Alexander of Tralles advised bleeding, in order to reduce the local inflammation, and he employed as an internal remedy a plant (her modactylus) that was probably allied to colchicum.
Aetius and Paul of YEgina respectively noted the hereditary char acter of the disease, and the conspicuous influence of fatigue, de bauchery, and drunkenness as exciting causes.
During the middle ages but little progress was made toward a comprehensive theory of gout. The over-rated Arabian physicians merely repeated what they had learned of the Alexandrian tradition.
But toward the close of the thirteenth century, a learned Greek physician, Demetrius of Pepagomenus, prepared for the benefit of his master, the Byzantine emperor Michael Paleologus, a summary of existing knowledge on the subject of gout. In this carefully wrought compilation the theories of Galen dominate the work, but the clinical picture of the disease is accurately drawn. Gout is represented as a general disorder with variable local manifestations, and its causation is ascribed to debility of the digestive apparatus, and an erroneous mode of living. These factors lead to an overloading of the body with peccant humors that discharge themselves upon the articulations. Hence the prime importance of moderation and temperance as pro phylactic measures. But this prescription, so easy to give, was in those days no more willingly accepted than in our own fin de siecle.
During all these centuries it is evident that the distinction be tween gout and rheumatism was not always kept clearly in view.
It was to the learned Baillou, who at the close of the sixteenth century stood at the head of the medical faculty in Paris, that must be credited the honor of establishing the differential diagnosis be tween the two diseases. A century later, Sydenham, in his classical essay, sharply defined the limits of the kindred articular inflamma tions, and studied in his own person the natural history of gout with the truly scientific spirit of the modern school.
The eighteenth century could add but little to the work of Sydeuham.
Musgrave devoted an essay to the consideration of the metastatic and visceral forms of gout; and during the later years of the century, Cullen endeavored to account for the phenomena of the disease by reference to a supposed disorder of the nervous function.
Upon the continent, Boerhaave, van Swieten, Hoffmann, and Stahl wrote learnedly, but contributed very little to the advancement of knowledge of the subject. For many of the years of the seventeenth and eighteenth centuries it was believed that the concretions which hampered the joints of the gouty were due to a precipitate of "tar tar" upon the articulations, this tartaric salt being derived from the ill-ripened wine that Was consumed by the patient.
Sydenham was too far-seeing and too well-read in ancient lore to admit so crude an explanation. He taught the ancient doctrine of
peccant humors that were thus eliminated from the circulation, but it was only through the process of chemical investigation that the true nature of the deposit was determined.
Wollaston and Tennant, in 1797, announced as the result of anal ysis that the concretions of gout consisted of sodium orate, a discov ery that has led up to some of the most important of modern theories of the disease. In England the leaders of medicine during the nine teenth century—Scudam ore, Front, Holland, Forbes, Graves, Good, Todd, Watson, Duckworth, and especially Sir Alfred Garrocl—have elaborated the doctrine of uric-acid intoxication.
In France the same views were accepted by Audral and Payer in the earlier part of the century. Cruveilhier and the pathological anatomists made careful studies of tophi and the articular lesions. Ranvier, d'011ivier, and Laucereaux have devoted much time to the lesions of visceral gout; and in comparatively recent years Charcot has enriched the literature of medicine with his lucid descriptions of arthritic disease, while Bouchard and his pupils have clone good ser vice by emphasizing the diathetic character of the disorder.
In Germany, where gout is less common, the subject has been ably reviewed by Virchow, Senator, Erlenmayer, Seligsohn, Ebstein, and Pfeiffer. It is in England, however, that the subject is still in vestigated with the greatest interest. Latham, Roberts, and Haig are among the most recent students and observers of their national disease. To Haig, especially, belongs the honor of being the most recent, the most enthusiastic, and the most perspicuous of all the writers who have illuminated the subject since Garrod commenced the work that is being thus continued. Incomplete as much of his labor must be considered, it is based upon a correct method, and only needs extension to reach the most important results.
In America the conditions of life during the colonial period were unfavorable to extensive observation of the manifestations of acute gout ; but with the settlement of the country and the growth of lux ury the disease becomes more frequent in the centres of population.
The famous Benjamin Rush devotes a chapter to the subject; and the medical journals of the early part of the nineteenth century con tain occasional references to exhibitions of the disease in the persons of stranded Europeans or Americans who had acquired European habits of life. But, with larger experience, it has become apparent that even among temperate Americans the irregular and masked forms of arthritism are not uncommon.
A whole literature of observations on this branch of the subject is in process of formation, and much that is interesting may be expected from this line of research.