for the Use of Milk, communicated to him by a noble Baron, wherein many useful and elegant Observations, founded upon Experiment, are contained. The late learned Waldsmid hath published a learned Dissertation upon the Relief of gouty Persons by Milk, wherein he agrees with the Authors now mentioned as to the Cure. I have lately received a Letter from a French Gentleman my Friend, who having been for many Years afflicted in a most terrible Manner with the Gout, hath been now by the Use of Milk, free for some Years. From these Examples I had Occasion to admire the wonderful Effects of this Diet, and therefore advised it to many gouty Persons here at Cassell, who have all recovered a perfect State of Health, by a strict Adherence to the Regimen Necessary in the Use of this Remedy: Even some whose Limbs were before perfectly crippled, are now able to walk and exercise. Colonel Nicholas Dumont hath experienced the Efficacy of this Method here at Cassell, for his Limbs were so entirely contracted that he was forced to use Crutches, but having confined himself strictly to the Use of this Diet for an Year and an half, he walks very well without a Cane, and hath performed several Journies. I have been free from the Gout my self upwards of an Year, notwithstanding I had three or four Fits every Year for Sixteen foregoing. Colonel Haste hath been restored by the same Means, though he hath had some mild Returns at several Times.
I shall in the first Place communicate the Letter I just now mentioned; next I shall lay down the Rules Necessary to be observed in the Use of this Milk-Diet; I shall then demonstrate from undeniable Principles, that this Method is the most convenient to asswage and cure the Gout, and that no bad Consequences can attend the Constitution, if it be taken with the proper Regulations. The Letter is as Follows.
To Monsieur de Collet
SIR,
Nothing can be more agreeable to me, than to satisfy the Desire of my Friends afflicted with the Gout, in communicating the Method of Diet, by which the Marquis de Bongi, Mons. Chamar, and my self were relieved from the Gout; you will please to take Notice, that the Milk we used was fresh drawn from the Cow, Morning and Evening, without other Art than that we both eat and supped it, as warm as we could well bear it; my Reason for mentioning eating and supping the Milk, is, because as soon as we arose in the Morning we supped a large Bowl of warm Milk; but the Milk which was brought us at Dinner and Supper, we eat with fine light Bread, cut thin and put therein; this is all our Secret in this Matter. Persons afflicted with the Gout may promise themselves Relief, provided that once a Month, during the Course of this Diet, or at least once in two Months, they take a gentle Purge, which we made Use of, and were so strict in our Regimen, that we neither drank Wine nor, eat other Food, than Biscuits made of very fine Flower, Eggs, and Sugar, and some sweet Fruits, as Strawberries in Summer, but we chiefly avoided Raspberries. For my own Part, I never sweetned my Milk with Sugar, though some Friends who were in the same Course did, yet without any bad Effect. The Marquis de Bongi used to mix Crabs Eyes with his Milk before Dinner, upon a Presumption, that it would prevent any Sourness in his Stomach, but neither Monsieur Chamar or I ever used that Remedy. When we had strictly adhered to this Diet for a Year, we began to hope we might eat Fish, or indulge our Appetites in some varieties of Food, which one or other of us did, more or less, occasionally, and without any bad Effects. At the End of Nine Months I apprehended my Stomach to be somewhat weakened, which made me resolve to use a Glass of Wine after my Milk, and accordingly after Dinner and Supper every Day, I drank one Glass of Wine, in which I sopped a bit of Bread; this was very delicious to me while I used it. At length as we found the State of our Healths to mend, we began to eat and drink with our Friends. This Method hath succeeded so well, that we live hitherto in our common Way upon Milk, yet not so strictly, but that we dine or sup, once, twice or thrice a Week with our Friends in their Manner, and return afterwards to our Milk without Ceremony; and by the Blessing of God we are wonderfully well. We dont here pretend to say, that none of us have been since afflicted with the Gout, for the Marquiss de Bongi hath had two or three pretty sharp Fits; but both he and I know the Difference between having two or three Fits in nine or ten Years, and of being perpetually oppressed, and confined to Bed with this cruel Distemper, which was our Case before; especially the Marquiss de Bongi, who at Six and Thirty was almost continually confined to his Bed, deprived of the Use of his Limbs, and the Joints of his Hands and Feet knotted and chalky; instead of which, he now uses his Limbs without any Marks of Infirmity, insomuch that any one who had seen him in his former bad State, and compares it with his present, would look on him as one raised from Death to Life. As for Monsieur Chamar, and my self, who are more advanced in Years, considering our Age, we are mighty well; ’tis true indeed that sometimes, as upon Changes of Weather, or of the Moon, we find (or at least we fancy so) that we have some Threatnings of Pain, especially about those Joints where the Gout used to ravage, but a little Exercise soon dissipates those Apprehensions.
