REFLECTIONS ON Dr. CADOGAN'S DISSERTATION ON THE GOUT, &c. REFLECTIONS, SERVING TO ILLUSTRATE THE DOCTRINE ADVANCED BY DR. CADOGAN, ON THE GOUT AND ALL CHRONIC DISEASES. By THOMAS DRAY, SURGEON. Canterbury: Printed and sold by J. Simmons and H. Kirkby, SOLD ALSO BY GEORGE PEARCH, BOOKSELLER, AT NO. 12, IN CHEAPSIDE, LONDON. The PREFACE. CHRONIC disorders make up a very considerable part of the evils with which the inhabitants of this island are afflicted; and as it is a truth more particularly observable amongst us than the genera- lity of mankind, it is reason- able to suppose that this hap- pens from our own peculiar bad conduct. This the inge- nious Dr. Cadogan has opened to a public view, and though the [6] the subject is not altogether new, yet, his dissertation, from the truths it contains, and the mode of conveying them, re- flects much honour on it’s author. The Doctor hath laid great stress upon acescents in the production of the gout, &c. which may not be clear to, or received as truth by every one. Prejudices in favour of them are very strong on the minds of people, from their long and general use, and not easy to be [7] be removed. If this little per- formance, which is intended to ascertain the truth of his opinion, should meet with the approbation of the public, and tend to the removal of these prejudices, the author will be abundantly satisfied for the little trouble he has been at, as his design is the advance- ment of truth. Two only of the grand causes, assigned by the Doc- tor, as productive of chronic diseases, viz. indolence and in- temperance, [8] temperance, can be said (by a plain implication) to be con- sidered in the following work, it may therefore be not amiss to observe here, that vexation, by hurting digestion, and other functions of the body, may be justly deemed a very pow- erful cause of them. In short, every thing which hurts di- gestion, and contributes to a relaxation of the body, may, with great propriety, be con- sidered as a remote cause of those evils. RE- REFLECTIONS, &c. NOTWITHSTANDING the comments that have been made, in order to weak- en the opinion of Dr. Cadogan, it appears clear to me, that there is too much truth in what he has advanced. His treatise is probably not unexceptionable, and he may in some instances have been too dogmatical: yet that he is right in his judgment of the grand causes of most of our chronic dis- B eases, [10] eases, reason and observatlon seem plainly to evince. Whether the gout be hereditary, or periodical it is unnecessary here to determine; that the gout is very frequent amongst us is but too true, as well as the stone, jaundice, and many other chronic disorders. To point out to the public the general causes of these disorders seems to have been the generous aim of Dr. Cadogan, and I hope to offer some reasons that may not a little help to confirm part of his doctrine.-It is not to be denied Dr. Carter, but fevers may, and do “lay the foun- dation of obstruction, the common and fruitful parent of chronic dis- eases:" or, that chronic disorders are [11] are incidental “to the workers in mines, to the makers of white lead, to the gilders, and various other occupations and employs*," every one’s observations must confirm this; but the afflicted from these causes are few, compared to the numbers who have not been obnoxious to any such cause. Disorders thus pre- valent must have general causes, and why should not these be at- tributed to luxurious indulgencies, when we see that luxury has crept into the habitations of almost every rank of people ? It was a saying, when I was very young, that acids produce the gout, * A free and candid examination of Dr. Cadogan’s dissertation, p. 2. B2 and [12] and I well remember that an aged relation of mine never could take any thing acid, as pickles, vinegar, and the like, without a gouty effect almost instantly following. The observations I have since made has confirmed to me this tendency in acids. Dr. Cadogan has told us, that things acescent "are in their nature, much more prejudicial than things already sour: for, besides, that people take not them in any quantity, the acescent never become sour but by the act of fermentation, which, being raised in the stomach, where it ought never to happen, produces strange tumults, wind, vapor, gas, that is that fume ari- sing from fermenting liquors of any kind, which has been known some- times [13] times to kill at a stroke*.”