Retrospectively viewed, many would regard the preceding cardiac condition as of “gouty” source. That the old gentleman, of florid countenance, plethoric build, and lethargic habit, was potentially “gouty,” there is no doubt. But he was also abnormally fond, not of alcohol, but, curiously enough, of sweetmeats and cakes of all sorts, hence “dyspeptic.” He had a feebly acting heart, but no detectable _valvular_ lesion, though _mural degeneration_ seemed likely. My own diagnosis was _flatulent dyspepsia with secondary cardiac disturbance_, and finally _acute gout_, the exciting cause of which, as I have so frequently seen, was a course of _hydrotherapy_. The patient never regretted his venture, and, I am glad to say, lived for some years. Such cardiac paroxysms are not uncommon in the “gouty,” and, alarming though they are, I question if purely _functional_ disturbances of this nature ever prove fatal. As to the _valvular lesions_ and _mural degenerations_ observed in the “gouty,” there is little or no evidence that they are dependent on gout. Indeed, the lack of a tendency to _endocarditis_ is one of the criteria distinguishing gout from acute rheumatism. I note that in one textbook _pericarditis_ is classed among the cardiac manifestations of irregular gout. But it must not be forgotten that _renal_ disease, a frequent concomitant of gout, predisposes to _pericarditis_, which, indeed, occurs in granular kidney even when unassociated with gout. As to the _respiratory organs_, such chronic maladies as _bronchitis_ and _asthma_ are very frequent in the “gouty,” but I question if they are more so than in non-gouty subjects. In any case their symptomatology and course are the same whether gout be present or not. Much, too, has been made of the fact that _asthmatic_ and _arthritic_ manifestations may _alternate_. But we must recollect that _asthma per se_ has a _paroxysmal_ tendency; it has a tendency to _periodicity_ and a liability to be excited or aggravated by much the same factors as favour outbreaks of gout. It is said, too, that there is a “gouty” _pneumonia_, and that the same has been replaced by an acute articular paroxysm. But, in respect of all these alleged “gouty” respiratory disorders, would it not be more scientific to cease talking of them as “gouty” and instead to speak of them as bronchitis and asthma occurring in “gouty” subjects? This, I may remark, is not to say that we should take no count of the reigning diathesis in our _treatment_ of all associated affections.