cotic or tuberculous. Tuberculosis and warts have a near relation, as is proved by the tuberculous matter producing warts by inoculation. "Goitre and nodosities in the breasts also depend on sycotic dyscrasia and are to be antidoted as early as possible by one dose of Thuja. Goitre is in most cases a kind of critical deposition, of which tuberculosis becomes latent; but, if interfered with by the common remedies, tuberculosis of the lungs is often the consequence. The same holds good of the nodosities of the breast; their operation favors cancerous destruction." A timely dose of Thuja is the remedy proposed to prevent these evils.

"Health and long life," says Sir Wm. Temple, " are usually blessings of the poor, not of the rich; and the fruits of temperance, rather than of luxury and excess. And, indeed, if a rich man does, not in many things, live like a poor one, he will certainly be the worse for his riches; if he does not use exercise, which is the only voluntary labor; if he does not restrain appetite by choice, as the other does by necessity; if he does not practice sometimes, even abstinence and fasting, which is the last extreme of want and poverty; if his cares and his troubles increase with his riches, or his passions with his pleasures, he will certainly impair his health, whilst he improves his fortunes, and lose more than he gains by the bargain; since health is the best of all human possessions, and without which the rest are not relished or kindly enjoyed."―(Sir Wm. Temple's “Works," Lond., 1770, Vol. III., p. 278.) PATHOLOGY.-Concerning the nature of the calcareous degeneration in the arteries of gouty subjects, Dr. Garrod says ("On the Nature and Treatment of Gout," London, 1859, p. 246):

"I have carefully examined those found on the valves of the heart, and the atheroma from the aorta of several gouty patients, having extensive chalk-stones, but have always failed to discover the least trace of uric acid; but the tabular crystals of cholesterine were often present in such matter." He remarks (page 510): "To consider the calcareous deposits as a proof of gouty inflammation, is altogether an error; for I have shown that in gouty subjects, with concretions of urate of soda in nearly all the joints, the deposits from the aorta were of a different character, consisting either of phosphate or carbonate of lime, or of cholesterine and fatty matter."

Calcareous degeneration of the arteries has long ago been observed. Mr. H. Watson ("Medical Commentaries," Vol. I., 1782) found, in the body of extremely gouty subjects the thoracic aorta healthy; but this vessel in the abdomen was ossified from the diaphragm to the iliacs. Morgagni (Vol. II., p. 619) gives the case of Cardinal Cornelli, who died in his sixty-fourth year from metastasis of gout to the heart. He was exceedingly corpulent. After death, the gall-bladder was contain a calculus; the right kidney contained eleven calculi, most of them of considerable magnitude. The cartilages of the trachea were

found to

hard; the aorta was somewhat dilated in the thorax, and in its course through the thorax and abdomen some ossification had taken place. Dr. Saunders (Edinb. Med. and Surg. Journ., Vol. XXX., p. 167) describes the case of a baronet, who died in his sixty-fifth year, and who had been "the subject of severe paroxysms of gout and politics for many years." The coronary arteries of the heart were completely ossified, and the inner surface of the aorta also exhibited ossific formations in different stages. Dr. Cheyne says of one gouty subject, aged sixty years, that "the aorta was studded with steatomatous and earthy concretions." The post-mortem examination of George IV., King of England, whose habits of life, frequent attacks of gout, and great corpulence, during the latter years of his reign, were matters of notoriety, revealed the effects of gout on an extensive scale. It was found that the "three semilunar valves at the beginning of the aorta were ossified throughout their substance, and the inner coat of that blood-vessel presented an irregular surface and was in many parts ossified." Signed: Henry Halford, Matthew John Tierney, Astley Paston Cooper, B. C. Brodie.-("The Times," Friday, July 2d, 1830.)

Dr. Garrod discovered urea in the blood in 1847. Since that time the following general results of chemical discovery have been reached: First. The quantity of urea or uric acid contained in the blood in health is so small that it is hardly possible to discover it.

Second. In gout the blood contains it in considerable quantities in the state of urate of soda. It can be separated from the blood in acicular needles or rhombic crystals of uric acid.

