5i6 DISEASES OF THE ORGANS OF LOCOMOTION. 



disease. We neither know whether the " uric-acid diathesis " be the 

 primary and chief anomaly in gout, and whether it be not accompa- 

 nied by other and more important changes in the composition of the 

 blood ; nor do we know the disturbances of nutrition by which one 

 of the constant products of normal nutrition, uric acid, is formed 

 in excess. The remote causes of gout are somewhat better knowa 

 It is proved by statistics that hereditary tendency is the most impor- 

 tant factor in the etiology of gout. It can be traced in about half the 

 cases. If there be an hereditary predisposition, a slight amount of the 

 following exciting causes will induce the disease, while persons with- 

 out this hereditary tendency are rarely affected by gout, even when 

 they are greatly exposed to the same injurious influences. Gout does 

 not oecur during childhood ; it is ' rarer among women than men ; in 

 the latter it usually occurs after the thirtieth year of life. Among 

 poor folks it is so rare, that the disease is hardly ever seen in hospital ; 

 among the well-to-do classes, it chiefly affects persons given to the 

 pleasures of the table, who drink wine or beer regularly, and take 

 little exercise. All these points render it probable that, next to he- 

 reditary predisposition, the supply of more nourishment than is used is 

 to be regarded as the most important etiological factor of gout. 

 Among children, women, mechanics, and poor people, this dispropor- 

 tion is rare ; but even during manhood, where it is common among 

 the better classes, those persons escape the gout who do not eat and 

 drink more than is necessary to replace what has been used up in the 

 body. The assertion that in the above mode of life a larger amount 

 of uric acid is formed, because so much of the nitrogenous constituents 

 of the body are broken up, that there is not sufficient oxygen intro- 

 duced by respiration to transform them into urea by further oxidation, 

 and that this increased formation of uric acid and its collection in the 

 blood appears under the form of gout, is a pure hypothesis which is 

 not supported by facts, although it seems very plausible. If the case 

 were so simple, the world would swarm with gouty patients, while, as it 

 is, only a small proportion of topers and gourmands are affected by gout. 

 The experiments of Hoppe-Seyler and Zalesky^ who, in order to 

 find out something about the origin of uraemia, tied the ureters in geese 

 and chickens, and, a few days after the operation, found almost all the 

 viscera covered with crystals of the urates and the joints incrusted 

 with them in a manner that very strongly reminded of gout, render 

 the following hypothesis of the relation of the gouty diathesis to thf 

 attack of gout the most probable. The gouty diathesis depends on an 

 anomaly of nutrition, in which far more uric acid is produced than in 

 healthy persons, although not to the same extent as in birds and ser- 

 pents. As long as the excess of uric acid is regularly excreted by the 



