INSTRUCTIONS 
FOR THE 
Proper Use and Application 
OF THE 
REMEDIES 
PRESCRIBED FOR THE 
GOUT. 
By D. SMITH, M. D. 
Printed for CARNAN and NEWBERRY, in St. Paul's Church- 
yard: Where may be had, by the same Author, A Letter to 
Doctor CADOGAN; Observations on Doctor WILLIAMS'S 
Treatise on the Gout; and his Apology for practising Physic.  



INSTRUCTIONS, &c. 
BEFORE I enter upon the proposed 
instructions, give me leave to declare, 
if they are not strictly and most exactly fol- 
lowed, the patient must not expect that re- 
lief, which I will undertake to promise to 
his faithful observance of them. The uni- 
form success which has, in every instance, 
attended the regular use and application of 
my medicines fully justify me in making 
this promise. 
It too often happens, that persons who 
have been afflicted with any chronical dis- 
ease, presume on their knowledge, and act 
contrary to the directions of their physi- 
cians. Most people who have done this, 
have had occasion dearly to repent it; and,
as  

(4)
as I have seen some very bad consequences 
arise from this conduct in gouty patients, 
I find myself under an indispensable necessity 
to warn all those, who may be inclined to 
use my remedies, not to deviate from my 
instructions. 
EXPERIENCE is the true touch-stone of 
knowledge; without it we are subject to 
perpetual errors; led by it we have a foun- 
dation for reasonable hopes of success.— 
This is particularly the case with regard 
to the science of physic, as every ingenuous 
and candid professor will allow. Few there 
are depending on the most plausible theory, 
who have not seen abundant cause to la- 
ment the falibility of human reason, and to 
retract opinions founded on mere conjec- 
ture: And how much more dangerous is 
it for men, unassisted by science, to deviate 
from the paths of experience? If, on a 
journey, two roads alike present themselves, 
and you take the wrong one, how quickly 
are


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are you led astray? An exact direction 
in this case, from one who had often gone 
the same road, would have been the means 
of guiding you safely to your journey’s end. 
The application is, that, as I have been af- 
flicted with the gout for upwards of twenty- 
five years, have made this disease so atten- 
tively my study, have had so long an expe- 
rience of the remedies used in my own case, 
and lately administered them with such suc- 
cess to others; I may surely, without vanity 
or presumption, consider myself properly 
qualified to instruct patients in the use of 
them with safety and advantage. 
First, let those gouty subjects who are 
in a tolerable state of health, but whose 
joints have been injured and made tender
by this disease, loosen the cork in the bottle 
of the weak liniment, and put the bottle 
into a bason of hot water, reaching half 
way up the bottle: Let it stand in the 
water till the liniment runs like oil; then 
anoint

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anoint every part that has been weakened, 
or made tender by the gout; covering it 
either with fine linen cloth, or soft white 
cap paper, and over that put a single flan- 
nel: In the morning the whole may be 
removed, and common stockings or gloves 
put on as usual, without any danger or con- 
finement. During this application, once or 
twice a week, take as much of the elixir, 
the first thing in the morning, as will pro- 
cure two stools in twenty-four hours, and 
no more; drinking half an hour after a ba- 
son of water-gruel. As different constitu- 
tions are variously affected by purgative 
medicines, begin with a tea-spoonful in a 
quarter of a pint of spring water, after 
having well shaken the bottle: If a tea- 
spoonful does not answer the end, increase 
the quantity till it does: In the day time 
use as much exercise as you can bear, and 
let some part of it be walking. Great tem- 
perance is absolutely necessary, both in eat- 
ing and drinking; I would however recom- 
mend

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mend a free use of acids, and all kind of 
fruit, particularly stewed gooseberries, straw- 
berries, raspberries, and roasted apples, with 
cream and milk of equal quantities. 
The above directions are to be observed 
before a patient has a regular fit of the 
gout; which will not perhaps return so 
soon as usual, if he nicely adheres to them, 
unless the acids should precipitate a fit, 
which may happen if he has been unaccus- 
tomed to their use. 
Secondly, Let those who may have a re- 
gular fit of the gout, and are stout and 
strong when seized, in the first or second 
day (and by no means after) lose from 
twelve to sixteen ounces of blood; and at 
night take the following draught, which 
should be repeated every night if the pa- 
tient continues restless, not otherwise. 
DISSOLVE half a drachm of nitre in two 
ounces of sweet fennel seed water; to this
add

