The inflammatory or violent state of the gout is said most commonly to affect the limbs. But this is far from being the case. It frequently makes its first attack upon the head, lungs, kidneys, stomach, and bowels. The remedies for expelling it from the stomach and bowels are generally of a stimulating nature. They are as improper in full habits, and in the recent state of the disease, as cordials are to drive the small-pox from the vitals to the skin. Hundreds have been destroyed by them. Bleeding in these cases affords the same speedy and certain relief that it does in removing pain from the stomach and bowels in the first stage of the yellow fever. Colonel Miles owes his life to the loss of 60 ounces of blood in an attack of the gout in his bowels, in the winter of 1795, and major Butler derived the same benefit from the loss of near 30 ounces, in an attack of the gout in his stomach in the spring of 1798. I could add many more instances of the efficacy of the lancet in the gout when it affects the viscera, from my own experience, but I prefer mentioning one only from sir John Floyer, which is more striking than any I have met with in its favour. He tells us, sir Henry Coningsby was much disposed to the palsy from the gout when he was 30 years old. By frequent bleedings, and the use of the cold bath, he recovered, and lived to be 88. During his old age, he was bled every three months. I have said, in the history of the symptoms of the gout, that it sometimes appeared in the form of a hectic fever. I have prescribed occasional bleedings in a case of this kind accompanied with a tense pulse, with the happiest effects. It confined the disease for several years wholly to the blood-vessels, and it bid fair in time to eradicate it from the system. The state of the pulse, as described in another place[61], should govern the use of the lancet in this disease. Bleeding is required as much in its depressed, as in its full and chorded state. Colonel Miles's pulse, at the time he suffered from the gout in his bowels, was scarcely perceptible. It did not rise till after a second or third bleeding. [61] Defence of Blood-letting, vol. IV. Some advantage may be derived from examining the blood. I have once known it to be dissolved; but for the most part I have observed it, with Dr. Lister, to be covered with the buffy coat of common inflammation. The arguments made use of in favour of bleeding in the diseases of old people in a former volume, apply with equal force to its use in the gout. The inflammatory state of this disease frequently occurs in the decline of life, and bleeding is as much indicated in such cases as in any other inflammatory fever. The late Dr. Chovet died with an inflammation in his liver from gout, in the 86th year of his age. He was twice bled, and his blood each time was covered with a buffy coat.