Distribution of Preference for large joints Small joints, hand lesions and markedly mobile. or foot often involved. Fixity typical. Local characters Joints exhibit slight reddish Scarlet hue and flush. No subsequent œdema with later desquamation. No residual peeling of cuticle change. and itching. Tendency to involvement of bursæ and tendons. Pain Chiefly evoked by movement. Spontaneous, more intense. Duration Twenty to thirty days, Six weeks to three sometimes longer. months. Associated Cardiac lesions common. Tophi. Occasionally phenomena glycosuria and albuminuria. Therapeutic test Salicylates a specific. Not so in gout, but colchicum takes this _rôle_. ACUTE GONOCOCCAL ARTHRITIS This disorder, as we know, is sometimes of oligo- or poly-articular distribution. Moreover, as the attendant pyrexia may be slight or absent, it may readily be confounded with the _afebrile_ variety of acute _gouty_ polyarthritis. Osier, discussing diagnosis of the latter condition, observes: “A patient with three or four joints red, swollen, and painful in acute rheumatism has fever, and while _pyrexia_ may be present, and often is, in gout, its absence is, I think, a valuable diagnostic sign.” This is of course true, but it still remains necessary, for reasons above cited, to eliminate _acute gonorrhœal arthritis_. The tendency to such confusion has been emphasised by Sir Rose Bradford and Sir William Roberts, and I would urge the necessity of being alive to this possibility even in middle-aged men. One thing is certain, viz., we should be extremely chary of pronouncing any coincident urethral discharge to be a so-called “gouty urethritis”; nor should we translate any coincident _conjunctivitis_ or _iritis_ as further evidence of the articular affection being “gouty.” It is far more likely to be _gonococcal_. Apart from these inflammatory ocular affections, the relics also of previous attacks—viz., irregularity in contour or inequality in size of the pupils—have before now put me on the right track in obscure types of polyarthritis. To sum up, the following are distinctive characters of _generalised_ gonorrhœal arthritis:—