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add tincture of Russia castor and saffron, 
of each, sixty drops for a dose; to be taken 
about ten o’clock. 
To the part affected by the gout, apply 
the weak liniment as directed in the first 
instructions: if this does not take off the pain 
in a quarter of an hour, anoint it a second 
time; if this should not procure ease within 
the time before-mentioned, then anoint with 
the strong liniment; which has never failed 
giving me perfect ease. If any other part 
of the body should be attacked, treat it in 
the same manner. Provided a violent swel- 
ling should come on in consequence of this 
treatment, (which will be a fortunate cir- 
cumstance) do not on any pretext whatever 
suffer the part to be opened and exposed 
to the air, till the swelling is subsided, as 
it may most probably repel the gouty hu- 
mor, which cannot fail of being highly dan- 
gerous. If the swelling should discharge, 
and the flannel stick to the part, as soon 
as

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as the swelling is gone, dress it with the 
gouty salve, spread thin on fine linen cloth,
which will soon heal it without the least 
danger or pain. Every morning, while the
fit continues, take the elixir as directed in
the first instructions. During the fit, ab-
stain from flesh meat, and let your food be
either beef, veal, or mutton broth, not 
strong, nor long boiled, with thin bits of 
bread; or water chocolate: At night, for
supper, eat a full pint-bason of fagoe, not 
thick, but well boiled; with the juice of
half or a whole lemon squeezed into it, add
one spoonful of either red or white wine, 
and sweeten it to the taste: With this eat
a few thin slices of bread and butter. If 
you are thirsty, water with a toast in it
will be a very good kind of liquor; and 
of late I have found it better than le-
monade. If you are oppressed with slatulen- 
cies, take half a drachm of the powder of 
sweet fennel seed, and repeat it if necessary.
B IN 

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INSTRUCTION THE THIRD. I advise those 
who are much debilitated by a fit of the 
gout, either from improper management, or 
any other Cause, to avoid bleeding; which 
in this Case will be highly injurious; so will 
much purging: A sufficient quantity of the 
elixir however must be given, in order to 
procure one stool in twenty-four hours, and 
no more; about half an hour after take at 
least half a pint bason of water-gruel. If 
this will not fit well on the stomach, squeeze 
half a lemon into it, with a spoonful of 
Canary wine, and an agreeable quantity of 
sugar. This kind of food I have frequently 
known stay in the stomach of such debi- 
litated patients when nothing else would; 
and it is absolutely necessary they should 
take much soft nourishing food, particu- 
larly sagoe as directed in the second instruc- 
tions. 
When those patients mentioned in the 
second and third instructions, are so well 
recovered as to be able to digest animal 
food,

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food, and find an inclination for it, let 
them take every day about half an hour 
before dinner, from 30 to 60 drops of 
elixir of vitriol in a gill glass full of spring 
water. By strictly observing this rule, they 
will not only recover their strength much 
sooner, but will likewise prevent the accu- 
mulation of gouty matter, and therefore 
will enjoy a longer interval of their fits, 
and will be better able to bear them when 
they come. 
If a gouty patient strictly observes the 
foregoing rules, (which are certainly not 
difficult,) I will venture to assert, he will 
live free from pain, his fits will be shorter, 
and he will very soon recover the perfect 
use of his limbs, provided the joints are 
not stuft with callosities or chalk-stones; 
and shouid this be his misfortune, it will 
prevent the farther accumulation of such 
substances. 
I shall now subjoin some instructions
with regard to the dress proper for a gouty
sub-

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subject, with some other minutiæ necessary 
to be observed during the paroxysm; which 
as they have contributed to alleviate my 
uneasiness, may serve for the relief of others 
under the same circumstances. Had any 
author done this before, it would have 
saved me from passing many restless and 
unhappy hours; the recollection of which, 
has drawn from me these instructions for 
the benefit of my fellow-sufferers. 
Provide yourself with a jacket made of 
thick soft freeze, lined with white flannel; 
the form of it may be like that commonly 
worn by sailors: Let it be made to unbut- 
ton from the collar to the end of the arm, 
that occasionally it may be taken off or put 
on, without being obliged to bend the arm: 
by this means the afflicted person will be 
enabled to apply the liniment either to the 
elbow or shoulder without pain or much 
trouble; it will likewise greatly facilitate 
his being drest or undrest, which is often 
the occasion of great uneasiness to a person 
labouring under a fit of the gout. 
IN


