As to frequency of incidence in the “gouty,” _eczema_ undoubtedly must be awarded the palm. But whether the scaliness of skin on extensor surfaces of arms and legs and back of neck, which ultimately, under the influence of skin infection through scratching, develops into a dermatitis which assumes the character of eczema, can be, strictly speaking, held as of “gouty” origin, is questionable. Certainly, whatever be the origin of the pruriginous scaliness of the skin, there can be no doubt that the later dermatitis is the outcome of infection by skin organisms. Frequently the presumption that the eczema is “gouty” rests upon general rather than specific grounds, on “goutiness” rather than “gout.” Accordingly I think it would be wiser to regard eczema as an occasional complication of gout rather than an integral element thereof. Lastly, there can be no doubt that many of the so-called “gouty” cutaneous disorders ensue at what may be called the arterio-sclerotic stage of life. It is when renal and cardio-vascular changes are present that we meet with exudative erythema, pityriasis, exfoliative dermatitis, and purpuric eruptions. All these have at one time or another been foisted upon gout, whereas they are far more closely related to the cardio-vascular and renal changes with which the disorder is so frequently associated. GOUT AND NEPHRITIS The association between gout and renal disease is admittedly intimate, in so far as gouty subjects often have granular kidneys, while gout is a frequent complication of this type of renal disorder. Nevertheless, the clinical relation between the two diseases is ill defined and, moreover, somewhat erratic. In most instances the renal defect is engrafted upon the antecedent gout, or the sequence is reversed; and, again, the two conditions may arise contemporaneously. Lastly, in sharp and disconcerting contrast to this mutual overlapping of the two disorders, we have the awkward fact that more commonly _gout_ and _granular kidney_ run to their fell end quite _independently_ of each other. Thus, Sir William Roberts observed: “It is quite common to see articular gout, even of chronic and inveterate character, run its entire course without any accompanying signs of structural disease of the kidneys.” The same, to be sure, is equally true of _granular kidney_, which may pass to its close without any suspicion of gout. Now, as we have seen, the primary _renal_ origin of gout fails of demonstration. Is _gout_, then, _causally_ related to _granular kidney_, or is there some less direct relation between them? As to this, to begin with, it is extremely rare that a “gouty” subject develops _acute_ nephritis. In the exceptional instances when it does occur it is either purely accidental or else the outcome of an _exacerbation_ of a _previously existing interstitial nephritis_.