-If the above be true, that acids tend greatly to produce the gout, which may be justly chosen a represen- tative† of the whole circle of chronic disorders; and that weak stomachs will have an acid generated in them from acescent things, it goes a great way in accounting for chronic dis- eases without calling in the aid of superabundance of food, or any other concurring cause. It is a prevailing notion that such and such things, which are gene- rally reputed antiseptics, are neces- sary to be taken to prevent a putrid * Dissertation on the gout, &c. p. 58, 59. sixth edition, † Ibid. p. 9. dis- [14] dissolution of the blood; but the greatest part of those who are of this opinion, seem not to be aware that evils are likely to arise from the contrary extreme. Yet this is evi- dently the case for these antiseptics, most of which are either acid, or acescent. when taken too freely, must occasion too great a predomi- nancy of an acid acrimony*, and various kinds of obstrustions will be thereby produced. It may be pre- sumed, that the humours of peo- ple who take plenty of vegetable, * That concretions are formed by means of an acid is highly probable, from the power alkalis have of dissol- ving those calculi, which it is likely they effiect by dis- composition; the alkalis having a greater affinity, than the bases of those calculi, with their acids. as [15] as well as animal food, rarely run spontaneously into a putrid state*. The weak texture of the blood, in relaxed habits, does not proceed from a putrescent acrimony, but a languid vis vitae, and therefore the blood wants not many things of the acid or acescent kind to preserve it, which have a tendency to weaken, rather than strengthen, the powers of nature. The state of the blood of those patients, who are called scorbutic, from the appearance of cuticular eruptions, may induce us to believe that a putrescent acri- mony is seldom the cause of those frequent eruptions we see, and * Contagion, and all other causes, that are accidental, capable of producing this effect, are excluded here. which [16] which are therefore, improperly, called scorbutic. To consider a few of those things, which seem to be received amongst us as maxims in physic, and see what inferences may be drawn from a comparative view of them may perhaps elucidate the point in hand. Animal bodies have all a great proneness to putrefaction; and it is well known that heat accelerates the same very greatly: therefore, in a proportion to the heat of our bodies, the putrefactive process will be quicker or slower. According as the action and re- action of the blood and vessels upon each [17] each other are more or less power- ful, which, in a natural state, de- pends upon the degree of elasticity in the fibres, so will the heat be greater or less: therefore; in per- sons of strong, elastic fibres, the putrefactive process will be quicker, than in those of weak, lax fibres.- Strong, tense fibres are the result of exercise; weak, lax fibres of inac- tivity. The learned Dr. Huxham, in his Essay on Fevers* tells us, that “a person, who lives on nothing but mere water, and flesh or fish, with- out any thing either acid or aces- cent, soon contracts a very great * Page 304. D rank- [18] rankness in all his humours; he grows feverish, and at length his blood runs into a state of putre- faction.” From hence it is plain, that a certain proportion of acescent things to correct the putrescent tendency in our animal food is necessary. But does it follow that the daily and unlimited use of acid, and acescent things, may not be prejudicial, be- cause a certain proportion is neces- sary to preserve the humours from becoming putrid? May they not be taken too abundantly? If it be granted that heat accele- rates putrefaction; and that persons of [19] strong, elastic fibres have more na- tive heat than those in a relaxed state: if it be likewise granted, that the former state is the constant re- sult of exercise of body, the latter, of inactivity; may we not naturally conclude, that acid and acescent things may be taken too abun- dantly by the sedentary; and that there is great probability, by the predominancy of them, of their producing much hurt? The diet of labouring men, as those in a farm-house, consists chiefly of bread, pork, milk, butter, cheese, apple-dumplings, potatoes, greens, and the like, and now and then butcher’s meat; with these, are sometimes united, salt and vinegar. D2 Their [20] Their drink, most frequently, is small beer and water. The diet of those in almost every other station of life consists of a greater variety of animal food it is true, But there are not only those acescent things above-mentioned, as part of the labouring man’s diet, but a variety of others taken by these, as wines, different kinds of beer, variety of puddings, and pies, &c. and a much more liberal use made of vinegar, and other acids, and sub-acids. Observe men in the former station, and you will see them healthy, and their blood in a rich, dense state, notwithstanding the genial