with a small amount of plastery deposit, apparently smeared in streaks over the surface of the cartilages, as shown in woodcut, fig. 15. The tendons at their

point of insertion into the condyles of the femur were also incrusted, especially on the surface corresponding to the small indentations in the condyle of the bone; the semilunar cartilages were freely sprinkled; the anterior and posterior crucial ligaments were whitened

Fig. 15 represents the end of the femur, showing the deposition of urate of soda in streaks upon the surface of the condyles. No chalkstones were visible externally, except two or three small spots on the cartilage of one ear.

externally, and on section, presented in their interior large spots of this deposit. The articular surface of the tibia was streaked in a similar manner to that of the femur, but less extensively; some patches also existed between tibia and fibula.

The right knee was affected in the same way as the left.

The great toe joint was found to be extensively diseased, the articulating cartilages being completely covered, as also the surrounding ligaments, forming in fact a complete solid case.

In the upper extremities the following changes were observed.

The anterior and posterior ligaments of the wrist joint which was examined were sprinkled with a white deposit; a small nodular deposit existed on the external surface of the styloid process of the ulna; the articular cartilage between the radius and ulna was covered with white urate deposit on both surfaces, so also were the articular cartilages corresponding to the wrist joint both on the carpal and radio-ulnar portions; over these surfaces it existed in very much larger quantities than in the knee joints. The fingers were variously affected; in some the sheaths of the tendons were the seat of the deposit, the tendons themselves being completely free; in others, as the index fingers, one joint had the articular cartilage and tendon free, another the surface healthy but the tendon with a very slight deposit on its surface; upon the whole, the tendon and ligaments, especially those around the

joints and at the points of insertion into the heads of the phalanges, were more generally affected than the articular cartilages themselves.

The ligaments connecting the carpal bones to one another and also to the metacarpus, and likewise the carpal ends of the metacarpal bones, especially on their dorsal surfaces, appeared to be one mass of chalk-like concretion.

Carpus.-All the articular surfaces of the cuneiform, semilunar, and scaphoid bones were covered with a layer of white matter, which penetrated and incrusted the ligaments uniting these bones; the ligament connecting the semilunar with the scaphoid was one mass of this matter; the cartilage on the surface of the cuneiform articulating with the pisiform bone was also implicated. All the cartilages of the articular surfaces of the unciform, os magnum, trapezium, and trapezoid, and the corresponding surfaces of the first row of carpal bones were more or less covered, those of the unciform and os magnum particularly so. The articulating surfaces of the second row of carpal bones with the metacarpal were still more uniformly and thickly covered, likewise the carpal surfaces of the metacarpal. The sheaths of the flexor tendons, also the tendons themselves, were superficially incrusted, and, in places, the plaster-like matter extended into the substance of the tendon.

The following were the appearances seen in dissecting one of the fingers of this subject, in which the disease had not made great ravages, as some of

the cartilages were unaffected and others very partially injured.

The cartilage of the metacarpo-phalangeal joint appeared quite healthy, but at the point of attachment of the lateral ligaments, a small amount of the white deposit was observed on each side.

The surface of the first phalangeal joint was partially covered with a thin layer, but much healthy cartilage was visible, and chalk-like deposit existed in considerable amount at the point of attachment of the lateral ligaments with the bone. The same phenomenon was seen in the second phalangeal joint; the tendons in the finger were found healthy, but many spots of matter were seen upon the sheaths.

Several joints in this subject were perfectly healthy, for example, the hips and shoulders, and the left elbow; but the right elbow joint showed considerable incrustation of the cartilages of the humerus, ulna and radius.

In most of the affected joints there was some thick white synovial fluid, which when put under the glass exhibited a crystalline appearance from the contained urate of soda. (Plate 5, fig. 3.)

CASE 7.-In 1858 I had an opportunity of making an examination of the body of a gouty man, who did not present to ordinary observation any appearance indicating the presence of chalky deposit.

The following is a short history of his case, taken during life. About 44 years of age, stout, of mode

rate height, with no hereditary predisposition to gout; had always lived well, and drank rather freely of porter, occasionally mixed with gin; had been exposed to some hardships, and was laid up with yellow fever in Spain. The first fit of gout occurred twelve years before his death, in the ball of one great toe, the second a year after in the same locality; since the latter date he has had several attacks in which the ankles, knees, elbows, shoulders and hips, have been affected; his death was very sudden and depended on cardiac disease; the heart after death was found to weigh nearly fourteen ounces, and there was evidence of much fatty degeneration of its tissue.

During life this patient was free from any stiffness or deformity of joints, and no concretions were visible, saving two or three very minute points on the helix of the left ear, none of which were so large as the head of the smallest pin; in fact, so small were they, that only a most minute and special search would have enabled any one to discover their existence. The post mortem inspection gave the following results in reference to the joints.

The surfaces of the bones in the metatarso-phalangeal joint of both great toes were found completely covered as if with white paint; there was also some redness of the synovial membrane. The right kneejoint, which had been recently inflamed, exhibited much vascularity both of the synovial membrane and fringes. The synovial fluid had a distinct acid reaction, and was speckled here and there with white points.