Third. In acute rheumatism the blood contains no more uric acid than in health.

Fourth. In a person under gout the serum of an ordinary blister yields uric acid, except when the part to which the blister is applied is affected with a gouty inflammation.

Fifth.-Perspiration seldom contains uric acid secreted from the blood in gout, instead of being greater, is less than usual. In the regular stage of acute gout, the return is scanty and the uric acid measured by the twenty-four hours' secretion is also diminished. That this acid is thrown out in much larger quantities as the disease is passing off, and it then may amount to even far above the patient's daily average.

In chronic stages of gout the excretion of uric acid becomes much faster decreased, the urea remaining but little affected; the deposits of urates are now more rarely seen, and the urine frequently contains a little albumen. Even in the intervals between the attacks, it is noticed that a deficient elimination of uric acid may point out that the kidneys have undergone some structural change.

The chief fact arrived at by these late researches, is this: that in

every instance gouty inflammation is accompanied by a deposition of urate of soda in a crystalline form; and this is considered a pathognomic phenomenon, seeing that it is not found after rheumatic nor any other inflammation. Numerous examinations have been made of subjects who had had gout in every degree, from the most severe and inveterate form to those who had only suffered in a single joint; and this particular condition was present in them all.

TREATMENT.-Diet.-This should be very light, chiefly amylaceous; diluents should be freely used; alcoholic stimulants should be avoided, except under peculiar circumstances.

Dr. Garrod recommends simple alkaline medicines in alternation with small doses of Colchicum.

Sesqui-carbonate of Ammonia.-When the vital powers are at a low ebb, and there exist great vascular and nervous depresssion. At the same time omit the Colchicum or use it in small doses. (Braithw. Retrosp., No. 41, p. 36.)

Local Applications.-Covering the part with cotton batting over which is spread oiled silk to protect the joint.

Employ all the agents capable of promoting the excretions, especially the kidneys and skin; restore the digestive organs to a healthy state, they being in all cases deranged.

Carbonate of Lithia.-Lithia possesses the remarkable property of possessing the most soluble salt of uric acid that is known. And, seeing that the insolubility of the acid and many of its salts leads to the formation of gravel and calculus, and probably to the deposition in gout the salts of this alkali offer a most promising remedy. Dr. Garrod says he has used them to considerable extent. (Lancet, 1859, p. 645.)

The principal remedies for acute gout, are: Bryonia, Nux-vomica, Colchicum, Bell, Aconite, Rhus, Pulsatilla, Actea-spicata, Actearacemosa, Guiacum, Arnica, Arsenicum, China, Ledum, Sabina, Cantharides. For chronic gout, the best remedies are: Calcareacarbonica, Sulphur, Phosphoric-acid, Aurum-muriate, Iodine, Hepar-sulphur, Phosphorus, Mercurius, Sepia, Silicea.

It will very commonly happen that several of these medicines will cover most of the manifest symptoms which are usually present in gout, but in making our selection, the strictest regard should be had to all the remote and exciting causes which may have exercised an influence. in originating the malady, in order that we may strike deeply at the foundation of the disturbance, as well as at the more immediate and visible phenomena.

In prescribing for gout, we may be governed by the general indications for the different medicines, as pointed out in the last section. Sabina.-Red shining swelling, accompanied by hæmorrhage of a

bright red color. Dr. Hendricks, of Germany, said, he cured a case of this kind by means of two doses of Sabina. Boenninghausen says, he found Sabina the most efficient remedy in gout. And, since it produces condylomata, it may be suspected that this malady so much dreaded by our fathers may have a sycotic anamnesis.

Colchicum is an irritant cathartic, emetic, and diuretic; it has some sedative action on the circulation, and has been long regarded as the specific for gout and rheumatism. Effects of large doses: it is an energetic, acrid, narcotic poison, producing severe vomiting, urgent diarrhoea; dryness and burning of the throat, excessive colic and heat in the abdomen, great depression of the circulation and sometimes suppression of urine. In some cases death results from exhaustion following inflammation of the bowels; death sometimes preceded by headache, delirium, stupor and insensibility, showing its action on the nervous system. All of these symptoms have been caused by two drachms. It was introduced into general practice by Sir Everard Home as a remedy for gout. It acts specifically in small doses, increasing the excretion of urea, even when it does not increase the urine; it is observed to produce all its best effects when it operates without purging.

