That Garrod’s _caveat_ was not uncalled for I feel sure, having myself known an acute gouty arthritis incised in the hope of evacuating pus. Sometimes the error in judgment is reversed and _pyæmic_ or _septic_ conditions in or near the great toe joint confounded with gout. Thus, Sir James Paget tells of an instance in which a pyæmic abscess forming near the great toe and consequent upon ligaturing of piles was thus confused. I recall, too, another example in which the supposed gouty arthritis of a great toe was of pyæmic nature, the outcome of a suppurating otitis media. Garrod, it may be recollected, ranked _pyæmia_ as one of the disorders to which gouty subjects were especially liable. Gouty inflammation resembles most other forms of the same morbid change, but some, however, contend that the association of _œdema_ therewith is pathognomonic. Indeed, by some of the older authors this concomitant feature of gouty inflammation ranked as a criterion differentiating it from “true rheumatic inflammation.” Œdema, of course, is not distinctive of gouty as opposed to other forms of inflammation. But its occurrence therein is, we would submit, but another token of its affinity with the _infective_ arthritides. We need but recall the constancy with which local œdema is met with in, _e.g._, _gonococcal_ arthritis. More typical of gout, however, is the _desquamation of the cuticule_ that follows the subsidence of the acute arthritis. Here we are reminded of the similar peeling of the skin that occurs in another _infective_ disorder associated with arthritis, _i.e._, _scarlatina_. Acute gout is _definitely paroxysmal_. The attack, at any rate when primary, is relatively ephemeral, lasts but a few days, and after it has passed, as Cullen says, “leaves the person in very perfect health, enjoying greater ease and alacrity in the functions of both body and mind than that for a long time before experienced.” In short, acute gout would appear to be a self-delimited disease, its fleeting duration predicating that if an organism be responsible, the same is short-lived. Even in _chronic_ gout, though it never quite loses its grip of those it has made its prey, yet nevertheless there are intervals of respite between the attacks, however long the latter may be. In other words, the disease never loses its paroxysmal character, which to my mind is very suggestive of a serial infection. The _periodicity_ of gout was, as we have seen, well known to the ancients. Its recurrence in early spring and late autumn has even been celebrated in verse:— “On whose sacred internodial Altars I Each Spring and Fall at least will sacrifice Morbifick, painful loads of Matter tartarous, With recrements of nervous juice impregnate.” “The Honour of the Gout,” by _Philander Misaurus_.