I have described the most common form of the disease; and which therefore, however diversified in the manner I have said, may still be called the regular state of the gout. Upon occasion, however, the disease assumes different appearances; but, as I suppose the disease to depend always upon a certain diathesis or disposition of the system; so every appearance which we can perceive to depend upon that same disposition, I still consider as a symptom and case of the gout. The principal circumstance in what we term the Regular Gout, is the inflammatory affection of the joints; and, whatever symptoms we can perceive to be connected with, or to depend upon, the disposition which produces that inflammatory affection, but without its taking place, or being present at the same time, we name the Irregular Gout.

519. Of such irregular gout there are three different states, which I name the atonic, the retroce→ dent, and the misplaced, gout.

520. The atonic state is when the gouty diathesis prevails in the system, but from certain causes, does not produce the inflammatory affection of the joints. In this case, the morbid symptoms which appear are chiefly affections of the stomach; such as loss of appetite, indigestion, and its various circumstances of sickness, nausea, vomiting, flatulency, acid eructations, and pains in the region of

the stomach. These symptoms are frequently accompanied with pains and cramps in several parts of the trunk, and the upper extremities of the body, which are relieved by the discharge of wind from the stomach. Together with these affections of the stomach, there commonly occurs a costiveness, but sometimes a looseness, with colic pains. These affections of the alimentary canal are often attended with all the symptoms of hypochon. driasis; as dejection of mind, a constant and anxi. ous attention to the slightest feelings, an imaginary aggravation of these, and an apprehension of danger from them.

In the same atonic gout, the viscera of the tho rax also are sometimes affected, and palpitations, faintings, and asthma, occur.

In the head also occur, headachs, giddiness, apoplectic and paralytic affections.

521. When the several symptoms now mentioned occur in habits having the marks of a gouty disposition, this may be suspected to have laid the foundation of them; and especially when either, in such habits, a manifest tendency to the inflam matory affection has formerly appeared; or when the symptoms mentioned are intermixed with, and are relieved by, some degree of the inflammatory gout. In such cases there can be no doubt of considering the whole as a state of the gout.

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522. Another state of the disease I name the retrocedent gout. This occurs when an inflam, matory state of the joints has, in the usual manner, come on, but which, without arising to the ordinary degree of pain and inflammation, or, at least, without these continuing for the usual time, and receding gradually in the usual manner, they suddenly and entirely cease, while some internal part becomes affected. The internal part most

commonly affected is the stomach, which is then affected with anxiety, sickness, vomiting, or violent pain; but sometimes the internal part is the heart, which gives occasion to a syncope; sometimes it is the lungs, which are affected with asthma; and sometimes it is the head, giving occa sion to apoplexy or palsy. In all these cases,

there can be no doubt of the symptoms being all a part of the same disease, however different the affection may seem to be in the parts which it at tacks.

523. The third state of irregular gout, which we name the misplaced, is when the gouty dia. thesis, instead of producing the inflammatory af fection of the joints, produces an inflammatory affection of some internal part, and which appears from the same symptoms that attend the inflammation of those parts arising from other

causes.

Whether the gouty diathesis does ever produce such inflammation of the internal parts, without having first produced it in the joints, or if the inflammation of the internal parts be always a translation from the joints previously affected, I dare not determine; but, even supposing the latter to be always the case, I think the difference of the affection of the internal part must still distinguish the Misplaced from what I have named the Retrocedent Gout.

524. What internal parts may be affected by the misplaced gout I cannot precisely say, because I have never met with any cases of the misplaced gout in my practice; and I find no cases of it distinctly marked by practical writers, except that of pneumonic inflammation.

525. There are two cases of a translated gout; the one of which is an affection of the neck of the bladder, producing pain, strangury, and a catarrhus vesica: the other is an affection of the rectum, sometimes by pain alone in that part, and sometimes by hæmorrhoidal swellings there. In gouty persons, I have known such affections alternate with inflammatory affections of the joints: but whether to refer these affections to the retrocedent or to the misplaced gout, I will not presume to determine.

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526. From the history which I have now delivered of the gout, I think it may be discerned under all its various appearances. It is, however, commonly supposed, that there are cases in which may be difficult to distinguish gout from rheumatism, and it is possible there may be such cases: but, for the most part, the two diseases may be distinguished with great certainty by observing the predisposition, the antecedents, the parts affected, the recurrences of the disease, and its connection with the other parts of the system; which circumstances, for the most part, appear very differently in the two diseases.

527. With respect to the gout, our next busi ness is to investigate its proximate cause; which must be a difficult task, and I attempt it with some diffidence.

528. Upon this subject, the opinion 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.

529. This doctrine, however ancient and generál, appears to me very doubtful; for,

First, There is no direct evidence of any mor bific matter being present in persons disposed to