_General Phenomena._—Symptoms, other than those referable to the affected part, vary widely in different cases. In this respect the acute _sthenic_ forms contrast with the acute _asthenic_ types. In the former the pulse quickens; the temperature rises, but rarely exceeds 101°-102°, though Garrod saw it reach 104°. The tongue is furred, the breath foul, with anorexia and thirst. Though the appetite is frequently impaired or lost, yet in some instances it is retained. Dyspeptic symptoms, hiccough, eructations, etc., are sometimes prominent, but often wholly lacking. The bowels are constipated, as a rule, the stools pale, or dark and extremely offensive. The urine is generally scanty, high-coloured, with a lateritious sediment on cooling. It may contain a trace of albumen. Severe _cramps_ affecting muscles of the leg, thigh, and upper parts of the body, are more or less prominent symptoms in a considerable number of instances. The _pyrexia_ appears to be _symptomatic_, more or less in proportion to the acuteness of the local phenomena. Comparably the highest temperatures are usually met with in _sthenic_ forms in relatively young or robust middle-aged subjects. Duckworth noted the interesting point that “a preliminary rise is commonly noted for one, two, three or four days before a joint is actively involved.” With the articular outbreak the febrile movement becomes more active. The temperature runs up to 100° or over, but with the morning abatement sinks to normal or nearly so. The following evening it rises again frequently to a higher level, 102° with a morning remission, and so it continues for a variable number of days, it may be only two or eight to ten. It then subsides, and frequently for a few days remains sub-normal. Lastly, the _acute asthenic_ forms, that occur often in women (Garrod), may be wholly _afebrile_. _Changes in the Blood._—Apart from its increased content of uric acid, further morbid changes take place in the blood in gout. Neusser in 1894 described what he termed “perinuclear basophilic granules” over and about the nuclei of the leucocytes in the blood of gouty patients. He held that the dark granules constituted the mother substance from which uric acid was derived, and that their presence in the blood was distinctive of the “gouty diathesis.” Subsequent researches, however, by Futcher and others appear to have shown the absence of any interrelationship between the amount of these granules and uric acid elimination, though Neusser claimed that cases showing them excreted uric acid in excess. More significant, however, is it that the blood in acute gout may show a high grade _leucocytosis_ with _secondary anæmia_. In a case under my care of _acute gout_ at classic site, though by no means of unusual severity, the following was the content of the blood picture:— BLOOD COUNT.