Part 5

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.

CHAP. IV.

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.