Another disease has occasioned us some little trouble, viz. a gutta rosea; an erysipelas affecting the joints, sometimes attended with pain. The distinction, though not easy, is on the whole sufficiently clear. The gutta rosea, though of a bright red, has not the peculiar colour, nor the shining appearance, of gouty inflammation: it does not exacerbate with the regular exacerbations of fever: it is not preceded by languor, which is removed by the pain; but often attended through its whole course with the particular low fever which attends erysipelas. The pain is rather in the skin than the ligaments, and the tumour bears pressure without greatly increasing it.

Some irregular pains in the joints have been styled gouty, but they are sometimes found in gouty habits without partaking in the nature of the disorder. The only requisite object of attention is, to be cautious in the use of cold applications.

The prevention of gout has employed the attention of the ablest physicians;"and we shall first consider the mode of prevention in those who have a strong predisposition to the disease, as well as in those who have experienced oneortwo gouty paroxysms. We shall afterwards consider the means of relieving or preventing the fit in those who have for a longer time experienced the disease.

If a person is strongly predisposed to gout, abstinence and exercise are absolutely necessary. In the works of an old experienced physician, a mode of diet is directed, consisting of different vegetables in each month. In fact, a milk and vegetable diet is in a great degree necessary, and these directions imply no more. The exercise should be constant and steady, not to fatigue, but to keep all the secretions in their due course. Walking is the only proper exercise; and if to this be joined a dry free air, frequent washing the feet in cold water, and daily friction with a flannel and a flesh brush, we shall obtain all the necessary advantages. Where the predisposition is not so strong, the severity of these rules may be relaxed: a little animal food of a mild nature may be allowed once a day, and cyder may form a portion of the drink. Above all, however, temperance, cheerfulness, early hours, and moderate study, only are requisite: the mind must be occasionally employed as well as the body, for idleness may lead to excess, to uneasiness, and its train of consequences.

If fits regular and painful have occurred, the general plan must be the same. Such, however, is the excruciating nature of this frequent disease, that men have gladly caught at every confident promise. On the first appearance of a fit an emetic has been recommended, to be followed by large doses of bark during the first remission. This it is said has succeeded, and it seems a probable measure, but we confess that we have had no experience of it. The Duke of Portland's powder has certainly prevented the return: it is said, however, by the first authorities, that the most fatal diseases, as apoplexy, dropsy, asthma, and infarcted viscera, have been the consequence. Indeed the circumstance of the remedy, though a very old one, having never maintained its credit for any long continued period, is a strong pre-sumptive evidence of its injurious tendency.

Another remedy employed to prevent gout is a warm cordial eccoprotic. Boerhaave's gout cordial is the prototype of all the secret formulae handed about with much mystery and confident pretensions. It consists of an ounce of rhubarb and two drachms of senna, with a drachm of cardamoms, and as much coriander seed digested in a pint of brandy. We omit the raisins, the saffron, and the cochineal, as useless additions. It has been our fortune to see this often tried with success, it is said: indeed the gout has been prevented, but in every instance apoplexy has terminated the scene at no very distant period. Alkaline aerated water and slight antimonials have been also recommended; but, as they have had no effect on the disease, they have done no injury to the constitutions. Costiveness should be undoubtedly avoided, and for this purpose the pil. rufi. with a few grains of the pulvis antimonialis given occasionally, or every other night, in constitutions liable to costiveness, has completely succeeded in our hands, and been equally effectual with the analeptic pills of Dr. James.

When the fits have appeared, other methods have been resorted to. Dr. Stevenson recommended blisters to the part, and spoke highly of their effects; but he, unfortunately, fell himself an early victim to the gout. Leeches have been recommended by others, it is said, with advantage. A new plan has been lately urged with some violence by Dr. Kinglake of Taunton, viz. immersing the affected part in cold water, and treating the disease as a common inflammation. It is not easy to speak, flagrante bello, without giving offence to one party, but we are impelled by considerations much more powerful than a desire of popular applause. We need therefore only observe, that the plan is wholly inconsistent with every thing we have seen or felt of the disease; and though we doubt not but constitutions have been found so robust as to prevent any injurious consequences from the trial, as some may lie in damp sheets, or take the Portland powder with impunity, yet to the generality it would, we fear, be fatal.

When the fit of gout is formed, it should perhaps be permitted, if regular, to pursue its course without interruption. It has been usual to lay it in soft flannel to ' keep it out' by a warm regimen, and keep the bowels open by the warmest tinctures: the true gout purgative, says an author of credit, is equal parts of the tinc-tura sacra and senna. The whole of this system we suspect to be erroneous. The pain of the fit is a remedy.

produced by nature; and as we in no instance understand, and cannot in any imitate, it, we think the whole process should be her own. We can throw out more gout by hot cordials, but we seem not to render the system freer; we can increase pain, but we do not by this means increase the tone of the stomach. It seems to us more rational, neither to clothe the part warmer nor colder than usual; not to change the diet or the drinks, unless languor or faintness makes cordials necessary. The burning heat of the part will prevent any bad effects from a common degree of cold, and we have generallv found the swelling go on sufficiently and effectually without urging or repressing it. We now speak, however, of a regular inflammatory gout. Many discussions occur in authors respecting the propriety of giving opiates in gout; our decision must depend on their general effects. If they relieve pain, without producing languor, sickness, or faintness, in other situations, they are of service in gout; and, joined with antimonials or ipecacuanha, they have often, we think, shortened and mitigated the fit without apparent injury. It is recommended not to give them in the beginning of a fit; indeed at that time they are of the least service. We see no room for choice among the different preparations, though Dr. Warner prefers his own formula. A tincture of opium in Madeira wine we have some reason to think an useful form; and the Dover's powder, with the acetated ammonia, we have known highly serviceable. Gradually and gently moving the foot, as soon as motion can be borne without much pain, seems to prevent stiffness and weakness in the joint; "and to wipe over the part with lukewarm water when the pain is abated, gradually substituting cold, contributes greatly to strengthen it, and remove stiffness and the more troublesome feelings. It often seems, however, to bring back a little soreness. Purging must be avoided at the end of a fit, as it often brings on a return: a circumstance not easily reconciled with the doctrine of morbid matter.