It is now Seven Years, that Monsieur Chamar and I have adhered to this Diet, in all which Time we have neither of us been so far oppressed by the Gout, as to be confined to our Beds, or even to our Chambers, so much as one whole Day; notwithstanding before we fell into this Method (though we were not perpetually under actual Fits of the Gout) we had a continued Weakness in our Limbs, we walked very infirmly and with difficulty, and if we chanced to make a wrong Step, or to slip in walking, we suffered Extremity of Pain; our Case is now so far altered, that we walk as firm, as if we had never had the Gout. I must confess indeed that both the Marquiss and I used the Diet for a good while, before we perceived any manifest Change, but afterwards our Pain diminished by Degrees, and the Strength of our Limbs returned. The Milk must be used a good while, that the natural Temper and Vigour of the Constitution may have Time and Leisure to come to itself; for though this Diet may be often used Six Months or even Twelve before the Patient can use his Limbs free from Pain, yet let him not despair, for if once he begins to gather Strength, it will daily increase. As to Purging, and Evacuation of the Humours, if possible it should be done once a Month, in the Decrease of the Moon: I hold purging extremely Necessary; for my own Part, it was what I did for the first Seven or Eight Months of this Diet constantly, till I grew tired of it. This is truly the Method I used, and though I afterwards remitted, I found no bad Consequence. The Marquiss and I, at present, take a Bowl of Warm Milk every Morning, but for the Rest of the Day drink and eat as usual. The Marquiss indeed, for the Space of Eight Years, hath had at Times several small Fits of the Gout, but for my self I have hardly had any, except sometimes upon Changes of the Weather, or of the Moon, I have perceived a Numbness and Weakness in my Knees and Joints, like Threatenings of the Gout; but I thank God, it never confined me, and as it came on easily, it as easily went off. The following is the Method of purging: Take of Scammony, white Turbith, Hermodactyls, Leaves of Sena, Sarsaparilla, Cinamon, and Sugar, of each one Drachm, powder them very fine, and divide the whole into Seven equal Parts, one of which is a Dose, and may be taken in white wine or a little Broth. It is necessary to purge once a Month, especially in the Decline of the Moon. If it be thought necessary to purge twice in the Month, let the first Dose be taken in the last Quarter, the second the last Day of the Quarter. The Day I took Physick, I used Milk after it as usual. When I had pursued this Course about Seven or Eight Months, I found my Stomach so much weakened from the Milk, that I was forced to take a Glass of Red Wine every Day after Dinner, which agreed mighty well with me, and I have continued it ever since; so that I am often impatient to finish my Milk, that I may have the Pleasure of regaling my self with a Glass of Wine, and a bit of Bread.
CHAP. II
In the foregoing Letter are contained many useful Observations about the Use of Milk, and its wonderful Efficacy in the Cure of the Gout, from uncontestable Facts, in the Account of the Persons there named. I shall next lay down the Method of this Diet, by which many Persons here at Cassell were relieved. Whoever expects Benefit by this Method, must observe the following Rules. No one ought to go into this Diet without having his Body duly prepared; he must take Care by Degrees to change his Habit, and for the first Month to regulate his Diet, by strictly avoiding all Salt or smoaked Meats; Legumes, and stale, acid or feculent Liquors, and to eat white Meats sparingly, with clear small Drink, as small Beer or Barley Water, or Decoctions of the Woods: A Glass of Moselle or French Wine free from Acidity, may be allowed at Dinner, and Gruels and Broths made of white Meats. There is a necessary Caution to be used, that both in Meat and Drink, the Quantity taken be rather within the Appetite than beyond it; for from overloading the digestive Powers, arise Crudities, Flatulencies, and acid Humours, which are the Origine of many Disorders. Upon this Account it is necessary to purge the Bowels, two or three Times a Month, with Tincture of Jalap, Elixir Proprietatis, Rhubarb, some of the purging Pills, as the Arthritick or Mastich Pills; that the Viscidity arising from indigestions may be carried forth of the Bowels, and the Stomach be better disposed to receive and digest the Milk. I am of Opinion, the first Dose should be taken the first Day of the Month, preparatory to this Diet, the second after some few Weeks of this first Regimen, and the third the last Day of the Month; after this I advice the taking an Ounce of Crabs-Eyes, or prepared calcined Hartshorn, especially if there yet remains any Marks of Acidity in the first Passages. This further Caution is very absolutely Necessary, that not only in the first Month, but in all subsequent, all Passion, chiefly Anger and Grief be avoided, because of their pernicious Consequences; more especially the Use of Women during the whole Year.
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.