While gout may throughout its life history confine its ravages to the _foot_, if not solely to the _toe joints_, it may, even in the _initial_ attack, involve many articulations. Such cases usually, if not always, occur in persons of marked _gouty heredity_. In its simplest forms the orthodox _monarticular_ seizure is simply exchanged for a sequential implication of each big toe joint. If so, as Trousseau pointed out, the joint that is the last to be involved is least affected, and the soonest to get well again, while the accompanying œdema is of shorter duration. But in more severe cases not only the big toe, but the _tarsal_ joints, the _knee_ and the _hand_, may be invaded in the _first_ attack. Occasionally, too, the disorder displays concomitantly its tendency to involve other structures, _tendons_ and _aponeuroses_, _e.g._, the _tendo Achillis_, _plantar fascia_. Such _widespread initial involvement_ is usually preceded by _prodromal_ phenomena of unusual severity and prolonged duration. These _initial_ attacks of _polyarticular_ distribution are extremely rare. Far more commonly acute gouty polyarthritis supervenes after several attacks of classic location have been suffered. The gouty inflammation in these cases invades the joints after a serial fashion. But each joint as it becomes involved goes through the same painful cycle. Thus, for five or six days the pain goes on increasing, then abates, and finally the wished-for crisis comes. So it happens that the gout may be raging simultaneously in several articulations, though in each at different stages of evolution. Consequently the symptoms do not pursue an even tenor, but are made up rather of a series of little attacks—_series et catena paroxysmulorum_, to invoke Sydenham’s expression. Frequently periods of apparent recovery take place. The temperature remains normal for some days, and welcome convalescence seems established, when, to the victim’s despair, the temperature again rises, and the same weary cycle, though perhaps shorter, is yet to be endured. Running this chequered career, the disorder may last for six weeks or two or three months. In such attacks not only the _feet_, _knees_, _hands_, and _elbows_, may be promiscuously involved, but often also the _ligaments_, _bursæ_, _tendon sheaths_, and _aponeuroses_. The suddenness with which the disorder shifts its seat from one joint to another, or from joints to bursæ or muscles, often leads to its confusion with _acute rheumatism_. In other words, that _fixity_ distinctive of gout in its monarticular forms is here exchanged for _mobility_, that specific quality of acute rheumatism.