heat of their [21] their bodies is much greater, from the vigorous action and reaction of their fluids and solids upon each other, than of those in the better station, who, in general, exercise* but little, and have but languid natural powers. If a greater pro- portion of acescents is necessary for the laborious part of mankind than for those in a relaxed state, and who consequently have less genial heat, what must we think, when it is ap- parent that the latter take a much larger quantity of acescent things? * In cases where there is a putrescent state of the blood and juices, exercise tends greatly to hasten the putrefaction of them, as is plain by the deplorable case which Dr. Huxham gives of an eminent surgeon in his neighbour- hood, and most probably by increasing the heat of body: and was there not a sufficient quantity of acescents taken by the labouring men, a putrescent acrimony would soon generated, and destroy them. May [22] May not an attention to the be circumstances induce us to believe that acids and acescent things are taken too abundantly by the inac- tive?—Should it be objected, that though the native heat of body is less in the inactive, than the labo- rious man, yet heat of body may be, and is, in general, excited by cordial, spirituous drinks, which will answer the purpose as well. I answer, that the heat excited by such means is not lasting and equa- ble like the other, and is, in gene- ral, affected by drinking of punch, strong beer, wines, and other such acescent drinks; and, if raised to any great degree by them, the body becomes languid (which every one knows) after their effects are over. The [23] The cordial warmth of these drinks may often prevent acidities from becoming immediately offen- sive to the stomach, and, whilst the heat they occasion lasts, may help to subdue the acids* taken down, and prevent the fermentative pro- * Huxham (in his Essay, page 304) says, that “the strongest vegetable acids we take in with our food are by the vis vitae soon changed into a neutral, or a kind of ammoniacal salts, and by being longer and longer exposed to the action of the vessels, and heat of the blood, they more and more approach to an alkaline nature, and at length would actually become alkaline, were they not di- luted, washed off, and corrected by acescent drink and diet.” I cannot form an idea how acids can be thus changed without an union with some other principle, as a basis. The blood and juices as they degenerate into a pu- trescent state become more and more alkalious; and when there are any of those alkaline salts to subdue, it is not hard to conceive, that a neutral or kind of ammoniacal salts will be produced by the vis vitæ: but if there is an acescency, or acidity prevalent, over and above what is ne- cessary to correct putrescency, I cannot apprehend but that there will be occasioned unnatural unions, by the vis vitæ and heat of the body. duction [24] duction of others from acescents*; but it is highly probable, that it does much more harm than good, by occasioning unnatural combina- tions of the predominating acids, from which (may reasonably be sup- posed) spring most of our chronic diseases.—Dr. Cadogan even denies any help wine is to digestion, on the contrary, asserts, that it does great harm by hardening our food and preventing its dissolution†. That acids prevent digestion, I have great reason to believe.—I had * If cordial drinks do invigorate the stomach, and pre- vent acids from immediately affecting the stomach, and acescents from fermenting, it can be only whilst their warmth lasts, what remains upon it afterwards will affect it much, and more readily ferment. See dissert. page 65. † Ibid, page 61. been [25] been for a long time troubled with a pain in my stomach, and had tried a variety of things to no pur- pose, when one day I thought I would try the effect of acids. I acidulated some water with a small quantity of the vitriolic acid, and drank freely of it with my dinner. My stomach was more than com- monly uneasy for more than three hours, when I was taken with a vomiting, and threw up my aliment as undigested as it went down.