But nevertheless the emancipation of gout from nervous and other alien disorders was slow of achievement, and largely, I think, through the wide acceptation of Murchison’s theory of a pathological state allied to gout and termed by him “lithæmia,” or the “uric acid diathesis.” According to this authority, the deposit of _lithates in the urine_ is a “manifestation of a morbid condition of the blood and of the entire system,” the outcome of a _functional derangement of the liver_. Such hepatic disturbance might endure for years without manifesting any other symptom than a frequent _deposition of urates_ and occasionally _uric acid in the urine_. But, added Murchison, the same if neglected “may ultimately be the means of developing gout.” Clinically it manifested itself by a variety of symptoms—depression of spirits, irritability, lethargy, headache, pains and aches in the limbs, vertigo, insomnia, dyspepsia, palpitation, raised blood pressure. Such were the motley group of disorders affiliated by Murchison to _lithæmia_. But his disciples, more ardent, set no limit to the manifestations of _uric-acidæmia_. Not only gout, but _rheumatism_ and allied disorders, were amongst its progeny, and Osler tells us that one writer enumerates not fewer than thirty-nine separate morbid conditions associated with _lithæmia_. But leaving aside the extravagant claims of Haig and his followers, the impression even now is but too prevalent that _gout_ and _lithæmia_ are convertible terms. There is little or nothing to justify the assumption that an increased output of uric acid in the urine or deposition of urates therein is diagnostic of gout. Such, moreover, presupposes the further assumption that _uric acid_ is the _cause_ of gout. We may affirm that certain symptoms betoken malassimilation of food or defective tissue metabolism. But it is by no means certain, as Murchison held, that a _functional disorder of the liver_ is the _fons et origo mali_, much less that _uric acid_ is the sole noxious substance. Yet in a masterly discussion of the subject Pratt, of Boston, tells us that as recently as 1895 a “leading clinical teacher” affirmed that “headache, migraine, depression of spirits, shooting pains, cramps, palpitation, vertigo, are a part of the symptomatology of lithæmia.” Surely, if we are to make any pretence of reducing the phenomena of _lithæmia or irregular gout_ to a scientific precision worthy of the present status of medicine, we should fight shy of such sweeping assertions. The _caveat_, we fear, is not superfluous. For as that judicial physician, Austin Flint, once satirically observed, “the designation ‘uric acid diathesis’ is used by some physicians in a rather indefinite way to describe various morbid states which may not at any time be accompanied by deposits of urates, and in which there is no proof of an excess of uric acid in the blood.”