Otto, two at least, those of Heister and Wells, are cases of general alopecia.* In his translation of Otto's work, Mr. South briefly alludes to the case (I presume, congenital) of

a man, aged 20 years, employed at the Courier newspaper office (London), in 1841, who had not any hair upon the head, eyebrows, eyelids, or chin, and was said to have had none on the pubes."

Rayer speaks of congenital deficiency of the hair as a malformation very rarely met with. He states that "it very seldom continues longer than the few first years of life, and ought rather to be regarded in the light of a late development of this appendage of the skin." He describes one remarkable case observed by himself in 1827, at the Hospital la Charité, in which this congenital defect was very complete :—“ The skin of this man's cranium appeared completely naked; although on examining it narrowly, it was found to be set with a quantity of very fine white and silky hair, similar to the down that covers the scalp of infants; here and there upon the temples there were a few black specks, occasioned by the stumps of several hairs, which the patient had shaved off. The eyebrows were merely indicated by a few fine and very short hairs; the free edges of the eyelids were without cilia, but the bulb of each of these was indicated by a small point. The beard was so thin and weak that Beauvais (this was his name) only clipped it off every three weeks. A few straggling hairs only were observed on the breast and pubic region, as in young people on the approach of puberty. There was scarcely any under the axillæ. It was rather more abundant on the inner part of the legs. The voice had the pitch and intonation of that of a full-grown and well-constituted man. He had had syphilis twice. He stated that his mother and both his sisters had fine heads of hair, whilst his father presented the same defect in regard to the hair which he did himself."+

* Pathological Anatomy, by South, p. 120. The case by Augustin, in Wolfart's Asklepieion, [quoted by Otto,] I have had no opportunity of verifying.

Diseases of the Skin, by Willis. 1835. p. 1049.

The permanent absence of one, two, or even a greater number of the teeth, is a defect respecting which the dentist will be more frequently consulted than the physician or surgeon, and which is probably not of very rare occurrence. The incisors (of the lower jaw particularly) and the bicuspids, appear to be more especially liable not to be developed.* Mr. Fox mentions an instance in which this defect attached to several members of the same family, none of whom had ever cut the incisors of the lower jaw.

Three cases are recorded in which all the teeth remained wanting through life. The first is that of a woman, sixty years of age, and is recorded by Borelli, who merely observes that the case proves "it is not always true, as has hitherto been believed, that paucity of teeth portends a short or feeble life."+

The next instance which I find recorded is more particularly interesting in connection with the cases which are the subject of this paper, and presents an example of the entire deficiency of both teeth and hair in the persons of two brothers. One cannot but regret the absence of further particulars of these cases, which, though promised by the author who narrates them, do not appear to have been ever given. The brief notice which exists is headed, "Concerning men without hair or teeth;" it is as follows:-"In our neighbourhood lives a Jewish family, of which two adult sons neither have, nor ever have had, hair or teeth. The more particular details are yet unknown to me."‡

The absence in the same cases of both teeth and hair, an associated defect, as we thus find, not now for the first time observed, is confirmatory of the opinion, at the present day entertained by many physiologists, that the teeth, hair, sebaceous follicles and mucous follicles constitute a common class of organs, subsidiary to the integumentary system; and that

Otto, op. cit., pp. 185, 188. Good's Study of Medicine, vol. i. p. 61. + Hist. et Obs. Med. Phys. Cent. II. Obs. xli. p. 144. 1676.

↑ Danz, in Stark's Archiv. f. d. Geburtshülfe. Vol. iv. p. 684. Jena,

they are closely connected in their development, growth and decay.

Cases have been previously recorded in which the sensible perspiration was stated to be entirely absent; but it may be doubted whether they rest on accurate observation.* In the cases which are described in this paper we may regret that no observations on the character and amount of the insensible perspiration were made during life.

