Meanwhile, accepting the general opinion as to the frequency of the co-existence of gout and granular kidney, is there any explanation thereof? For myself, I am inclined to believe that the common overlapping of the two disorders is in large measure due to this, that the factors, _i.e._, excess in alcohol, overeating, etc., that make for the eruption of gout, are largely identical with those that promote the development of _granular kidney_. Hastings Gilford holds “there is very little doubt that syphilis, lead, and gout do not so much originate Bright’s disease as excite it into activity when it already exists in a smouldering or latent condition.” With this view I feel much in accord, and if to the malign effects of gout be superadded the effects of alcohol or, haply, lead also, how incalculably greater the chances of fanning into flame any latent tendency to nephritis—a legacy, perhaps, of some long bygone infection. PROGNOSIS IN GOUT Gout _per se_ rarely, if ever, proves fatal. Certainly, as Sir Thomas Watson long since said, “_gout in the extremities_ is not a mortal disease.” When death did occur during or in close relation to an _acute_ paroxysm, it was by our forefathers attributed either to its _retrocession_ or to some _misplaced_ or _irregular_ manifestation. Indeed, their attitude was very much that of the French physician who observed: “La goutte articulaire est celle dont on est _malade_, et la goutte interne est celle dont on _meurt_.” But, as we shall see later in our chapter on _Irregular_ Gout, most, if not all, of their instances of the assumed translation of the _materies morbi_ of gout to some vital organ are without foundation. The demise, often dramatically sudden, was not due to _gout_, but to some insidious, unguessed-at organic degeneration, or to one of the accidental intercurrent maladies to which these subjects seem especially liable. To sum up, the immediate danger to life from regular gout when uncomplicated is slight. Not that gout is salutary, lessens the liability to other diseases, or promotes longevity. Very much the reverse—“a tendency to _recurrence_ is a law of the disease.” Broadly speaking, the more pronounced the tendency to recurrence of articular outbreaks, the more protracted the isolated paroxysms, the worse the outlook, the more sombre, too, the greater the number of joints involved. Conversely, if the disease, though it recur, restrict itself to the classic site, the big toe, the longer, as a rule, the intervals of freedom, the brighter the prospects of long life. Lastly, the more the subject is crippled, the more pronounced the tendency to tophaceous deposits, the more likely is the disease to pursue a downward course, the greater the risk of associated degenerations in renal and vascular tissues.