Atonic gout is a disease peculiarly obstinate and distressing: it is the prelude of misplaced gout, and appears often in the interval between the repulsion of the active inflammation in the feet, and the attack on the viscera. It is known by the various forms of debility and irregular action in gouty habits. Low spirits, giddiness, headach, fainting, melancholy, wandering delirium, palsy, and apoplexy, are occasioned by its affecting the head; bastard peripneumony, asthma, and, it is said, consumption, when it attacks the lungs; anorexia, dyspepsia, eructations, and hiccough, when in the stomach; diarrhoea, dysentery, irregular pains, and obstinate costiveness, when in the bowels; in the bladder, stone; in the intestinum rectum, piles, terminating often in fistula. In all these complaints we are directed to bring on gout. We may indeed ' call spirits from the vasty deep,' but they will not obey. The direction is easily given, but it cannot be executed. In such cases we may remove the present complaints, strengthen the constitution, lay the foundation for future gout, but we can do no more. Bark and aromatic cordials are in such cases proper; the bowels must be kept free by aloetic pills, occasionally interposing the warmer tinctures, encouraging exercise and cheerfulness, keeping the stomach in a proper state by occasional emetics and a moderately warm generous diet, changing the scene, and diversifying the objects. These are the cases chiefly benefited by mineral waters, where all these means are

Comnbined, and those of Bath are unrivalled for their powers in this state of the disease. In many such instances sea bathing may be allowed, especially when young people, either from the violence of the hereditary disposition to gout, or their own early imprudence, have become premature martyrs to the disease. In cases where stone is combined, the Pyrmont waters, which contain the fixed air with steel, are highly useful; and the aerated alkaline waters are often found serviceable. If the Cheltenham waters do not prove too purgative, they may be also useful. Steel itself is often employe:!, and probably with advantage: there is little choice in its preparations; but if the stomach is much disordered with flatulence, the flores martiales with the gum pill will probably be most useful, washed down with a warm, cordial.

In all violent attacks of the head and stomach, the warmest cordials must be immediately employed, and the Irish usquebaugh, as peculiarly warm and active, has been a favourite. If there is time for choice and preparation, the aether is preferable, or the union of the volatile alkali with aromatics in the spiritus ammoniae compositus; and the efficacy of these remedies is increased by the addition of a warm opiate. The doses must be measured only by the exigency; and the quantity of spirit sometimes swallowed in such instances, not only with impunity but advantage, is astonishing.

In the other complaints from gouty atony, a more regular and steady stimulus is required. To the common cordials, Cayenne pepper in pills has been added; and the arum, in large doses, has been often useful. The serpentaria, particularly its tincture, we have often seen employed by former practitioners with advantage, and have perhaps from that cause contracted a predilection for it. No medicine, as a permanent and powerful stimulus, seems to exceed it in these cases. When fistula, stone, or other diseases, come on, which require peculiar treatment, the.relief must be conducted in the usual way.

Retrocedent gout is in reality the atonic, but it is generally distinguished by authors; and we notice it just to mention, that on the sudden recession of gout a variety of nervous medicines, as aether, musk, and castor, have been employed. Except as stimulants, they seem to possess no peculiar advantage; and perhaps, as superseding the full use of stimulating medicines, they may be injurious.

The warm bath has been employed at the end of a fit, to restore flexibility to the joints; and the warm waters of Bath are, on many accounts, preferable. A muriatic bath has been lately advised; that is, water slightly impregnated with the muriatic acid; and, like all novelties, highly commended. When we speak of warm bathing, we shall show that the water does not penetrate beyond the cuticle, and of course that the acid cannot reach the calcareous depositions; but it will be obvious to any one who observes the skin of gouty patients, that the same calcareous phosphat penetrates every part of the cuticle, and fills its rugae. The muriatic acid will dissolve the salt; and this effect, with the influence of the heat and moisture, will restore in a great degree the pliability of the joint, and add to the comfort of the arthritic. Cold bathing also in the intervals of gout, when the system is wholly free, is an excellent remedy for supporting the activity and energy of the consitution.

There are various other complaints that alternate with gout, viz. wandering pains, erysipelas, inflammations of the eye, pains of the back, resembling nephritic pains. These must be treated in the usual way, taking care, when the cause is suspected, not to lower the patient by too great evacuation.

This disease generally attacks men of robust and large bodies, men of large heads, plethoric habits, and whose skins are covered with a thicker rete mucosum, which gives a coarser surface; particularly if the earlier period of their life has been spent in indolence and luxury, or if their minds have been much harassed with vexation and painful reflection. It seldom attacks persons employed in constant bodily labour, or those who live much upon vegetable aliment; and it is less frequent among people who make no use of wine, or oilier fermented liquors. It seldom seizes men before the age of thirty-five; oftener at a later period. Neither children nor youths are exempt from it; and the females who are liable to it are those of the more robust and full habits; though it seldom attacks that sex, or eunuchs, unless they are strong, lead indolent lives, and live very full.

See Sydenham's Works, who admirably describes the regular gout, with notes by Dr. Wallis: Musgrave on the Gout; he excels in his description of the irregular gout. See Warner's full and plain Account of the Gout; he includes the chief of what his predecessors have written on this subject. Cullen's First Lines, vol. ii. edit. 4. Kirkland's Inquiry, vol. i. D:. Cadogan's Dissertation on the Gout. Hoffman De Dolore Podagrico. Boerhaave De Podagra. Dr. Kirk-land and Cheyne on the Gout.