As a matter of fact, enlargement of the lymphatic glands does occur. Thus, my colleague James Lindsay cites an instance thereof. The subject, a painter, fifty-three years of age, had gout of some three years’ standing. During an acute paroxysm thereof “there was a mass of glands in the right groin, synchronous with an acute inflammation affecting the right knee and periarticular tissues. On the subsidence of the gouty inflammation the glands became smaller, but never entirely disappeared during the four weeks he was subsequently under observation.” _Splenic enlargement_, states Duckworth, has been met with in many cases of gout, and occasionally infarcts. But such splenic enlargement is, he thinks, _not specifically_ related to gout, but is due to associated conditions. Personally, I have not as yet met with splenic enlargement in gout. This aside, is it not palpably significant of infection that Paget, Garrod, and others, repeatedly noted the incidence of acute _phlebitis_ in a limb the seat of acute articular gout? Did we observe such a complication in any arthritis other than gouty, should we not inevitably regard it as indicative of the spread of an _infection_ from the joint to the related veins? Reverting to the _local articular phenomena_, they are not only compatible with, but emphatically suggestive of, an _infective source_. The typical signs of inflammatory reaction are swiftly installed in acute classical gout, and this with an intensity unrivalled save by the most sthenic types of acute arthritis. Witness how insistent were our forefathers, _e.g._, Scudamore, on the differentiation of acute gout, not so much from acute rheumatism as from _erysipelas_ or _phlegmon_. Garrod, indeed, held that “if a medical man, by chance entirely ignorant of the nature of gout, were to see a toe affected by this disease in its full intensity, swollen, hot, red, and tender, he would probably think that the affection must of necessity terminate in suppuration, yet I believe this never happens as the result of simple gouty inflammation.” This leads us to note a salient feature of gouty inflammation, viz., it never results in _pus formation_. Now, allowing for the increased powers of discrimination that happily to-day are ours, is it not, I ask, significant that the disorders deemed most likely of confusion with acute gout belong to the frankly _infective_ category?