I have met with a deposit within the osseous tissue, but even here the deposition appears to be in immediate connection with the matter in the articular cartilage.

As Cruveilhier stated that small cretaceous masses sometimes exist in the substance of the bone itself, quite removed from the cartilage, I have, with a view of testing this point, made numerous sections of bones taken from different gouty subjects, when the surfaces were completely incrusted, but in only two cases was I able to detect the slightest traces of urate of soda.

I consider this a question of importance, having a close relation to the pathology of the disease, believing that deposition can scarcely take place in a very vascular tissue, or, at any rate, in one whose circulation at the time is active. The amount of deposit in the finger (fig. 3) is so extensive that the bloodvessels must have been considerably pressed upon, and probably the circulation in the part was extremely defective, and the cretaceous-looking mass in the metacarpal end of the bone was immediately in contact with the cartilage, which was itself completely infiltrated. I have chemically examined bones where the cartilages were infiltrated, but could never detect a trace of uric acid in their substance.

There are on record some analyses of the bones of subjects of chronic gout, some of whom are stated to have had tophaceous deposits about the joints; one was made by Marchand of the upper part of the

femur, and of the radius and ulna of a person with

chalk deposits on the knees and elbows.

of his examination were as follows:

The results

Lehmann also analysed the bones of three persons

with chronic gout; their ages varying from 40 to 50 years. He found:

It will be seen that there was no uric acid in these bones, thus confirming my own observations; the chief difference between gouty and healthy bones appears to consist in the diminished quantity of earthy matter, and the large augmentation of the fat. Although I have not quantitatively determined the amount of fat in the bones of patients who have died from aggravated forms of gout, I am convinced that it often exists in large quantities, but whether this change is related essentially to this disease, or is merely dependent on imperfect nutrition, requires further observations to determine; it seems that other

tissues besides the bones are apt in these cases to become the seat of fatty degeneration.

One point in connection with the mode in which deposits take place, pointed out by Dr. W. Budd, and which has a considerable bearing upon the pathology of gout, or at least of its local manifestations, is the fact that urate of soda avoids the contiguity of bloodvessels. Dr. Budd states that in the larger cartilages, such as those of the knee-joint, immediately under the synovial membrane, and at the point where this membrane becomes attached to the border of the cartilage, there is a rich network of blood-vessels; from this a series of straight vessels arise, which pass to a certain distance over the free surface of the cartilage, forming loops, which often present considerable dilatations; wherever these vessels extend, the gouty matter is either very scanty or altogether absent. A margin of free cartilage surrounds them on all sides, so that the deposit seems, so to speak, to recede before the blood-vessel. This is clearly shown in Plate 3, fig. 1, a, where the mode in which the deposit has taken place on the surface of condyles of the femur is depicted.

All chalk-stones probably have their origin in fibrous or cartilaginous structures, and are never primarily connected with highly vascular tissues, although by increase of growth and the pressure thus induced, they may subsequently appear on the surface of the body; they are first observed externally in parts of the body where these structures approach

nearest the surface; as, for example, in the ears, on the palmar surfaces of the tips of the fingers, and in other like situations; it will be seen by reference to the drawing in Plate 3, fig. 3, how readily deposition in such parts become visible.

The same remarks especially apply to the white specks so frequently seen on the ear, and which are equally connected with fibro-cartilaginous tissue.

II.—Examination of subjects of Gout, with no appreciable deformity, and no visible deposits of chalk-stones, except one or more specks on the cartilage of the Ear.

CASE 6.-The subject of the sixth case was a man about 50 years of age, with whom I was unacquainted;

he was tall and strongly made, and had died of some acute disease. There were no appearances of deformity of the joints, the movements of which seemed to be performed with tolerable ease, and with the exception of three small nodules of urate of soda, upon the edge and fold of the helix of the right ear, no other deposits were visible externally.

The ear being more closely examined, the nodules were observed to be attached to the fibro-cartilage, bulging outwards, and separating the integuments; it was exceedingly difficult to detach them from the cartilage, as they appeared to penetrate into the very substance of that tissue. Under the microscope the white matter exhibited the crystalline appearance before alluded to (Plate 5, fig. 3), and consisted of

urate of soda, united with the elements of the structure in which it was imbedded.

Each kidney was small, under three ounces avoirdupois, and much contracted in size; on section, the cortical matter was found to be very deficient, and many white streaks of urate of soda were seen in the tubules of the pyramids: appearances which will be more fully described further on.

As there was so complete an absence of deformity, and merely the presence of a few nodules upon the ears, it was a matter of considerable interest to ascertain the condition of the joints, in order to discover whether deposits of urate of soda take place upon the ligaments and cartilages of the articulations, when external appearances would not indicate their presence.

The left knee was first examined; there were small patches of deposit upon the surface, and in the substance of the ligamentum patellæ, as likewise in all the other tendinous structures of the joint; in the former these spots were seen on the superficial layer, extending through to the surface of the bone; the patella itself was quite free from this matter, although sought for by making sections of the bone in various directions; the cartilage on the surface of the patella, which is turned inwards and performs part of the articulation, was of considerable thickness, and sprinkled on its surface and throughout its substance with small white points, some of the spots in the interior not being connected with those on the surface. The articular surface of the femur was marked on both condyles