That gout is caused by a morbid matter of some kind is a consequence apparently so clear and obvious, that it is not surprising to find it made the basis of every theory. Indeed, nothing but the strong mind and intuitive sagacity of Dr. Cullen, could have led us from this beaten track. It is indeed an argument against the existence of morbid matter, that authors have differed so widely respecting its nature; yet we have depositions of chalk stones in the joints, and the observation of Berthollet, that previous to the fit there is a less proportion of phosphoric acid in the urine- If how-' ever the chalk stones were the morbid matter, we should see the deposition most copious after a regular fit: they do not however appear until the constitution is weakened, and the fit irregular; and the retention of the phosphorated salt is not peculiar to gout, but generally attends irregular fevers, which chiefly -affect the nerves, as we have often seen. Morbid or acrid matter in the blood will undoubtedly produce fever; but there is no instance where this effect follows, but from some previous change in the state of the constitution, as we shall in a future article show; and, in the instance of hectics only, does this morbid matter produce such regularly formed remittents. Indeed, whether in the access or the decline, the degree of the paroxysm of gout is determined soon after its attack; with the force of its invasion it continues for twelve or twenty-four hours. The kind of inflammation also is peculiar; and it is surprising, that though we have had so many medical arthritics, this has not yet been pointed out. The pain though violent, and the part though brightly ruddy, feels numbed, heavy, and incapable of action. If the pain could be for a moment forgot, the foot would be found to feel like a paralytic one; and, though the muscles Bb 2 which raise the leg are not affected, they drag it along with great difficulty.

Again, supposing morbid matter a cause of gout, the most violent and regular fit should discharge it by depositions on the ligaments, by perspiration,or by urine; but every arthritic knows, that at the moment the most regular fit has ceased, it may be again produced by a variety of causes, and run the same course as before; nor after this second deposition are many constitutions secure. Besides, if there is a period of time when the arthritic is more than at any other free, it is the day or two before the attack. Where then is the matter?

The predisposing and the exciting causer; are equally inconsistent with morbid matter. The former are causes of debility, and the latter cold irregularities of diet, particularly an indulgence in acescents, violent vexation, or fits of passion-. In short, however probable the doctrine, however plausible the arguments, the system is untenable.

Dr. Cullen, in his Pathology of the Gout, says, in some persons there is a certain vigorous and plethoric state of the system, which, at a period of life, is liable to a loss of tone in the extremities. This is in some measure communicated to the whole system, but appears more especially in the functions of the stomach. When the loss of tone occurs, while the energy of the brain retains its vigour, the vis medicatrix naturs is excited to restore the tone of the parts, and accomplishes it by exciting an inflammatory affection in some part of the extremities: when this has subsisted for some days, the tone of the extremities, and of the whole system, is restored, and the patient returns to his ordinary state of health; and it is owing to a deviation in some of these principles that he accounts for the difference in the species. Dr. Cullen, and indeed several others, consider the gouty matter as an effect, and not a cause, of the disease.

To this theory there may be numerous objections; yet the principle is clear, that gout is a disease of the constitution; that it is produced by debilitating causes; and that the inflammation excited in the ligaments, seems to restore the tone. In an impending fit of gout, an emetic, with aromatics and bark given freely, has suspended or prevented it. The kind of inflammation, and the means by which this change is effected, we cannot vet understand. The boasted vires medicatrices naturae will, we suspect, be ultimately found only accumulated irritability in consequence of its suspension; and we must at last refer to a principle already stated, which we shall often recur to, that debility occasions irregular action only. Thus, in gout, while the extreme vessels are powerfully excited, the muscular system is apparently more torpid; and this torpor of the nerves and muscles of the extremities is, on the other hand, compensated by increased tone of the stomach. If it were the object of this work to build systems, this might be easily expanded: it is our wish rather to establish principles.

As the gout is allowed to be constitutional, so it is undoubtedly hereditary: and the predisposition is often from hence so strong, that avoiding most strictly the remote causes will not prevent it. We must, however, admit, that the disease is most often the effect of the accumulated consequences of the remote causes. These are excesses of every kind; long continued anxiety,.

deep study, late hours, inactivity, &c: each a cans exhausted irritability.

The distinction of gout is a subject of considerable importance. Its relation to rheumatism often occasions much difficulty; and, though we. consider the two diseases as perfectly distinct, yet they are sometimes so combined and blended, as to prevent our seeing which is the principal complaint. In general, rheumatism occurs in consequence of an evident cause, as cold; the gout without any such cause. Rheumatism has no preceding complaints; gout is preceded by languor, flatulency, and indigestion; rheumatism is the disease of the strong and active; gout of those advanced in life; rheumatism attacks the larger, gout the smaller joints: rheumatic limbs, though swollen, are not red like gouty: and rheumatism is not attended with fever so decidedly remitting. These circumstances will contribute to the distinction; but the cases so often run into each other, differ by shades so transient and minute, that the greatest difficulty is found in the distinction of particular complaints.