The defect in all these discussions of the gouty or non-gouty nature of hay fever or of neurasthenia is our lack of a sure diagnostic sign of the disease gout. Gout occurs in two forms, typical and atypical, irregular gout. In typical gout, with the deposits of urates in the joints and cartilages, the diagnosis may be easy. In atypical or irregular gout we may have a group of inflammations or functional disturbances in any tissue of the body. From their frequent occurrence in gouty people, we suspect them to be gouty, but can prove nothing. When they appear in people who have never had typical gout we can only say that a gouty origin is probable. There is no sign in the blood or in the urine or anywhere else by which we can say that gout is or is not present. It is in this class of atypical gout that hay fever and neurasthenia belong, if they be gouty at all. Until somebody discovers a diagnostic sign of gout that is available in these irregular cases, the evidence of the gouty nature of hay fever and neurasthenia must remain exactly what it was to de Mussy fifty years ago, analogies of symptom groups, and not an exact laboratory diagnosis based on physiological or chemical tests such as we have come to depend upon with such confidence in recent years. One matter that should be made clear in the reader's mind is that the so-called _uric acid poisoning_ or _uricacidæmia_ is not the same thing as gout by any means, though Grayson confuses it with gout, as do nearly all American authors. For fuller discussion of this point, we will pass to the next chapter. CHAPTER IX _THE URIC ACID THEORY_ Uric acid is a substance about which more has been written and less understood than many others in medicine and that is saying a great deal. As a basis of the suboxidation theory of Bence Jones' day, as the cause of gout with Garrod, as a step in our knowledge of metabolism and as a popular fad, uric acid in its time has played many parts. =Uric Acid in Hay Fever.= In 1893, Dr. Seth Bishop announced before the American Medical Association that "excess of uric acid in the blood causes hay fever and nervous catarrh;" and advised elimination and control of the uric acid as the principle of treatment. The article may be found in the _Journal of the American Medical Association_, 1893, and abstracted with an interesting discussion on the treatment of hay fever, in the _Philadelphia Medical News_, 1894. This position, of course, is also that of Haig (_Uric Acid_, seventh edition, page 386) and his followers. Now, in 1893, the theory of uric acid poisoning flourished like a green bay tree and all sorts of queer and misunderstood pathological processes came and roosted in its branches. Patients came to our offices, not complaining of headache or lumbago or cough, but asking for "something for that uric acid." As patients will, they had already made the diagnosis from the newspapers and wished our advice only for the remedy.