may perhaps most correctly be relegated, along with some others, to a class of diseases which may be termed neuro-humoral.
On reviewing these several propositions, I am, at this distance of time, disposed to be less dogmatic respecting some of them. I stand firmly by the position that gout owns a nervons as well as a humoral pathogeny. I am not now so strongly disposed to insist on that part of the theory which tended to localize defi- nitely the actual centre of disturbance in a limited portion of the cerebro-spinal axis. Nor am I prepared to shift my ground, and claim any other definite tract of the nervous mass as the affected and unstable centre. must freely admit my inability to do so, and would express myself more cautiously in deference to the opinion of the eminent Parisian professor who did me the honour to criticize my theory. Te reproached me for seeking to localize "at too limited a point the primordial lesions of a nalady essentially general, one which is, and always will be, typical of one of the best-marked of all diathetic conditions." While, how- over, ceasing to insist on this part of my theory, I still look kindly upon it, because many of the features of arthritic diseases afford support to it, and none can doubt that the medulla oblon- gata consists of series of centres, some amongst them possess- ing intimate relations to the most distant and varied organs and structures of the body.
I think it not only helpful, but absolutely essential, to add to the purely humoral views which have chiefly prevailed respecting the nature of gout a conception of the presiding nervous element. In accepting this, we greatly enlarge our point of view, and explain some of the most difficult points which have hitherto per- plexed careful inquirers. For y part, I cannot dissever the two ideas, and, hence, I affirm that gout is a neuro-hnmoral disease.¹
It is, without doubt, the case that, hitherto, no theory has been set forth which appears to embrace all the multiform pheno- mena of gouty disease. The greatest advance of modern research has been to establish the certainty of some special relation to it, in the greater number of instances, of uric acid, and so far there is clear warrant for retaining a measure of humoral pathology in our conception of the malady,
I propose to discuss, first, the arguments which lend support to the view that the nervous system is largely involved in gouty pathogeny; and in doing so, I shall have to refer to many points which inust later on engage our attention more in detail.
1 In respect of rheumatism, I am prepared to affirm the same, thus explaining the manifestations of that branch of the basic arthritic diathesis.
