Still in this matter of the onset I must not overlook the findings of my colleague James Lindsay. In 569 cases, the onset was sudden in 458, and in the remaining 111 examples gradual. It was noted that only 14·5 per cent. of the male cases were of gradual onset. But no less than 47·1 per cent. of the female cases developed after this fashion. Again to resume, it is by no means invariably the case that the onset is _nocturnal_. For, as Duckworth has pointed out, many attacks begin during the day, and this is perhaps more often the case after the disorder is fully established. _Locality._—Gout in its classical form is _monarticular_ in distribution. In 375 out of 512 _initial_ seizures, Sir Charles Scudamore found that the metatarso-phalangeal joint of the great toe of one or other foot was the joint affected. Garrod, too, noted that, excluding the great toe, in not more than 5 per cent. were other joints implicated. As to the frequency of incidence in joints other than the big toe, opinions differ. For Scudamore it is the ankle, for Garrod the instep, and afterwards the outer side of the foot and the knee. In contrast, Hilton Fagge holds that next to the great toe gout vents its initial fury with greatest frequency upon the _metacarpo-phalangeal_ joint of the index finger, adding, “certainly not the thumb.” Most authorities however agree that gout in its early stages rarely attacks the joints of the _upper_ limb, and even in its most inveterate form the _shoulder_ and _hip_ joints are immune. Personally, I have never seen a case of gout in the shoulder or hip; such cases are usually examples of _osteo-arthritis_. Exceptionally, even in first seizures, more than one joint may be affected. Thus it may migrate from one big toe to its fellow, or travelling further afield, may invade ankle, knee, wrist, or elbow, or small joints of hand. W. Gairdner held that in gout the joints of the _left_ were more commonly attacked than those of the right limb. But James Lindsay’s figures would appear to indicate precisely the reverse, viz. a predilection for the _right_ side of the body. _Pain._—If we may accept the lurid imagery of its victims, even the tortures of the Inquisition failed to transcend in agony the— “... pangs arthritic that infest the toe of libertine excess.” _Cowper._ Sydenham said that at its onset the pain was as that of a dislocation (_ossium dislocatio_). At its zenith it was as if the flesh was being gnawed, squeezed in a bootscrew, or scalded by molten lead or boiling water. Sensory perversions are superadded, and, as Ambrose Paré said, “some patients say they burn, while others complain of icy coldness.”