As to correlation of the metabolic phenomena of gout with the postulated infective element, I would suggest that, although abnormalities of metabolism form an integral part of gout, they are of themselves inadequate to achieve its efflorescence. As we shall see when we come to consider those elemental manifestations of gout, _i.e._, uratic deposits, or _tophi_, neither the purely physical nor the purely chemical theory of their origin will suffice, nor, for that matter, can any solution of their formation be gleaned from even a blend of the twain. In short, such hypotheses are too _mechanical_. The intrusion of some other factor, “something vital, something biological,” seems essential for the elucidation of _uratosis_, _i.e._, uratic deposition. For this, _not uricæmia_, is the specific characteristic phenomenon of gout. If we cannot explain uratosis on physical or chemical grounds, then how much less, in view of the _non-toxicity_ of _uric acid_, can we on this basis account for the _inflammatory_ phenomena of the disorder! Now _inflammatory reaction_ is, I hold, an invariable _antecedent_ in all gouty processes, whether of _articular_ or _ab-articular_ site. Granted that inflammatory reaction is a necessary prelude, the specificity of gout is attested by the fact that the same is followed by local deposition of urates. But while this sequential uratic deposition invests all forms of “gouty” inflammation with a specific character unshared by any other disease, it follows that the cause of the said inflammation must, if possible, be ascertained. Now, as I believe, “gouty” subjects are _ab initio_ victimised by innate tissue peculiarities, doubtless reflected in corresponding obliquities of tissue function and metamorphosis, and through their medium the general resistance of the body to invasion by _infections_ is lowered; in other words, under the influence of these morbific agencies the latent morbid potentialities of the gouty become overt and manifest. For in the gouty, as Walker Hall observes, “a slight injury or indiscretion of diet, an overloaded intestine, or increased toxicity of the intestinal flora, may be followed by a disturbance of the general nuclein metabolism and a local reaction in certain tissues.”