But if we would condemn those who, in the presence of unequivocal tokens of gout, label _antecedent_ or _intercurrent dyspepsias_, etc., as “gouty,” what are we to say of those that even in patients who have never had _regular gout_ or exhibited _tophi_ yet presume to classify their associated digestive troubles as “gouty”? This, I contend, is wholly unjustifiable. I would say more, that such conjectures are hazardous in the extreme, this both in the overtly gouty as well as in the non-gouty. I recall the instance of an individual who suffered from classical articular gout which palpably alternated with attacks of abdominal pain, but the clue to the true nature of the latter symptoms, as revealed at operation, was a _chronically inflamed appendix_. If so in this case, how many so-called “gouty” acidities have resolved themselves into _appendicular or gall-bladder dyspepsia_! My conclusion then is that the _gastro-intestinal_ disorders attributed to gout cannot legitimately be regarded as examples of _irregular gout_. They should not be held “symptomatic” of, but _etiologically_ related to, _gout_, a view more calculated to lead to exact diagnosis and rational therapy, and incidentally to elucidate the true nature of gout. In respect of other organs and the symptoms connected with them in “gouty” persons the case is very much the same. Always and ever are we confronted with the same difficulty, inability to determine whether _antecedent_, _co-existing_, or _consecutive_ affections in certain examples of gout, are not associated merely by _coincidence_. Disturbed _cardiac_ action is not uncommon in gouty subjects, _palpitation_ and _arrhythmia_ and _syncopal_ threatenings, and frequently symptoms difficult of differentiation from true _angina pectoris_. I am reminded of an old physician whom I saw in consultation some years ago, who suffered from alarming attacks of _precordial_ anxiety. He was well on in the sixties, and very obese. He was convinced that his cardiac irregularities, etc., were of _gouty_ origin, and often exclaimed regretfully: “If I only dared to take two bottles of port, and got it in my toe, all would be well.” He had never had an articular outbreak, and based the diagnosis of his case on the fact that from time to time his _urine_ for long since contained _excess of urates_. Having suffered much of many physicians, he at last grew restive, took the bit between his teeth, rushed to a spa, and forthwith embarked on a very strenuous course of “waters and baths.” At once he got a severe attack of acute polyarthritic gout, and _mirabile dictu_, all his cardiac troubles straightway ceased.