_Intestinal_ rather than gastric indigestion is, I think, more typical of the gouty subject. It will be recalled that the food nucleins are unaffected by the gastric juice, and though the protein moiety is split off from the nucleinic acid by the pancreatic ferments, yet neither the poly- nor the mono-nucleotides are thereby acted upon. It is in truth the _succus entericus_ with its nucleotidase that plays the most important digestive _rôle_ as regards nucleins, breaking them up into nucleosides which are, to a large extent, absorbed as such. To resume, this condition of _intestinal indigestion_ may arise from a variety of causes: excess or deficiency of gastric juice, defective motility, and diminished secretion of intestinal juices, and in all cases improper food may determine such _intestinal derangement_. The clinical features presented are very variable. It is often difficult, if not impossible, on the basis purely of the subjective symptoms, to decide in any given instance how far the symptoms are referable to _intestinal stasis_, or to a _chronic infection_, with a resultant catarrhal state of the mucosa, or to both causes combined in varying proportions. But, be the explanation what it may, in our experience the most common antecedent or concomitant of gout is _intestinal dyspepsia_. Its secondary consequences are far reaching, especially if the small bowel be involved, catarrh of which may lead to _reduction_ in the secretion of _bile_ and _pancreatic juice_. How commonly in these cases do we meet with symptoms indicative of sluggishness of the hepatic functions, such as turbidity of the urine, a pale or abnormally dark colour of the alvine evacuations. Also, whatever be its true etiology, they exhibit not so uncommonly _sugar_ in the urine, the so-called “gouty” _glycosuria_. Now, as a mere glance will show, diminution and impairment of the biliary and pancreatic secretions have far-reaching consequences. Foodstuffs undergo abnormal changes, are less easily absorbed, and simultaneously chemical products are formed which irritate the intestinal mucosa. Nor do the baneful effects cease here, for, owing to the unusual nature and reaction of the intestinal content, the _bacterial flora_ in the bowel undergo modifications. Thus, organisms normally present only in small numbers in the small intestine find the altered medium more suitable for their growth and multiplication; while others, whose usual habitat is the large bowel, migrate upwards, and infect the ileum and duodenum, and ultimately the biliary and pancreatic passages. In the presence of such deficiency in the intestinal juices, proteins are imperfectly digested, and putrefaction under microbic action favoured. At the same time the digestion of carbohydrates is impaired, organic acids are formed, and gases in larger amounts liberated. Ultimately, owing to absorption of these irritating products, a condition of _chronic toxæmia_ results. SUMMARY