when employed alone, are chiefly applicable when the disease consists generally in stiffness and coldness, without much pain. When, however, the latter prevails to any extent, which is very commonly the case, our most powerful resource is opium: it may be given in substance uncombined, to the amount of a grain morning and evening; or, what is better, it may be taken in conjunction with antimony, and occasionally a little calomel. In other cases, 10 or 12 grains of Dover's powder may be tried. Opium also, applied externally, is often of great service in affording relief from pain: two drachms of the tincture, may be added to an ounce of the lin. ammoniæ, or any other form of embrocation, and rubbed for five or ten minutes upon the part, before the fire. When the strength of the patient will permit, much benefit will often be derived from the judicious application of the warm bath, the douche, the vapour bath, and shampooing; the selection of these being left to the discretion of the practitioner, or to the result of an actual trial.

In many instances, the constitution of the patient is much impaired; and chief attention must be directed towards improving the general health, correcting the state of the digestive organs, and promoting a more vigorous circulation; such practice not only promoting the recovery of the of the patient from his present attack, but proving the most certain means of preventing a recurrence of the complaint.

When the disease assumes the form of lumbago, and the pain is very severe, cupping from the part presents the most powerful remedy; which, together with opium and antimony, with or without a little calomel, will seldom fail to afford considerable and speedy relief. In less violent forms of the complaint, a blister or some warm or stimulating plaster to the part is often sufficient; and in still milder cases, friction, night and morning, for a quarter of

an hour, with any of the liniments and laudanum already mentioned, will often quickly afford relief. Whatever local treatment may be adopted, we are often called upon to administer opium at night, in order to procure repose. Should the opium cause constipation, it may be counteracted by laxatives, or we may give at the same time, for the purpose, the mixture of carbonate of magnesia, and sulphate of magnesia, with the wine, vinegar, or tincture of colchicum; which, besides maintaining an action on the bowels, probably has some share in affording relief to the patient's disorder.

In sciatica, the treatment ought to be conducted on precisely similar principles. Of course, should cupping or blistering be deemed advisable, the application must be made behind the great trochanter, in order to approach as near as possible to the seat of the disorder. Caustic issues, moxa, and even the actual cautery, have all been occasionally employed from the earliest periods. Both in lumbago and sciatica, acupuncture has not unfrequently afforded considerable or even complete, and, in some instances, instantaneous relief. When there is much torpor of the limbs affected with chronic rheumatism, electricity and galvanism are occasionally found of essential service in restoring activity to the superficial circulation, removing the stiffness and numbness, and giving tone to the muscles. Sparks should be taken at the origins of the nerves from the spine, and continued till a manifest irritation is produced on the skin; whilst a few slight shocks may be passed through the course of the nerves. When galvanism is preferred, the galvanic current may be made to pass also in the direction of the nerves of the affected limbs.

To guard against a relapse, the patient should be warmly clothed, whilst we endeavour to give tone to the system and to the limbs by the judicious application of cold or tepid bathing, and by the use of the flesh-brush.

GOUT THE PODAGRA OF CULLEN.

Gout, in some respects, greatly resembles rheumatism; so much so, that the ancients failed to discriminate the two disorders, but treated of both under the general term arthritis; and even at the present day we are compelled to admit that they are not unfrequently associated together in the same individual, constituting a compound disease. By modern nosologists, the term gout is intended to express a great diversity of ailments, affecting either the system generally or particular parts of the body; all, however, apparently depending upon or connected with a similar peculiarity of constitution, all arising from the same causes, and moreover exceedingly liable to alternate with each other. It is the extreme diversity of character occasionally assumed by gout, which renders it extremely difficult to arrange distinctly and with exact precision all the varied, general and local, derangements referable to that morbid condition: nevertheless, we think that, upon the whole, the division of Dr. Cullen will be found to answer every useful practical purpose. He has divided gout into the regular and irregular; subdividing the latter into the atonic, the retrocedent, and the misplaced.

REGULAR GOUT.

The regular gout may be acute or it may be chronic. In its acute form it is characterised by pain, swelling, and bright redness suddenly affecting the joints of the feet or hands, but especially the ball of the great toe, and often accompanied by œdema of the surrounding parts; generally preceded by some unusual derangement of the stomach; followed by symptomatic fever; and at length going off with a gentle but universal perspiration, a more or less copious

sediment in the urine, and with itching and sometimes desquamation of the cuticle of the affected part; its frequent recurrence leading to great weakness, deformity, and distortion of the extremities, and occasionally to the formation of chalk-stones, either in or around the diseased joints, or in other parts of the body.

The above may be regarded as a very general definition of an attack of acute regular gout; but of course it is variously modified in different cases, and even in the same person at different times. It very commonly happens, that for some time previous to an attack, the individual suffers more or less from flatulency, acidity, pain or uneasiness at stomach; from eructations; or from feelings of anxiety, oppression, and lowness of spirits; or he probably experiences a sense of weight, coldness, numbness, or cramp in the limb about to be affected; with or without a remarkable fulness of the veins: it nevertheless frequently happens that he has no such warning, but is suddenly seized in the night, on awaking from sleep, with severe pain in the joint originally attacked, which, as already observed, is most commonly the ball of the great toe. It is indeed true, that in some instances the pain is moderate at first, somewhat resembling spasm or cramp, and thence leading the person to imagine that he has received a strain or hurt: in a majority of cases, however, the pain is loudly complained of from the beginning, and is compared by the patient to a gnawing, tearing, or laceration of the part; or he feels as if melted lead were poured upon it; whilst, from the extreme sensibility of the inflamed joint, the slightest touch or movement cannot be borne: indeed, this extreme sensibility and torturing pain constitute the most striking feature of an attack of gout; and serve in some measure to distinguish it from rheumatism, to which, as before stated, it is very closely allied.

It generally happens, that in about twenty-four hours, or towards the morning of the following day, the pain abates; the abatement being usually attended with a gentle perspiration. The respite, however, is but transient, the pain for the most part returning in the evening, in some instances, with increased violence, and attended with bright redness, swelling, and such extreme sensibility of the part, that the patient feels and expresses the greatest alarm at the mere prospect of any thing approaching or touching it. With these symptoms, there is commonly more or less symptomatic fever, indicated by great restlessness, a quick and strong pulse, a hot and dry skin, thirst, a white tongue, some morbid change in the character of the urine; and in some cases, by such disturbance of the brain as to amount to actual delirium; the whole frame, both body and mind, manifesting in most instances a remarkable degree of susceptibility. In a short time the daily accessions of pain become gradually less and less severe; and at length, perhaps at the end of a week, ten days, or a fortnight, cease to return; the redness and swelling subside; the cuticle perhaps desquamates; the perspiration is secreted more freely and universally; the urine probably deposits a more copious sediment; the surrounding oedema disappears; and the patient not only becomes suddenly convalescent, but very often, especially if it be a first attack, experiences afterwards a degree of alacrity, both of body and mind, to which he was formerly a stranger: or, what is not less remarkable or less common, some inconvenience or discomfort, connected with pain or uneasiness in some part of the body, which had annoyed him previous to the attack, entirely vanishes, leaving him with at least renovated spirits, if not with an actual increase of bodily vigour.

The above may be regarded as a general description of what usually takes place in an attack of acute regular gout;