We know that, given _oral sepsis_, sequential infections of the _appendix_ and _gall bladder_ are not uncommon. Recently it has been remarked that many _gouty_ patients suffer with attacks of pain in the region of the appendix, and simultaneously tenderness over the gall bladder. That the subjects of gout enjoy no immunity from appendix or gall bladder disorders is certain, and at this we need not be surprised, seeing the frequency with which they suffer from alleged causes thereof, _i.e._, dental sepsis, etc. But what we would insist upon is that we should not be content merely with dubbing these symptoms “gouty,” as they are much more likely to be, not symptomatic of gout, but _etiologically_ related thereto. If then we are to arrive at the exact nature of the underlying lesion, the probable site of infection or toxic absorption, we must invoke all modern methods of investigation. Thus, how valuable the existence of an X-ray barium or bismuth meal in furnishing positive evidence of gastric or duodenal ulcer on the one hand or of _gall bladder_ or _appendix_ disease on the other. What an aid to the location of adhesions the demonstration of _ileal_ and _cæcal_ stasis, etc.! In obscure cases the _fæces_ may have to be scrutinised for evidences of _pancreatic_ inefficiency, viz., bulky pale stools, undigested meat fibres, and excess of neutral fat. Their _bacterial_ content, too, if abnormally high, should be noted. As in other arthritides of unknown origin, the results following the administration of _vaccines_ prepared from the predominant organisms have been such as to suggest a causal connection. The urine should be subjected to _chemical_ and _bacteriological_ examination. As to _uric acid_, the delusion still widely prevails that gouty subjects excrete large amounts thereof. How frequently is “the degree of acidity” of the urine or “its content of uric acid” held to justify a diagnosis of gout. The deduction is quite unjustifiable. Equally so the assumption that the reverse, a defective excretion of uric acid, is an invariable feature of the gouty diathesis. For though when on a _purin-free_ diet the output of uric acid in the gouty is low, it rarely, if ever, falls below the level of normal. The truth is that we cannot _on the mere basis of the variations in uric acid excretion in the urine_ presume to diagnose gout.