Mr. Farr, the eminent secretary to the Registrar, applies to gout the designation diathetic disease; what is meant is that gout exists in the system for a time in a latent state, as a condition, not necessarily exhibiting any symptom of disease either general or local. "A gouty constitution" is the popular expression for this. Sometimes, indeed, it reveals its presence to an experienced observer by shifting or wandering pains (erratic gout), but these are easily mistaken for pains of a different character, if occurring before an overt attack has been experienced. As is well known, acute disease of a very painful and peculiar kind may show itself in such constitutions at any moment, either altogether spontaneously, or excited by some accidental circumstance. The toes, fingers, or other parts of the feet or hands, are usually the seat of the first attack.

After a first overt attack of gout, we may be sure there is the gouty diathesis; and it is now certain that it is a frequent cause of the premature abridgment of life.

Gout is usually attributed to high feeding and luxury. This is by no means universally true. It

occurs, perhaps, more frequently in persons who have indulged to excess in the pleasures of the table, but the taint may be hereditary, or it may be generated by a low diet, and abstinence carried

to extremes.

The question for us here is,-Is there any remedy for the gouty diathesis? A proper regulation of the diet is of course indispensable, and to this is commonly added the free use of alkalies, potass, soda, and lithia, or the alkaline earth magnesia, or the oxide of bismuth. These, either as medicines or in mineral waters, are employed, because in gout there prevails an acid in the system-uric acid, and they serve to neutralize acids. Some slight amelioration, perhaps a prolongation of the intervals between the attacks, attends at first the use of these alkalies, but subsequently, as many medical authors allege, and by their continued action, they aggravate

the disease.

There is one vegetable remedy which has a reputation for relieving the gouty constitution from the pervading poison. It was known and employed long ago, but like many other remedies has

slipped from the books of the colleges, and therefore from practice. This was also for a time the fate of colchicum. The value of colchicum as a means of relieving overt gout was known to physicians 200 years ago; was forgotten, and only came into use again by being made a secret medicine of. Sir H. Halford has the merit of its rediscovery in recent times. In like manner, the winter cherry (Physalis alkakengi) is said to be the active ingredient in a patent medicine reputed to obliterate the gouty constitution.

The very name of the winter cherry, as well as its use as a remedy, was forgotten until I gave a brief account of it in "Household Medicine," in 1862. Since then it has been in a few instances employed, and found to deserve its ancient reputation.

To any reader of this book, who has given attention to the recent progress of science, it will be no surprise to learn that there is good reason to hope that a remedy has been discovered which, at no distant period, will reduce the number of deaths from gout very greatly, if it does not entirely obliterate this item from the Registrar's list. How soon it may be recognised and brought into use, it is impossible

to predict. In the year 1800, a great chemist announced the discovery of an anæsthetic, an agent having the power to render the human body insensible to pain under surgical operations, namely, nitrous oxide, or laughing gas. Teeth could be extracted, limbs amputated, without giving the slightest pain. Sixty-eight years elapsed before it was adopted by surgeons. In the meantime other anæsthetics were discovered: ether, chloroform, etc.; but these also were known many years before adoption.

Again, chloral was discovered in 1832, by Liebig; nearly forty years passed ere it was used to procure sleep, for which it is now found to be so valuable.

How long will it be before sarcosine, the substance alluded to, and described by German Physicians, comes into fashion for the cure of gout?

RHEUMATISM.

Acute rheumatism, or rheumatic fever, a very formidable disease from the amount of suffering it entails, commonly attacks persons at an earlier age than the epoch we are considering. It is very

apt, however, to leave serious damage in the system after its acute symptoms have subsided, which lasts in many cases through a whole life. One of its effects is a tendency to more or less frequent attacks of chronic rheumatism. This may be termed rheumatic diathesis. In whatever it

consists, whether a poison is generated, or a change wrought in the tissues by the acute disease, it too often lingers into old age. I have already mentioned that other painful states in elderly people are very commonly confounded with it. Hence the confusion and contradiction we constantly meet with respecting the effect of remedies. a patient suffering from diffused pains in the muscles, joints, etc., has experienced at some former period of life an attack of rheumatic fever, it affords a presumption that his present pains are rheumatic.

If

The locality of the pains, when they are partially or wholly localized, helps the diagnosis. What are called the fibrous textures,-the ligaments and coverings of the joints, the sheaths of the muscles, are the most frequent seat of rheumatic pain. The coats of the nerves, too,