The subject, a middle-aged spinster of lean kind, came to Bath for treatment of her supposed gout, and for which indeed she had previously received spa therapy. Her feet when bared showed a condition of double _hallux valgus_ with related _bursal thickenings_. The occasional inflammation of these latter structures and the recital of doubtful ancestral proclivities were the sole evidence on which was based the diagnosis of _gout_. In addition, as is so frequent in hallux valgus, there was associated therewith a _bilateral flatfoot_, and it may be added that in the left foot a _hammer-toe_ had been removed some years since. Unfortunately the neglected symmetrical flatfoot had, as so frequently happens, initiated, through the erroneous deflection of a body weight, a condition of _chronic villous synovitis_ in both knees. This again was misinterpreted as but another proof of her assumed “gouty” diathesis. Reflecting upon human nature, how curious the reluctance with which such subjects elect to part with their “gout.” Women especially hold tenaciously thereto, even those of austere type, clinging to the taint handed down to them from some far-off ancestor whose “superfluity of naughtiness” was a by-word among his generation. To exchange gout, _morbus dominorum_, for “flatfoot” and inflamed “bunions,” savours of degradation, and to couple it with aspersions on their footgear is well-nigh insupportable. Nor are the “lords of creation,” we fear, exempt from this failing. We recall during the War being consulted by a highly placed officer who complained of gout. A well-preserved man of nigh sixty years of age, he obviously prided himself on being immaculately booted. As such patients frequently do, he brought his own diagnosis of “gout.” Removing his footgear, manifestly too small, his crucified toes stood out with bunions in a state of hot resentment. But impeachment of his boots was too much for him. Persuasion and argument were futile, and I doubt not he walks to-day stiff, a martyr to his vanity. “Il faut souffrir pour être belle.” GOUT IN THE HEEL In some instances the first manifestations of gout occur in the heel, while in others the sheath of the neighbouring tendo Achillis is the part first invaded. Probably there is no region of the foot in which there exist more pitfalls, and doubly careful should we be before concluding that any painful or inflammatory condition thereof is one of “gout.” _Referred Pain._—Pain in the heel affords many loopholes for misinterpretation. It may, as Sir James Paget pointed out many years ago, be symptomatic of a _renal calculus_. In my own experience it is sometimes complained of by the subjects of _internal hæmorrhoids_, the pain waxing and waning with the variations in the rectal trouble, and only disappearing permanently when the piles have been radically treated. It is, again, a symptom sometimes complained of by the victims of _enlarged prostate_. LOCAL SOURCES OF FALLACY