In summarising the doctrines of Ord and Ebstein, it may be observed that if the latter’s contentions have been disproved, Ord’s claim that the tissues of gouty subjects exhibit a specific tendency to _degeneration_ has also as yet not been substantiated. Albeit, we must not forget that in 1883 Ralfe subscribed to Ord’s views as to the tendency to _textural degenerations_ in gouty subjects, either through heredity or acquirement. For this observer, however, the basal factor in the production of the disease was a diminished _alkalinity of the blood_, due to a surcharging of it with acid and acid salts. Disagreeing with Garrod’s assumption that _deficient renal elimination_ was the prime cause of the retention of uric acid, he was of opinion that “the first step in the process lies in the failure of the _tissues_ to reduce the acid, as it occurs in health.”... “In the large glands or where the current of the circulation is free, the uric acid is carried into the blood and gradually reduced to urea; in tissues outside the current of the circulation, the insoluble uric acid is not so readily carried off, and so on the slightest disturbance is deposited, as is the case in cartilages of the joint, the ear, etc.” As to the determining cause of the gouty attack, he invokes the agency of the _nervous_ system to explain its incidence, for he held it probable that the primitive failure of the tissues to reduce uric acid eventually led to derangement of some special nerve centre, which disturbance occasioned the gouty outbreak, with resultant “accumulation of uric acid in the blood and deposition of urate of soda in the tissues.” In 1895 Berkart propounded a mode of genesis which may be regarded as a variant of Ord’s theory. The severity of the symptoms of acute gout were such as he deemed incompatible with their production as a result of simple mechanical irritation by crystals of biurate of soda. Uric acid, he held, must be afforded a humbler _rôle_ than that of a proximate cause. It was, for him, but an _epi-phenomenon_, the accompaniment of a _panarthritis_, the origin of which was as follows:— While not postulating the identity of rheumatoid arthritis in gout, he yet held that both disorders originated in some obscure form of _atrophy_ of the bone substance, and that the degenerative change also overtook the cartilages and fibrous tissues of the joints. Subsequently, there ensued a _necrosis_ in the tissues in and around the joint. The degeneration and subsequent necrosis, he held, were the outcome of a profound “vice of nutrition.” The pain, inflammatory reaction, œdema, and cuticular desquamation were the direct result, he thought, of the necrosis. The excess of uric acid in the blood he referred to _leucocytosis_, and in part to disintegration of the tissues. HEPATIC INADEQUACY