PREFACE.

A PREFACE, modestly stating the grounds on which the author presumes to emerge from the obscurity of private life, and embark on the stormy waters of publication, is deemed essential to every book. I shall therefore briefly state that the reasons which induce me to incur the anxieties and perils of authorship are, that during the first few years of my professional life, I was taught, as others have before and since been taught, by reading, lectures, and clinical instruction, to know rheumatism when I saw it; but I never could obtain any satisfactory explanation from any source as to the true nature of the malady—the cause, in fact, of those symptoms which taken in the aggregate constitute the morbid phenomena which we recognise as this disease.

My medical pastors and masters appeared, when appealed to for an explanation, to be involved in a kind of mental fog. One would rush boldly through by asserting "that it was

caused by inflammation of the fibrous tissues;" another would say "that it was no doubt dependent on the retention of lactic acid and its salts in the circulation." Very strong grounds for doubting the correctness of the first opinion have long existed; and after having searched long and hopelessly for any evidence of the retention of lactic acid and its salts, as the materies morbi of this affection, I was also compelled to abandon that theory, as based equally on a delusion and a myth. The doubts which arose during my pupilage followed me into practice, and I was never able to prescribe for a case of rheumatism without feeling that I was committing legalized quackery.

Numerous circumstances, which it is not neces sary now to enter on, favoured the assumption that rheumatism was a blood disease; while the tenacity with which the disease clung for a time to particular joints or tissues, and then quitted them for others, made it equally manifest that local as well as constitutional causes exercised their due share in the development of this disease. The observation of Liebig that there was

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every reason to hope that we may be enabled by a very simple chemical operation to reason backwards from the urine to definite conclusions as to the quality and composition of the blood,

and by the aid of which the physician may ascertain the changes in the composition of the blood in disease," led me to reconsider the nature of the urinary deposits, in both gout and rheumatism. The remarkable analogy which exists both in the character of the urine and of its deposits in these two diseases, and the striking points of resemblance in some respects between some of the symptoms of the two diseases and the equally remarkable discrepancy which existed between others, led me to infer that the two diseases depended on the formation of the same morbific matter, generated under different circumstances, and acting on opposite conditions of the blood. In order to arrive at any definite conclusion on these points, it became essential to obtain a more accurate knowledge of the laws of lithiasis, or the the physiological principles which regulate the formation, retention, and ultimate deposition of lithates or urates in those tissues for which they have the greatest affinity. This necessarily must be to some extent a matter of conjecture, but my observations and the conclusions derived from them are embodied in the following pages; and however imperfectly they may be expressed, and however feebly they may be advocated, I offer them to the profession and the public, not with an assurance of their

infallibility, for that would be presumptuous, but with that strong conviction of their general correctness which a careful consideration of the subject entitles one to hold. Many men who form opinions, differing from those generally entertained on any given subject, are frequently deterred by the fear of criticism from giving them publicity; if all were influenced by this morbid sensibility, science would stand still. Criticism promotes discussion, discussion ventilates the facts and elicits truth, and it is by the truths of science that pathology becomes enriched and suffering humanity relieved. I therefore venture to publish this book, because I rely with confidence on the old saw,

"Magna est veritas et prevalebit;"

because I am somewhat sceptical of the supposed savage severity of reviewers, and because I believe

in

"The average justice of the popular din.

If it is bad they will not take it in,

Nor will it take them in."

If, on the contrary, the principles are sound, they will conduce to the public good, and will not detract from my humble reputation.

It will be observed that I have avoided appending formula of prescriptions in the treat