ment of these diseases. My reason for doing so is, that every well-informed professional man knows that he never sees two cases of either gout or rheumatism in which the symptoms are precisely alike, and in which the treatment that might be applicable in one case would not require to be very much modified to meet the exigencies of another; and although he might be willing enough to recognise the general correctness of the principles advocated in a treatise of this description, he would never think of adopting prescriptions from this or any other medical work for the treatment of diseases so variable in their character and peculiarities. The public, on the other hand, unacquainted with these circumstances, will use or rather misuse prescriptions in medical books; and they do so, not only to their detriment, but they bring discredit on the science of medicine in general, and the author in particular; and as I despair of attaining the ultima thule of medical bliss, and making "every man his own doctor," I have thought it better to adopt a conservative practice in this respect, by preventing as far as is in my power any man doing himself harm and laying the blame at my door. If rheumatism has been a constant source of doubt and difficulty to the pathologist, it must be admitted by all that

gout has been from time immemorial a fruitful bone of contention. As the last holder of the bone, I have picked it to the best of my ability, and in again throwing it into the arena of medical discussion, I must adopt the language of the heralds of old, “Dieu defend le droit." Doubtless some of my professional friends who hold opinions at variance with mine, will sharpen their pens (their wits, ever keen, will not require it) in order to enter the lists of medical literature, and run a tilt with me in defence of their own views. To this I can offer no objection, as I feel assured that however much we may differ on points of physiology, pathology, or therapeutics, we shall be unanimous in our desire to promote the cause of truth, to elevate that science in which we have a common interest, to rescue this disease from the empiricism which has hitherto surrounded it, and to raise it to that position which from its importance it is entitled to hold, not merely within the pale of the Practice, but also of the Science of Medicine.

2, Suffolk Place, Pall Mall East,

January 1st, 1858.

CONTENTS.

RHEUMATISM.

CHAPTER I.

Introduction-Frequency and obscurity of the disease-Opinions of

Dr. Watson, Dr. Fuller, and the author-Urate of soda, pro-

bable materies morbi—Physiology of urea and uric acid-Liebig's

theory in the main correct, but sufficient latitude not allowed for

disturbing causes in both health and disease-Becquerel's tables

of the comparative quantities of uric acid and urea, as quoted by

the late Dr. Golding Bird, reconsidered-Practical conclusions

to be drawn therefrom

pp. 1-26

CHAPTER II.

Cold and moisture check oxidation of tissue, and thus generate uric

acid-Reasons for supposing rheumatism a blood disease-

Reasons for supposing the urate of soda the materies morbi—

Enfeebled condition of fibrous tissues essential for the deve-

lopment of the disease-Cold and moisture much more favourable

to the induction of rheumatism than cold alone—All debilitating

circumstances predispose-Effects of cold most severely felt

while in a state of exhaustion-Although the symptoms vary in

intensity in every case, they are sufficiently uniform to show their

dependence on the existence of same causes-Dr. Taylor's ob-

servations, showing the relative frequency of fatal pericarditis

in Bright's disease and acute rheumatism
pp. 27-39

CHAPTER VI.

Gouty complications-Obstinacy of local injuries in persons of a

gouty tendency-Undeveloped gout very common in females-

The organic changes which occasion angina pectoris caused by

the long-continued circulation of gouty blood-Comparison of

the most remarkable symptoms in gout and rheumatism, showing

in what respects they most resemble and differ from each other,

and why
pp. 181-199

CHAPTER VII.

Treatment of gout-General observations-Bleeding-Purgatives-

Colchicum; its modus operandi-Ill effects of colchicum; how

induced; the best mode of administering it-Vegetable salts

of potass-Vapour baths and hot-air bath-Pure air promotes

recovery-Inhalation of an atmosphere largely surcharged with

oxygen-Diet-Local treatment Convalescence Remedies

during

General observations on the prophylactic treatment, or the preven-

tion of gout

pp. 239-266

CHAPTER II.

Subject continued-Class of persons who are exempt from gout-

Reasons why-Persons most liable to gout-High development of

the nervous system ill adapted to excesses in diet-How excess

of stimulating ingesta induces condition of circulation favourable

to gout.

pp. 104-117

CHAPTER III.

Function of respiration, how impaired by excess of food and defi-

ciency of air and exercise; its influence in generating the gouty

diathesis-Intellectual pursuits, mental anxiety, high living, and

little exercise combined, generate the gouty diathesis without

any hereditary taint.

pp. 118-130

CHAPTER IV.

Cutaneous action, its influence in preventing gout and lithic acid

calculi-Hereditary tendency considered-Inverse ratio of de-

velopment of the lungs and liver throughout the animal kingdom

-Hereditary tendency to gout aggravated by mismanagement

in early life-Recapitulation of arguments, showing how the

various exciting causes generate that condition of vascular system

favourable to gout

pp. 131-148

CHAPTER V.

Different kinds of gout-Premonitory symptoms-An attack of gout

described and explained-Pain salutary, as shown by the late

Dr. Marshall Hall's theory of reflex action-Atonic form of the

disease-Fatty degeneration of the muscular system, especially

of the heart-The gouty do not die of gout, but from diseases

resulting from organic changes from constant circulation of im-

pure blood-Case of retrocedent gout.

pp. 149-180