Gout , a painful disease affecting principally the fibrous tissues about the smaller joints, and intimately connected with an excess of uric acid and its compounds in the blood. Various names have been given according to the part affected, as podagra when in the feet, chiragra when in the hands, etc.; but all such, and probably many cases of neuralgia accompanied by oxalic deposits in the urine, are mere forms of one disease. A common attack of acute gout is generally preceded by uneasiness, indigestion, loss of appetite, nausea, and vomiting, biliary derangement, dull pains or numbness in the parts to be affected, often with feverish symptoms; but in some cases, on the contrary, the disease comes on in the midst of apparent health and well-being, and occasionally at night during refreshing sleep. In most cases it makes itself known by an acute pain in the metatarso-phalangeal joint of the great toe; different sufferers compare this to the sensations produced by the contact of a drop of cold water, or of cold or heated metal, or by twisting, dislocation, or laceration, as by a nail or wedge driven into the foot; this is accompanied by feverish symptoms, urinary sediment, extreme tenderness, restlessness, involuntary muscular contractions, sleeplessness, and perspiration; the affected joint is swollen, red, and hot.

This series of symptoms may last four or five days, to be followed after a day or two by three or four others, continuing in all from two to three weeks; the severity of the attack, its persistence, its seat, and its metastases vary according to circumstances. This first warning past, the luxurious epicure may not receive another, even if he persist in his indulgences, for months, or perhaps years; but the second comes, and the third, and so on, the intervals between the attacks becoming less; though the pain be less severe, the joints are more discolored and swollen, with oedema and chalky deposits in their neighborhood; and by a sudden retrocession toward the internal vital organs, life may be seriously threatened. When gout becomes chronic the attacks are more irregular, less severe, more frequent and sudden, leaving one joint for another after slight exposure to cold and moisture, excess at table, or vivid emotions; in this form, the continuance of the pain and the fear of injuring the gouty joints render its subjects cross, fretful, and disagreeable, though persons thus affected are often able to devote themselves to serious study and important private and public business.

The pathology of gout reduces itself chiefly to the abnormal presence of uric acid in the blood, and to the deposit of urate of soda in the fibrous tissue around the joints and sheaths of tendons. Gout is rare before the age of 20, and men of robust constitution and of a mixed sanguine and bilious temperament are far more liable to it than females; it may be inherited, and seems independent of climate except so far as it influences the diet of a people, the northern races being generally less temperate in the use of stimulating food and drinks than southern nations. A life of indolent sensuality, amid the excitements and passions of civilization in cities, and the use of highly seasoned animal food with alcoholic stimulants, are the predisposing causes to this disease. A person may have a gouty diathesis, and die from the evils arising from it, without having experienced what is popularly understood as a "fit of the gout;" the gout poison (uric acid) may be eliminated from the blood in any organ rich in fibrous tissue, and from recent researches it would seem that many cases of neuralgia (sciatica and hemicrania), lithiasis, and oxaluria, with oxalate of lime deposits in the urine, are symptoms of the same morbific action, and excess of uric acid in the blood either from over production or accumulation; the habits and manner of life, the tissues most affected, and the peculiar urinary deposit, indicate the identity of the above forms of disease, and the propriety of the same treatment in all.

Organic chemistry teaches that in the gouty diathesis, with excess of urates and oxalates, there is a deficiency of oxygen in the system; hence the uric acid may remain unchanged, or may be oxidized only into oxalic acid, the later remaining as such instead of undergoing further oxidation and being converted into carbonic acid and urea, in which forms it can be removed from the organism. We find gout attacking the upper ranks of society, who indulge in a highly nitrogenous diet, which tends to produce uric acid in excess, even though the normal quantity should be duly eliminated, and the disease assumes the form of urate of soda deposits in the joints; in the lower classes, consuming less animal and stimulating food, and taking in more oxygen from their daily exercise, the uric acid becomes the oxalic, and the gouty diathesis manifests itself in neuralgia with oxalate of lime in abundance in the urine. By many authors rheumatism is considered closely allied to gout; and accordingly cases of the latter disease affecting especially fibrous tissues are sometimes called rheumatic gout, a pathological hybrid as absurd and impossible as scar-latinic measles would be, as Dr. Garrod has clearly shown; a gouty person may have also rheumatism, but the two diseases are distinct and cannot pass the one into the other, the former having as a prominent character an excess of uric, and the latter of lactic acid. - There are few diseases which have more empirical remedies extolled for their cure than gout; almost every drastic purgative, diuretic, tonic, and narcotic has been pressed into the service, either for external or internal use.

To say nothing here of soothing topical applications, colchicum has enjoyed, and deservedly, a great reputation in the treatment of gout and neuralgia, between the attacks and in their chronic forms; it is most efficacious when it acts upon the skin and bowels. The acetate of potash and other alkalies are in favor with many, both for their diuretic property and as alkalizing the acid in the blood and urine. Ni-tro-muriatic acid has been found of advantage for supplying the oxygen necessary for the conversion of the uric into oxalic acid, and the latter into carbonic acid and urea. The judicious use of purgatives, abstinence from highly nitrogenous food and stimulating drinks, attention to hygienic rules, and avoiding exposure to dampness, cold, and fatigue of body or mind, are absolutely necessary as aids in the treatment of this disease.