JAM. 12, ah tow $elaia Dr. Ganod divided into artiular MA nmtiwula; theo foer, d pahaps the latter, might be gibw act or chronic; and ai, gout might be either _tbeni or asthenie. The atilar gou is the most oommon *m, and is generally attributable to hereditay tendency or to fe livg, and mosy follows indulgence of the appetite. Setimes, however, it oceurs in temperate and hardworking persons in the lower ranks of society; this fact was illustrated b# the descrption of the case of a porter, who

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... d been under D r. aod's care. In such subjects, the affection of the great toe is sometimes ascribed to mechanical injury, but the affection in other parts will aid in the diagnosis. In proportion, however, as the disease extends, it becomes difflicult to diagnose it from rhoumatism; and hence it is important to bear in mind the ollowing distinctive characters of the two affections. 1. Gout oocur chiefly in the male sex: rheumatism in females. 2. Gout generally appears at or after middle age: rheumatism is common in the young. 3. The hereditary tendency is more marked in gout; but to this Dr. Garrod did not attach much importance. 4. High living acts as a predisposing, and an ting cause of gout: while low living predisposes to rheumatism. 5. In gout the great toe and other smaller joints are affected, there is pitting on pressure, and the constitutional symptoms are slight in proportion to the local disease: in rheumatism, the larger joints are attacked, there is generally no pitting on pressure, and there is much constitutional disturbnoe, the heart also being commonly affected. 6. In gout, chalk-stones are present: not so in rheumatism. Dr. Garrod had observed that the great toe was affected in 83 per cent. of gouty cases: and that there were deposits of urate of soda in 40.9 per cent. These deposits occur chiefly in the ear, and often are found there alone. In practice, a difficulty in diagnosis may arise from gout assuming many of the characters of rheumatism; a circumstance which has given nse to the application of the term " rheumatic gout" to a certain class of cases-a term, the propriety of which Dr. Garrod was not disposed to admit. To aid in the diagnosis, then, other means are necessary; and Dr. Garrod pointed out that this aid was afforded by ascertaining the presence or absence of uric acid in the blood in abnormal quantity. This acid he has found in the blood of all gouty patients, while it is absent in rbeumatism; and it is also present in effused fluids, as in the fluid of the pericardium, and in the serum of blisters. The method which he commonly employed was to immerse two or three ultimate fibres of linen in a drachm or two of serum, and allow it to evaporate; when, if uric acid were present, it would be deposited in rhomboidal crystals on the thread. Another aid to the diagnosis is the formation of concretions of urate of soda. These are most frequently present in the cartilages of the ears, sometimes in the eyelids, and in the tips of the fingers. These are never found unless the urate of soda exists also in the blood; and are never present in rheumatism. Gouty patients are very liable to be affected by the action of mercury; a grain and a half of calomel has in such a case produced severe salivation. This may occur independently of the presence of albuminuria.