Upon the continents of North and South America, the distribution of gout follows the same course that has been observed in Europe. Seldom witnessed in the southern States of America or Mexico, its oc currence becomes more frequent as one approaches the valley of the St. Lawrence. But it is rarely encountered among the hardy and temperate farmers of the country; it is among the wealthy and lux urious children of the newly rich who inhabit the great cities of the sea-coast and the humid shores of the great lakes that the disease in its pronounced articular form is beginning to appear. Upon the great plains and among the mountains of the far West it is practically unknown. The same description applies to the states of South America—gout is unknown among the peasantry, and only occasion ally manifests itself among the opulent classes in the large cities. In the islands of the West Indies the indolent inhabitants rarely suffer with gout, probably as a consequence of their comparatively temper ate habits and life in the open air. Throughout the torrid zone
the malady is unknown, for the same reasons. Consequently, the inhabitants of the greater part of Africa, the whole of India, Siam, Cochin-China, and the larger portion of China, Australia, and Japan, enjoy an almost perfect immunity from the incidence of the disease. Among the islanders of the Indian and Pacific Oceans, although a tendency to obesity is not uncommon, its articular congener is not experienced. It is said that among the numerous English residents of India, but few suffer with gout. This is probably due to the youth and great activity of that population, made up chiefly of laborious officials, soldiers, and adventurers eager for gain. As a contrast may be cited the frequency with which gout occurs among the elderly and opulent English who congregate in Madeira and other sub-tropical health resorts. The same thing may be observed among the wealthy inhabitants of Egypt or South Africa whenever they yield to the se ductions of luxury.