Given in the large doses usually thought necessary for gout it often removes the local symptoms of pain and inflammation; but it has a tendency to "leave the disease much stronger in the system, and leads to still more calamitous, because still more constant pains of the chronic form of the disease." (Seudamore, On Gout, p. 108.) We have often seen its action prompt, and, at least temporarily, beneficial. When given in doses short of such as excite purging in acute cases, it apparently moderates the local inflammation and arterial excitement, makes the pulse smaller, softer and less frequent; mitigating considerably the severity of the pain. Mr. IIaden, in a work on Colchicum (1820) says, it "controlled the action of the heart and arteries, curing those states of the constitution called diseases of excitement."

Sir H. Halford, in a communication to the Royal Society, says from his long experience, there is no disease for which he prescribed with so much confidence as gout. He found the disease common in every part of the body, the eye, the kidneys, urethra, prostate gland, tonsils; it may appear as angina tonsillaris. An eminent physician tried long to cure one such case, and at last plunged a lancet into the tonsil. Only a little blood flowed; but in a few minutes the disease seized violently on the ball of the great toe, and the angina was forgotten. Colchicum was his exclusive remedy. The celebrated Eau Medicinale, a secret remedy for gout was composed of it.

Rhus-tox-Gout or rheumatism occurring in the spring season symptoms aggravated by external heat, and generally by rest, and manifested by evening and night. See p. 158.

4. ARTHRITIC DYSPEPSIA.-DYSPEPTIC GOUT.

CAUSES. Gout in its irregular forms usually occurs in persons of constitutions naturally feeble, or those weakened by debauchery and excess, or worn out by the cares, fatigues, and accidents of life. It has commonly been supposed that the gouty diathesis depends upon a morbific matter which was in some way eliminated from the system. But this theory, though easily constructed, has furnished little practical proof of its correctness. More recently it has been held to have its origin in dyspepsia; but the best writers have shown that, although symptoms of disturbed digestion are frequent, if not invariable attendants upon gout, they are themselves originated by the same remote cause on which is based the gouty diathesis with all its attendant manifestations of disordered health.

Dr. Gairdner (On Gout, its Causes and Cure, London, 1849, pp. 232), says: "One of the most remarkable results of arthritic indigestion is the presence of acid in nearly all the excretions of the body. This has of late been called the uric acid diathesis." But the term diathesis should be applied to denote a condition of the constitution, "not a simple affection of certain fluids of the body."

Though this acid condition is very general; since Dr. Garrod has proved the existence of uric acid in the blood, and Wollaston found it in the joints; Landerer discovered it between the coats of the aorta, and others have shown that it constitutes a part of various fluids of the body in a state of disease; but we still object to the term expressed in "uric acid diathesis," for various other acids have also been found in the secretions. Berthollet thought that the acid of the sweat was the phosphoric, Berzelius and Anselmino showed it to be lactic. Thenard found it acetic; and in cases of dyspepsia we have, no doubt, the hydrochloric, the lactic and the acetic in the stomach. Again, we have urates in the urine, not only in gout, but from indigestion, ephemeral fever, and other diseases. Dr. Prout says "the lithate of ammonia in the urine is one of the most common attendants of slight dyspepsia from errors of diet." In the course of severe, general diseases, the same substance appears in the urine in a less transient form; "when no food has been taken into the stomach, and when therefore its formation can only be attributed to secondary mal-assimilation of the albuminous contents of the blood and albuminous tissues." Gairdner says, there are also durable deposits of urate of ammonia without much constitutional disturbance, where there was no disintegration of the tissues, and no probable interruption of ordinary wholesome nutrition. He also says that he has often seen cases of true regular gout, in which there was no evidence of excess of urates in the urine;