The frequency with which this misconception occurs is very noticeable. If a _middle-aged_ woman of florid complexion and _corpulent_ habit begins to complain of pain and stiffness in her knees with more or less swelling thereof, there is a very prevalent tendency to attribute not only her joint disorder to _gout_, but any gastric or nervous symptoms that she may simultaneously complain of are translated as being confirmatory of the assumption. It gathers weight too from the traditional and widespread belief that “the change of life” is the period _par excellence_ at which women develop the morbid vagaries associated with “irregular gout.” Now, as Bassett Jones and I have pointed out in a previous work, this condition, _symmetrical villous synovitis_ of the _knees_, is a very common joint disorder in _women_ at or near the _menopause_. Frequently they give a history of numerous _pregnancies_, or of _rapidly increasing obesity_, while with or without this latter they display a _faulty postural attitude_, indicative of lowered muscular and ligamentary tone. Following in the wake of these, the subject develops a _symmetrical flatfoot_, which, according to the stage at which it is seen, may be of flexible or rigid type. Now, such is the mutual _static interdependence_ of the component parts of the lower limb that this condition of flatfoot promotes or favours the incidence of _villous overgrowths_ in the proximal joints, the _knees_. As to the _modus operandi_ we have put forward the following explanation: “The everted foot, with its sunken arch, as before stated, determines an alteration in the normal coaptation of the articular surfaces in the knee, and this incongruence is revealed in skiagraphs by the marked prominence laterally of the external tibial tuberosity beneath the external femoral condyle. Coincidently, and for the same reason, additional strain is thrown upon the internal lateral ligament. This in turn favours a state of passive congestion or hyperæmia of the synovial membrane, which becomes relaxed and thrown into folds, especially at its reflexions near the edges of the cartilages. If, as often happens, the individual is the subject of _varicose veins_ or suffers from a _general lack of tone in her muscular or ligamentary structures_, this tendency to venous engorgement of the knees is much enhanced.” “Under the influence of these mechanical factors and their associated circulatory disturbances, _thickening and enlargement of the synovial fringes ensue_. The inflammatory condition thus produced tends to increase automatically, as, owing to the articular incongruence, the enlarged fringes are very prone to become caught between the joint surfaces; in other words, a vicious circle is produced, as with the increasing villous hypertrophy the liability to internal traumatisms increases _pari passu_.” VILLOUS SYNOVITIS STATIC AND NON-GOUTY IN ORIGIN