_Acute Gonococcal Arthritis._—We may recall that Van Swieten, a disciple of Boerhaave, held that sometimes a wife while nursing her gouty husband had contracted the same disorder. A tribute, we fear, to Van Swieten’s diplomacy rather than to his clinical acumen—an euphemism for gonorrhœal rheumatism! Of course in adolescents or in young adults _monarticular_ pain, with or without swelling, heat, or redness, should not suggest “gout,” but an _infective_ disorder either in the _joint_ or the related _bone-ends_. At the same time middle-aged men enjoy no immunity from gonorrhœa, and we may add that _gonococcal infection_ of the _metatarso-phalangeal_ joints is not so uncommon. When located in that of the great toe, it is easy to see how readily the acute arthritis may be confused with gout. But, unlike the latter, its duration is measured by months or weeks rather than by days. It is well to recollect, too, that “gouty” persons are more prone to develop arthritis following gonococcal infection. Given therefore a history even remote, we should in doubtful cases recall the longevity of the organism, its persistence in the prostatic recesses, and the need for bacteriological investigation. _Traumatic Lesions._—Its exposed situation renders the big toe very liable to trauma. Often, too, the injury being slight, and not followed by any immediate consequences, the connection may easily be overlooked. A blow or a fall may readily bruise the synovial membrane without at first any external sign. But given trivial hæmorrhage into the cavity or subjacent tissues, an acute synovitis with effusion is induced. Again, joint disorder following _injury_ is usually _monarticular_, whereas the same when the outcome of so-called “constitutional” causes is generally _oligo_- or _poly_-articular. The relevancy of this is obvious when we recall that _initial_ attacks of _gout_ are _monarticular_. Accordingly, given a history of definite injury to the toe joint, the question arises, Is it _acute gout_ or _acute traumatic arthritis_? this especially if the subject has not had a previous attack of gout at this site. Here I would lay stress on the fact that _indirect_ rather than direct traumatisms are more common antecedents or determinants of gout, viz., sprains or strains. Moreover, in reviewing the writings of the older physicians one is driven to the conclusion that frequently a septic cellulitis, synovitis, or a frankly traumatic arthritis was confused with acute gout.