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IN the next place order a pair of breeches 
of white freeze lined with fine flannel; let 
these likewise be made to unbutton from 
the top to the bottom; in which case they 
can be put on or taken off without bending 
the knee: this will prove highly necessary 
on a variety of occasions, more particularly 
as then there will not be any pretext for 
opening the knee while the liniment is on it. 
Procure also a bed-chair: this is a most
necessary piece of furniture for a gouty 
man. The chairs commonly sold under 
that denomination do not answer the pur- 
pose in any degree; that which I am in 
possession of is exceedingly convenient, of 
which the following description, together 
with the drawing annexed, will, I appre- 
hend, enable any workman to make the 
like. The frame is 18 inches square; the 
legs from the bottom of the frame is 2 
inches long; the back of the chair from 
the frame is 26 inches long, 16 inches wide 
at the bottom, 21 inches at the top; the
side

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side flaps are 17 inches long from the top, 
and 10 inches wide in the centre. 
HAVING the bed properly made for a 
person in the gout is a nicety little attended 
to, tho’ of so much consequence to the un- 
happy patient who lies on it. The fol- 
lowing method has contributed much to my 
ease. In the first place let there be a stout 
foot-board made to fix or remove at plea- 
sure. If there is the least probability of 
the patient’s being confined to his bed for 
any time, let the feathers be drove from 
the head of the bed to the feet; this will 
pre-

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prevent him from sliding too far that way, 
which he will otherwise be apt to do; on 
this place a mattress, and let it be well 
pressed down equally all over the bed, that 
he may not sink too low in the bed, which 
on many accounts is inconvenient. Let 
the under sheet be spread under the bolster, 
and tuck’d under the bed, which will be 
the means of keeping it smooth and easy 
during the whole confinement: It is also 
necessary the sheet should be placed in this 
manner, because whenever the bed-chair is 
put behind the sick person, the bolster and 
pillow must be removed. 
However trifling these instructons may 
appear to persons not much afflicted with 
the gout, I hope they will not be considered 
in that light by those that are, for whose
use alone they are intended; and I am per- 
suaded they will be kindly accepted; at 
least by such as cannot contrive or invent 
with greater facility than myself. To con- 
clude, it is a rule with me as soon as I am
con-

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convinced of the approach of a regular fit 
of the gout, to take to my bed, put on my 
jacket, and wear it as long as I continue 
there. I sleep with my hands out of bed, 
covered over with flannel, or a pair of 
worsted gloves when I can put them on. 
Thus cloathed, I sleep as upright as pos- 
sible, kept up with bolsters and pillows. 
In the day time I have the chair placed 
behind me; and by such simple contrivances 
pass away the time with greater ease and 
satisfaction than can be conceived by any 
who are without these advantages; and, 
during the fit, feel no uneasiness but what 
naturally arise from confinement: I never 
quit my bed ’till I can do it mostly by my 
own efforts, and, for years past, eight or 
nine days have been sufficient for this pur- 
pose, notwithstanding the gout was in almost 
every joint. 
FINIS. 


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APPENDIX. 
TO the first instructions. If any erup- 
tions appear in consequence of the Ap- 
plication of the liniment, discontinue the use 
of it till they are gone; when it may be re- 
peated as before. 
To the second instructions. During the fit, 
take (every day) the juice of two lemons at 
least, sweetened with sugar: Tho’ this may be 
contrary to general practce, be assured no bad 
consequences can possibly happen from it; 
on the contrary, that fever which invariably 
attends a fit of the gout, will be lessened in 
proportion to the quantity of lemon juice 
taken. If the fit has been exasperated by 
the patients having drank much wine, or 
spirituous liquors, or having eat animal or 
high seasoned food, it is possible the liniment 
may not give that speedy relief promised, the 
first day; tho' it certainly will the second,
pro- 


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provided these intructions are in every re- 
spect exactly followed. 
If the patient should take cold during 
the fit, and in consequence of it have his face 
swelled or inflammed, let him in this case 
discontinue the use both of the elixir for the 
gout and the liniment till the inflammation 
disappears; which it will soon do, however 
if he is under any fearful apprehensions, and 
will not wait for its going off naturally, he 
may take every Morning while it last, about 
two drams of cream of tartar, increasing or 
lessening the dose, so that it may give two 
stools in the day. 
Let the elixir for the gout be taken at 
least once a week for two months after the fit 
is cured. 
It will be best to take the elixir of vitriol 
in lukewarm spring water.