_Infection or Sub-infection._—Our knowledge as to the exact manner in which _local foci of infection_ work their malign effects almost daily undergoes expansion. It will be recalled that Stewart has shown that “bad teeth” are often etiologically responsible for tonsillar inflammation. It further is well established that _streptococci_ are of common incidence in the _tonsils_, and Rosenow and Brown from experimental observation have established that these hemolysing organisms, migrating _viâ_ the blood stream, exhibit a marked predilection for forming a fresh nidus in the _gall bladder_. Here they may initiate a _cholecystitis_, and secondly gallstones, and in sequence thereto the symptoms associated with _gall-bladder-dyspepsia_. The same formidable list of sequels may follow infection of the gall bladder from the _teeth_, _stomach_, or _intestines_, notably from the vermiform appendix. In like fashion the origin of _appendicitis_ may be traced back to _septic foci_ in the _mouth_, _tonsils_, _naso-pharynx_, or to the _gastro-intestinal tract_. Here again there ensue the symptoms of so-called _appendix-dyspepsia_. As in the case of the gall-bladder variety, the _primary lesion_ in the _appendix_ may be _latent_, and the exact diagnosis may be a matter of great difficulty, often indeed only to be achieved _retrospectively_, viz., when abatement of the symptoms follows ablation of the appendix. We see, therefore, how far-reaching are the consequences of _local foci of infection_ in the _mouth_ or elsewhere. Now, the _gouty_ subject enjoys no immunity from the remote sequels of local sepsis. But as a rule, unfortunately, whatever be the nature of his _dyspeptic_ symptoms, they are, like his _dental anomalies_, his _tonsillar inflammations_, forthwith dismissed as _symptomatic_ of gout, not etiologically related thereto. Now, I have seen pyorrhœa and chronic appendix-dyspepsia running side by side in the same subject with recurring classical attacks of gout in the big toe. The faulty teeth were extracted, and later the chronically inflamed appendix removed; and though he had an attack of gout shortly after the operation, there has as yet been no recurrence thereof.