Postscript, July 14, 1848.-Though such cases as those described in the foregoing paper are no doubt rare, they are probably less so than would generally be supposed. Thus, on the occasion of the paper being read to the Society, Dr. C. J. B. Williams mentioned the case of a young female to which I am happy to refer in this postscript. The young lady was described to Dr. Williams as being without hair and without teeth. When seen by him, however, he found that she was not entirely so. She was fifteen years of age; her hair was fine, scanty and white, and she had scarcely any hair on her eyebrows, or any lashes. She had three or four projections resembling teeth, which were decayed. The nose was imperfectly developed, and she breathed with difficulty through the nostrils. She suffered from chronic ulceration of the lining membrane of the nares, attended by a discharge, having an unpleasant odour. She had great delicacy of constitution and appearance; and her manner was so timid, that she was thought by some to be imbecile. This, however, was the result of a neglected education. Menstruation was not yet established, although there were indications of its approach. She had never perspired. A tonic plan of treatment was resorted to, and under proper care she improved.†

Good's Study of Medicine, vol. iv. p. 531.

+ London Medical Gazette, vol. xli. p. 336.

OBSERVATIONS

ON

CERTAIN PATHOLOGICAL CONDITIONS

ОР

THE BLOOD AND URINE

IN

GOUT, RHEUMATISM AND BRIGHT'S DISEASE.

BY ALFRED B. GARROD, M.D.,

ASSISTANT PHYSICIAN TO UNIVERSITY COLLEGE HOSPITAL.

COMMUNICATED BY C. J. B. WILLIAMS, M.D., F.R.S.

Received Feb. 7th-Read Feb. 8th, 1848.

In the present paper I purpose to make known some researches on the condition of the blood and urine in gout, rheumatism and Bright's disease, which appear to throw considerable light on their pathology.

The ancients considered gout to depend on the presence of some morbid humour in the blood, which, becoming deposited in weak parts, gave rise to the affections of the joints: as to the nature of this matter their ideas greatly varied. At the present time, gout is regarded by some as depending on vascular plethora, by others as due to local debility, accompanied with general plethora; but the balance of opinion appears to be in favour of its arising from some alteration in the circulating fluids. The nature of this change, however, has not been defined, although most agree in regarding it as connected with an excessive formation of uric acid in the system; the frequent presence of chalk-stones or tophaceous deposits in

and around the joints, the liability of gouty patients to uric acid deposits in the urine, and the formation of urinary calculi consisting of the same acid, strongly favouring the idea. But as gout sometimes occurs in patients not having such deposits in their urine, and also in broken-down constitutions not generally considered prone to an excessive formation of uric acid, it has been doubted by many whether this substance is the "materies morbi," or only an occasional accompaniment. Those who look upon gout as depending on a uric acid diathesis, have entertained various views as to the cause of this abnormal state, and the presence of the acid in the blood has hitherto never been proved.

As far as my experiments regarding the nature of this disease have been prosecuted, they appear to show that—

1st. The blood in gout contains uric acid in the form of urate of soda, which salt can be obtained from it, in a crystalline state.

2nd. The uric acid is diminished in the urine, immediately before the gouty paroxysm.

3rd. In patients subject to chronic gout with tophaceous deposits, the uric acid is always present in the blood, and deficient in the urine, both absolutely and relatively to the other organic matters, and the chalk-like deposits appear to depend on an action in and around the joints, &c., vicarious of the "uric-acid-excreting" function of the kidneys.

4th. The blood in gout sometimes yields a small portion of urea (no albumen being present in the urine).

The experiments and analyses which favour these conclusions were chiefly made on patients in University College Hospital. In support of the 1st conclusion viz., that in gout the blood contains uric acid, the following analyses were performed.

In June 1847, a male patient, R. Hartley, was admitted into the hospital suffering from gout. During the three last years he had been subject to repeated attacks of the disease, and several chalk-stones had formed about the fingers, and a few in other parts. At the time of his admission, many