This is due to the presence of lithic or uric acid in the blood. The attack usually makes its appearance in the night. The patient is first awakened by an intensely burning and wrenching pain in the ball of the great toe, or some other small joint. This pain continues for about twenty-four hours, and is accompanied by fever. It then remits, and the patient may get sleep, though for several successive days he suffers from the attacks. A similar visitation will likely result after a considerable interval. Recovery from the first attack may be complete--the skin peeling off from the red and swollen joint, and leaving it strong and supple as ever; but, after several repetitions of the attacks, the joint becomes stiff, owing to the deposit of lithic acid concretions or chalk stones. It is a disease entirely local in its character. It vitiates the blood, affects the general system, and the attack is generally preceded by general symptoms, irritability of temper, unpleasant sensations in the stomach and head, and uncomfortable feelings of body and mind are premonitory symptoms of this disorder. The pain is most excruciating. The stomach, heart, lungs, head, eyes, etc., may also be subject to gouty inflammation. It is caused by luxury and indolence, in the plurality of cases.

TREATMENT. -- During the paroxysm the anodynes should be given and applied; subcutaneous injection of morphine is best. The constitutional treatment should be composed of chimaphilin and apocynin in combination; aolchicum is also a very good remedy; chloroform liniment may also be externally applied. The patient's habits must be regulated, and his diet simplified, to prevent recurrence of the disease.

Those who may desire consultation with the author, in regard to this disease, are referred to page 390. Consultations, either in person or by letter, from those who may desire treatment, are carefully and gratuitously attended to.