These are the premonitory signs of an approaching attack of gout. It is of much importance to form a clear conception of them, and mark them distinctly, for this is the best season for remedies. In the next chapter I shall give a somewhat detailed account of the usual course of the disease. I believe there is much truth in an observation of Dr. Craigie, in his 'Practice of Physic,' repeated by Dr. Todd in his 'Croonian Lectures,' that it is in the natural history of gout its real character and nature must be sought. Its natural history, I apprehend, is best seen in its external manifestations, not, however, grouped according to the methods often followed by the students of the great kingdoms of nature in artificial and local arrangements to aid the memory, nor even slavishly set down in the mere order of time. The history of gout has been thus written by the older physicians with a particularity which leaves no room for any new dissertation; but the descriptions of a malady, which distresses every part and every texture of the body, which perplexes and vitiates every function, if given after such methods, only leave a confused picture on the mind. Its various symptoms appear unconnected by any common bond. If the history of the atonic and irregular forms of gout be set down in the order of time, the observer is only led into

doubt and amazement; by meditating over them, and tracing divers signs to a common cause, we shall gain a clearer light, and more faultless beauty of arrangement. It is true, that to describe a disease according to a preconceived notion of its nature is hardly admissible in a science of observation; but the well instructed reader, and still more, the experienced practitioner, do not require that I should weary them with the oftrepeated tale of gout. They will, however, take an interest in seeing its manifold symptoms classed according to some general idea, by which that which was before chaotic and unintelligible · becomes organic and distinct, presenting to the mind a clear outline and satisfactory explanation.

HISTORY DURATION-SEQUELA TERMINATIONS-APOPLEXY— MENORRHAGIA-MELENA-DROPSY-SUDDEN DEATH-CASES

HEREDITARY NATURE.

THE gout has been divided into a great variety of species by nosologists. These distinctions have chiefly had in view the part affected, or the manner of the attack; they have been little attended to by practising physicians. Dr. Cullen reduced the number of these species to four. This, indeed, was avowedly done by that celebrated physician, and has been much followed since his time, less on account of any admitted difference in the nature of such species than for the sake of convenience; but they seem to me not even to possess this very humble recommendation. They tend rather to mislead the mind, by fixing it on unessential, and therefore unimportant distinctions. The four species recognized by Cullen are the regular, the atonic, the misplaced, and the retrocedent gout. Of these, the regular and the atonic gout alone

deserve a separate place; they alone have a solid distinction in the nature and form of the disease. It might be easy to devise a better nomenclature; but these names are now well known, and I am averse to the introduction of new terms into a science already overloaded to such a degree, that the most distinguished practitioners feel the language of our profession more copious than useful or easily remembered.

But there is a distinction to be made in the history of the regular gout of far more importance than these artificial ones; it is that of the different stages of the disease, marking its nature by the effect on the constitution, and guiding our practice by an accurate appreciation of the inroad it has made. In my experience of this complaint, it has appeared to divide itself most naturally, and very easily, into three stages. These, indeed, are not to be separated by any very clear outline, nor by any precise intermissions of time. They are characterised by their effect on the constitution, and are so plainly marked in the history of each individual case, that they cannot fail to impress the mind of a thoughtful practitioner.

In the first stage of gout, the patient, whose strength is yet undiminished, and whose constitution is unhurt, has experienced the attacks of the disease at irregular and distant intervals.

These attacks, it is true, have been severe, and, for the time, have weakened him both generally and locally, but the fury of the malady being once spent, and the balance of the constitution reestablished, he feels little inconvenience, and for the most part altogether forgets his misfortune.

His

The second stage of the disease is marked by more serious affliction. The fits of gout, indeed, are seldom so painful as in its earlier period; but their frequent returns, and the greatly diminished strength of the patient, demonstrate the strong hold which the malady has taken. He now finds exertion much more laborious than formerly. The diminished strength of the limbs, and particularly of the ligaments which embrace the joints, is made painfully evident to him. step has lost its elasticity, his tread its firmness and resolution; his hand-writing, once clear and strong, becomes tremulous and indistinct; he is subject to frequent dyspepsia, and finds it necessary to regulate his diet with great care; many articles of food, formerly taken with impunity, must now be carefully avoided, any excess being attended with serious inconvenience. Intermissions of the pulse, palpitations, and faintness mark the part which the heart takes in the general disorder; the complexion loses its clear