either gout or rheumatism, according to the extent to which the vital powers of the patient have been impaired from mal-assimilation of food, sedentary habits, hereditary predisposition, or any of those peculiar circumstances which generate that condition of the circulation most favourable to gout; we, moreover, see that in both diseases the morbific matter follows the same general law in fixing its habitat in those particular fibrous tissues which possess the lowest degree of vitality, whether that impaired vitality arises from the depressing influence of cold on structures at all times possessing a low degree of organization, or from their having been the seat of recent disease or injury, or from their being furthest removed from the centre of the circulation. But before entering on the pathology of either of these diseases, it is essential to consider, and if possible arrive at, some definite conclusion on that quæstio vexata, the physiology of urea and uric acid.

The origin of urea and uric acid is one of those mysteries of vital chemistry which the light of modern science has hitherto been unable to penetrate. That they are the means by which both effete nitrogenous matters which have already discharged their office in the animal economy, and by which superfluous nitrogenous

elements arising from an excess of nitrogenous ingesta or from imperfect animalization of the chyle are eliminated from the circulation, there can be no doubt. It is equally certain, from their absence in the chyle and from their presence in the blood in small quantities, even in health, as proved by the researches of Dr. Garrod, that although the nature and quantity of the ingesta, and defects in one or all the functions of chymification, chylification, and sanguification which constitute the primary assimilation of Dr. Prout may increase the quantity of both urea and uric acid, and alter their healthy and relative proportions to each other, that they are the immediate products of vital changes which take place during the second stage of the secondary assimilation of Prout, or the metamorphosis of tissue of Liebig.

The theory of the formation of urea which is at the present day generally taught, although it is very universally doubted, is that of Liebig, who considers that uric acid is the primary product resulting from the action of oxygen on nitrogenous elements which have already discharged their office in the animal economy, and that urea is the secondary product arising from the action of oxygen and water on the uric acid. He says "When uric acid is subject to the action

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

CHAPTER VIII.

pp. 200-238

General observations on the prophylactic treatment, or the preven

tion of gout

pp. 239-266

101,

185,

234,

14, for "discountenance," read "discon-
tinue."

1, for "four," read "few."

pulmonary anections) scarcely амуницу so frequently demands the aid of the physician as that of rheumatism; there is scarcely any that is attended with so much suffering to the patient, that so obstinately baffles, at all events for a time, the best directed efforts of medicine to relieve it, and which, when relieved and even apparently cured, so constantly leaves behind it the germs of future, and only too often of fatal organic disease. It is, therefore, for each and

B

all of these reasons a subject of the utmost practical importance; and, as such, has doubtless on many past, and will again on many future occasions, occupy the serious attention of every practitioner of medicine, from the patres conscripti of the profession down to its youngest members. Our anxiety, however,

when first called in to a case of acute rheumatism, is not alone dependent on the feeling that we have an obstinate, vigorous, and subtle foe to contend with-which may at any time leave the outworks in which it is temporarily located and entrench itself in the heart, the very citadel of life-but it is very materially enhanced by the conviction that our treatment of this disease has not hitherto been based on that sound and accurate knowledge of its true and precise nature which is essential in order to enable us to prescribe with confidence and success, and we cannot help admitting to ourselves, with a feeling very much akin to humiliation, that although we have no difficulty in diagnosing the disease —that although we are acquainted with its immediate exciting cause, and recognise it in the aggregation of symptoms then before us as rheumatism, we are still unacquainted with those changes which supervene on the application of the exciting cause, whether in the blood