—It is not to be supposed that the vege- table acids, or the fermenting acids produced in weak stomachs from the acescent things that are taken in, will act as powerfully that way as mineral acids, but I made no doubt of their having this tendency. E From [26] From what has been said, it is highly probable that a greater quan- tity of acid, and acescent things, than is necessary to correct and pre- serve the blood from putrefaction, is taken down by the sedentary: and that they are a powerful concurring cause of most of those evils, which we complain of, of the chronic kind. The quantity of food has been hitherto but barely hinted, but when the prevailing abuse of this is joined to what is above advanced, it seems a clear solution of the difficulty in accounting for the generality of chronic diseases. When exercise is little, and the body, for want of it, much relaxed, to [27] to take down a large quantity of food*, which the stomach can but illy digest, or if digested, will be more than sufficient to nourish the body, must reasonably produce very ill effects: but much worse are to be apprehended when an acid acri- mony prevails at the same time. I think it cannot well be denied, that the stomach may be provoked to take in more nourishment than it should do in this state of body, by means of the common decora- ments of the table, salt, pepper, vinegar, and mustard, when used * I believe there are few persons of sedentary lives, but what take down too much food. Dr. Cadogan says, "all men eat twice as much as they ought to do provoked by variety." [28] in excess; and notwithstanding the good qualities ascribed to most of them, it is not unreasonable to sup- pose that they may prove hurtful by their acrimony*. Wine, drank at meals, is a great provocative to sa- tiety, and though it may seem to invigorate the stomach, must tend greatly to hurt by this means, par- ticularly those who are in a relaxed state of body. Though it appears very clear, that every one should be careful (the inactive particularly so) that they do not take down too much food? and acescent things; and that, next to exercise, nothing can be so likely * See A free and candid examination of Dr. Cadogan’s dissertation, page 41. as [29] as this caution to prevent the attacks of chronic disorders in general: yet, from the many cares and anxieties in life, every one must find a neces- sity, now and then, of cheering the mind, which cannot be done by any drink do well as wine, though deemed so extremely hurtful by the ingenious Dr. Cadogan. The very frequent use of wines hinders their having this good ef- fect when needful, unless in very large quantities; and, at the same time, the body is hurt by their acescency. It is necessary for every one to know, whether, when dis- pirited, it is for want of what is become habitual or not, otherwise a person may argue that to be of use fre- [30] quently, which in truth is an abuse. When we find ourselves cheer- ful and alert, can cordials be of service? And what plea can be alledged to authorise our recurring to them at this time? They are taken, in general, indiscriminately, but, I am confident, often without any real benefit, and too often to our hurt. The prevalence of cus- tom, and the common mode of as- sociation, are all that can be said for the very frequent use of strong drinks; and indeed it is difficult to avoid drinking more than is be- neficial to us, unless we could get the better of our natural affection, and desire, for society. If drink- ing [31] ing or not associating is the alter- native, and we determine (as social affection must prompt us) in favour of the former, let us be careful in the choice of our drinks. Inactive persons should not match them- selves with those who are in almost constant exercise, but drink such liquors as are not acescent, as brandy, rum, or gin, and water, and these with care. However repugnant it may be to mens inclinations, and however de- termined they may be to pursue the sensual pleasures of eating and drink- ing freely of every thing they fancy, it is a fact, that no persons can have the least shew of title to such a freedom but those who take a great deal [32] deal of exercise; and sooner or la- ter, the dire consequences of such an unlimited freedom will be felt. Exercise has the most salutary effects upon the human frame; it exhilarates us beyond any thing, though not so immediately, much more permanently, than cordial drinks. It invigorates the body, and enables us to enjoy the plea- sures of society without fear of fu- ture ill. In short, by means of exercise we may enjoy health, and yet take moderately of all the good things of this life; but without it, health is hardly to be purchased at any rate, and most assuredly must be soon impaired by a very free in- dulgence in the use of these blessings. There [33] There is one thing advanced by Dr. Cadogan*, which every one ought to speak loudly against. I mean, that a man may without dan- ger quit at once the habit of free-li- ving: this is so very repugnant to reason and experience, that it a- mazes one to see such a doctrine broached. Nature cannot bear such shocks without hurt, and when an habitual course has led us into one extreme, the worst of consequences are to be apprehended from our run- ning precipitately into another. * Dissertation, page 91. FINIS.