INFLAMMATIONS. 119 



autumn. But the recurrence of rheumatism is not steady, and 

 subject to the action of the exciting causes ; the gout, on the 

 other hand, is, with the exception of uncommon cases, pretty 

 steady to the above periods. 



" Fifthly, A distinction which generally holds is the time of 

 life. We have, in these latter days of indolence and luxury, 

 had instances of very early gout : I have even a case of it in a 

 patient of twelve years old, which, by the sequel, has proved to 

 be as much the gout as in one of fifty ; and there are other in- 

 stances of it both in males aud females under twenty ; but these 

 are very singular and uncommon. To establish a general rule, 

 I would say with Dr. Cheyne, that the gout seldom appears be- 

 fore the meridian of life, which he places at thirty-five. The 

 rheumatism, on the contrary, while it may affect at any period 

 of life, in nine cases out of ten appears in persons under the age 

 of thirty-five, and frequently under the age of twenty-five. 



" Some kind of difference may be taken from the sex of those 

 who are subject to it. The rheumatism belongs to both sexes : 

 the gout is more common in men. But this is still to be ad- 

 mitted only in a general view. Hippocrates says, that women 

 are not subject till after their menstruation is over. I know, 

 however, that this does not apply to our climate ; for I have 

 known women have the gout before that evacuation disappeared, 

 and even such as menstruated frequently, and in great quantity. 

 And a creditable author informs us of a goutish paroxysm in a 

 girl of sixteen. 



" To sum up what we have said : The rheumatism is an ac- 

 cidental disease, not owing to any particular predisposition or 

 propagation from parents to children. It is topical, and does 

 not affect the nervous system. The gout is, on the other hand, 

 a constitutional disease, is general, and affects the viscera and 

 nervous system." 



DXXVII. With respect to the gout, our next business is to 

 investigate its proximate cause, which must be a difficult task, 

 and I attempt it with some diffidence. 



" The theory of gout is not only to me interesting in itself, 

 but it is of importance with regard to our general pathology, as 

 we have occasion at the same time to discuss our fundamental 

 propositions. 1 ' 



I 



