pleasure in adding the following, contained in a note in the second volume of the London Medical Commu

nications.

"I quote Dr Cullen as one of the latest and most respectable authors, the mention of whose name always gives me a singular pleasure, as it brings to my remembrance the many advantages I derived from his instruction, and the happiness I long enjoyed in his society and friendship. 'Ηγησεσθαι μεν τον διδάξαντα με την τέχνην ταύτην ίσα γενετησιν ἐμοῖσιν. Hippocr. Jusjurand."

Great and valuable as the additions made to our knowledge of inflammatory diseases, since the publication of Dr Cullen's First Lines, have unquestionably been, a comparison of the accounts which he has given of this class of diseases with those of later writers, will evince that these additions have hitherto tended more to the improvement of the diagnosis and histories of particular inflammatory diseases, than to the introduction of any important changes in the modes of treating them. It is curious to find that even the mode of treating inflammatory affections, particularly of the Chest, by the internal use of large doses of emetic tartar, which has of late years been so strongly recommended by some Continental physicians, had been made the subject of clinical experiment and remark by Dr Cullen in the Royal Infirmary of Edinburgh. In a clinical lecture delivered by him 5th April 1768, formerly referred to (see vol. i. p. 114), in describing a case of fever with inflammatory diathesis, in which the patient had been blooded three times with but little relief, and in which Dr Cullen was averse to the repetition of bloodletting, he observes,-" We trusted to emetic

tartar and blistering. Neither four grains given in twelve hours on the 10th, nor two grains given in three hours on the 11th, had any effect on the disease, because the intervals were too large or the doses too small, but more especially the first.

But doses of one grain each, given every half hour to three times on the 12th, and to five times on the 13th and 14th, brought down the pulse, and made it fuller, firmer, and more equable, induced sleep, and took off delirium."

Among the inflammatory diseases, Dr Cullen included the Gout, and from the bearings of this disease on his general system, he was led to bestow on it much consideration; and he certainly seems to have discussed it in a more simple, and at the same time more precise, manner than had been done by any preceding writer. The opinion which Dr Cullen was led to form respecting the pathology of this disease differed so widely from those entertained at the time he began to teach the Practice of Physic, as to procure for it no inconsiderable degree of attention.

"The opinion," he remarked in his lectures (See Works, vol. ii. p. 120), "which has generally prevailed is, that the gout depends upon a certain morbific matter always present in the body, and that this matter, by certain causes thrown upon the joints or other parts, produces the several phenomena of the disease. Stahl is the only writer who has thought that the supposition of a morbific matter was not necessary, and that the disease could be better explained by the state of the motions of the system. I very early adopted this opinion of Stahl: the contrary, however, is generally received; and when persons wished to shew the absurdity of my opinions, they thought that this was the strongest proof

of it, that I denied the existence of a morbific matter in the gout.'

Sir Charles Scudamore, in a professed treatise upon Gout, has made a number of criticisms on Dr Cullen's definition and history of this disease and its different forms, which it is proper to notice here; their tendency being to induce the belief that Dr Cullen had not duly considered the subject. Sir Charles objects, in the first place, to Dr Cullen having introduced into his definition of gout the character of a "hereditary disease," alleging that the gout is found to be more frequently acquired where no hereditary reference can be traced, than where such influence does exist. In his First Lines, Dr Cullen had himself restricted his defintion by observing (§ 493) that "the gout is generally a hereditary disease, but some persons, without hereditary disposition, seem to acquire it; and in some a hereditary disposition may be counteracted by various causes.

These

circumstances," he adds, "may seem to give exceptions to our general position, but the facts directly supporting it are very numerous." The proportional number of cases in which gout appears as a hereditary or as an acquired disease, will probably in a great measure depend on the state of society at the particular time or in the particular country. Where society is very stationary, wealth remaining confined to the same

*As a proof of the difficulty with which the opinion of the nonexistence of a morbific matter in gout was received by medical men, it deserves to be mentioned that Dr Cullen's theory of gout was opposed on this ground in an inaugural thesis, published by Dr Tode at Copenhagen in 1784, and in another, published two years afterwards at Halle, by Dr Luther.

families from generation to generation, the hereditary character of gout will be most marked. Where, again, by manufacturing skill or commercial enterprise, many persons are raising themselves from the necessity of active labour to affluence and its accompanying ease and luxuries, a large proportion of cases of acquired gout may be expected to occur.

A second character in Dr Cullen's definition of Gout to which Sir C. Scudamore objects, is that of its "arising without any evident external cause," the gout being, according to him, often called into action, even in the first fit, by a cause equally external and evident as that which leads to rheumatism. In his First Lines, Dr Cullen has observed that "physicians have been very confident in assigning the occasional causes of gout; but in a disease depending so much upon a predisposition, the assigning occasional causes must be uncertain, as in the predisposed the occasional causes may not always appear, and in persons not predisposed they may appear without effect." In pointing out what he thinks may be considered as the occasional causes of this disease, which are, for the most part, of an internal description,-he mentions cold applied to the lower extremities; and in his lectures, in pointing out the grounds of distinction between gout and rheumatism, he observes,-" One cause they have in common, viz. sprains; for, if desired to recollect, most patients attribute to this the first fit of the gout, as well as of the rheumatism."

It is not meant by these observations to deny that Dr Cullen's definition of gout, as given in his Nosology, might be improved by being expressed in a more

restricted manner, in respect of the two characters objected to by Sir C. Scudamore; but merely to shew that the exceptions were not overlooked by him in his writings or in his lectures.

Sir C. Scudamore objects to Dr Cullen's division of gout into Regular and Irregular, on the grounds that “the fundamental distinctions convey, on the one hand, more precision of definition than the various modifications which the disease assumes, seem to admit; and, on the other, allow more looseness and latitude of application than is compatible with good practice." "An attack of gout," he adds, "is not the less regular because it seizes some other part not belonging to a joint, or appears in some other situation instead of the foot and hand, or because it proves of long duration, and changes frequently its seat." Sydenham had given the name of Irregular to gout when it appeared in any other situation than the foot; but this was not the signification in which that term was adopted and understood by Dr Cullen, who used it rather as equivalent to the term anomalous, as employed by Musgrave; that is, according to Musgrave's own representation, as synonymous with Internal. In the 518th paragraph of his First Lines, Dr Cullen has stated, in very clear language, the grounds of his distinction between regular and irregular gout, leaving, it is conceived, no room for the very vague objections urged against it by Sir C. Scudamore.

"In the whole of the history already given," says Dr Cullen, "I have described the most common form of the disease, and which, therefore, however diversified in the manner I have said, may be still called the regular state of the gout. Upon occasion, however, the disease assumes different ap

VOL. II.

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