One fact in regard to gout has relation to its intimate chemical and structural pathology, not less than to its outward characters; and forms, in fact, the pathological connection of a great number of its phenomena. The concretions found in the joints in all cases of well-marked and highly developed gput have nearly a uniform composition, into which the mute of soda (see Ulm Amy) enters as a considerable proportion. Uric acid has long been known as one of the constant organic elements of the urine, through which it seems to be habitually expelled from the system. In certain circumstances, uric acid is ddposited also in the form of urinary gravel or calculus (q.v.); 'and it is this particu lar kind of gravel to which the gouty are especially subject, as we have indicated above. A conjunction of facts so striking as these could not but arrest the attention of patholo gists; and it is long since sir Henry Holland and others threw out the hypothesis, that uric acid wart to be regarded as the very materies morbi of gout, of which ancients and moderns had been so long in search. It would be out of place to cuter on the discussion of this subject here; but it must be indicated as a fact of recent discovery, that uric acid in a certain excess has been shown by Dr. Garrod to be characteristic of the blood of the gouty, although a minute amount of this substance is probably present even in per fect health. The most recent speculations, accordingly, tend to connect the gouty pre disposition either with an excessive formation, or a checked excretion, of this impor tant nitrogenous organic acid, the product, as physiology teaches, of the vital disinte gration of flesh and of the food, after these have subserved the daily wants of the system. At this point, the inquiry rests for the present.
The cure of gout, in the highest sense of the word, demands the careful consid eration of all its predisposing causes in the individual, and the strict regulation of the whole life and habits accordingly, from the earliest possible period. It is the difficulty
of accomplishing this which makes gout a disease proverbially intractable; for the regular attacks of the disease seldom occur till pretty late in life, long after the habits have been fully formed which are most adverse to the cure. Rigid temperance in eating and drinking, with daily exercise proportionate to the strength and condition of • the individual, in reality constitute the only radical cure of gout, the lesson of ages of experience as read to the gouty' by the light of science. But the lesson is not learned, or only learned when too late. It should never be forgotten that a man of gouty family, or individually much exposed to the causes of the disease, can only hope to escape it in his old age by habits of life formed at an early period, and by a careful avoidance of most of the common dissipations of youth. That the disease may be warded off in this way, there is ample evidence, and it is not less certain that there is no other way of living secure from gout. The treatment of the fit, in so far as it does not resolve itself into the celebrated prescription of "patience and flannel," must be a subject of medical prescription. The well-known virtues of colchicum (q.v.) are perhaps some what overrated by the public; and its dangers are not less striking than its virtues. It is certain, however, that in cautious medical hands colchicum is a remedy of great value in the gouty. .paroxysm; and of equal value .perhaps are certain natural mineral waters, as those of Vichy and Carlsbad. Alkalies and'theit Salts, especially potash and lithia waters, as prepared artificially, with minute doses of iodine and bromine, have likewise been much recommended for the cure of gouty deposits. For the distinctions of gout and rheumatism, and the presumed relation between them in some cases, see .