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It makes me particularly happy to be indulged
in this my earnest desire of consulting you upon the fol¬
lowing case, convinced that if medicine can relieve, my
Patient may hope for it from your eminent knowledge
and experience. The Gentleman is now in the 48th. year
of his Age of Middle Stature, a lively Imagination, a bi¬
lious habit & exquisitely irritable. Before I enter upon the
present State of his health, it seems to be necessary to take
up his history from the first moment of his existence.
He was born to unhealthy parents, in their decline of
Life, His Father, an eminent Physician, was many years
troubled with thoracic complaints, an Hæmoptoe put a
period to a Life which had been for years prolonged by
art & regularity. His mother dies of a Cancer in her breast.
In his earliest Infancy he was severely afflicted with
the Rickets, the care of his attentive Father in a conveni¬
ent time restored him to perfect health; the principle me¬
dicine made use of was Calomel. As he advanced in years
his health became complete, & his strength was simply es¬
stablished, so that he was as capable of every exertion, &
every degree of Fatigue as any of his Intimates. Untill
his middle time of Life he was accustomed to constant
& sometimes tolerably severe exercise, at this period he
became more sedentary, his Profession (that of the Law)
requiring close application. In the 22d. year of his Age
he felt the first attack of the Gout in his Ancle, in about

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two years he had a return, since which time the Paroysms have
recurred more frequently untill now when he labours under five
yearly. They are almost always exceedingly painfull, & are
for the most part attended with a great degree of Fever, his belly
bound, much thirst, Skin hot & dry, & his pulse full hard &
frequent. his Nervous System is at those times always very
essentially engaged & so very distressing & indeed alarming
are ↑the↑ Spasm which he then experiences that Opium, not¬
withstanding any indication to the contrary has been con¬
stantly found to be indispensably necessary. The fit gene¬
rally terminates in about twelve days & his recovery is
amazingly rapid. You will naturally suppose that such
frequent attacks cannot fail to leave unhappy effects be¬
hind them. He has indeed suffered much, he is nearly alto¬
gether deprived of the use of the Inferior extremities & much
enfeebled in the superior. He has had the advice from many
Gentlemen of great reputation & has tried a vast variety of
Medicines, hot & cold Baths, he has also repeatedly visited
Buxton, Bath, Spa &c. from none of which has he ever
received any kind of benefit. About three years are now
past since at my request he entered upon a Milk & vegeta¬
ble diet, it was but a short time prior to his time for
visiting bath, so that it fell not to my lot to make suffi¬
cient Observation, however he remained here long enough
to convince me that he escaped thereby one expected Parox¬
ysm. the next he had was at bath under the Care of Dr.
De La Cour, that Gentleman was of Opinion that his milk
diet was injurious to him, by his advice therefore he reassured

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his animal food. In February 78 Dr. Fothergill of London was
consulted, he again desired him to return gradually to a vegetable
diet, & also prescribed a constant course of the Decoct: Mezereon
with an injection to keep the Bowels free with a laxative
Electuary occasionally. Possessing sufficient resolution, he
entered upon this Regimen with clearfullness, & persisted
in it with a constancy which merited a better reward, he
does not yet think himself benefited. He certainly is not
in the least let down by his abstemious living, his spi¬
rits are remarkably good, nor is the vis Vitæ in any degree
injured. He has sometimes passed no small quantity
of Gravel in his Urine, & within these few days a stone
of no inconsiderable Size has come away without much
pain or uneasiness. This has made me think seriously
whether the Mephitic Acid with the present diet might
not probably be attempted with some advantage. Indeed
it is an Idea which I conceived on reading your Theory
of the Gout in your first Lines, some time even before I
thought it necessary on account of any nephritic com¬
plaint. ¹ these two disorders you have observed are almost
always to be found in the same subject; & sometimes one
& sometimes the other is indifferently entailed upon the Chil¬
dren of a gouty Parent. does not this in some degree imply
that the predisposing cause of both may be somewhat simi¬
lar? & may we not reasonably hope that a Medicine
which has been found efficacious in one complaint, may
in some degree benefit the Other? I request the favor
of an answer by return of the Post.

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✍

Dr. Jacob Concerning
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May 1 1779.
V. ix. p. 176