Garrod recognises in addition a second type, in which phlebitis, “usually of a much less acute character, ensues without the previous development of gouty inflammation in the neighbourhood of the part.” Here we may recall that, according to Paget, the incidence of phlebitis in an elderly person without any external cause warrants the suspicion of gout. Perhaps the chief justification for such an assumption rests on the fact that phlebitis appears sometimes to be _hereditary_. Paget cites the instance of a man who suffered from phlebitis of both saphenous veins during an attack of acute gout. On the maternal side his mother, two uncles, a grandmother, and two cousins had been the subjects of phlebitis. In conclusion, for myself, I would suggest that the term “gouty” phlebitis be restricted to those instances in which a limb, the seat of _acute articular gout_, is complicated by _phlebitis_ of the veins of the affected part. Here we are dealing with what is palpably an extension of the gouty inflammation from the affected _joint_ to the _veins_, and which, I venture to assert, is strongly confirmatory of the view that an _infective_ element intrudes in “gouty” arthritis. We may recall that, _e.g._, _gonorrhœal phlebitis_ of the lesser saphenous veins is not so uncommon, while the frequency with which phlebitis complicates _infections_ calls for no emphasis. Leaving aside these rare instances of _acute gout complicated by acute phlebitis_, I think there is a too flippant tendency to regard any phlebitis occurring in middle-aged or elderly subjects as being of this nature, this often in the absence of any evidence, hereditary or other, of a gouty element in the case. Frequently, too, the subjects are women with _varicose veins_ of long standing, and _ipso facto_ potentially liable to phlebitis. But why, in the absence of ancestral or acquired gout, dub such cases forthwith as “gouty”? We may, it is true, as in Paget’s classical instance, elicit a _familial_ tendency to phlebitis, but even so I doubt the legitimacy of the inference that the phlebitis is necessarily “gouty.” Is it not equally true that the tendency to _varicose veins_ is hereditary, and _ergo_ predicates an enhanced liability to phlebitis? CUTANEOUS DISORDERS The incidence of tophi in the skin naturally engendered the conception that gout was responsible for many and diverse types of cutaneous affections. In accordance with this, every effort was made to prove that they were the outcome of uratic infiltrations, but in vain.