Our forefathers, like ourselves, realised the innate complexity of the problem, that in the development of the disorder both _heredity_ and _environment_ played a _rôle_. In other words, that in the genesis of gout not only _intrinsic_ but _extrinsic_ agencies were concerned. Of the intrinsic influences the most important are age, sex, heredity, bodily conformation, and individual peculiarities. _Age._—Gout is slow in evolution, tardy of appearance, confined in the main to the middle and declining years of life. Said Sir Thomas Browne, “Leprosie awakes not sometimes before forty, the gout and stone often later.” Experience but confirms the dictum, for, as Cullen long since observed, it rarely declares itself under the age of five-and-thirty. This relative immunity of youth is not the least striking feature of the disorder; whence the Hippocratic aphorism, “Puer non laborat podagra, ante veneris usum.” Both Sydenham and Heberden were also doubtful of its occurrence before the age of puberty. Gairdner, however, records the incidence of fits of gout even in _infants_ at the breast! and in one death therefrom. Garrod, too, met with two cases of classical type in _girls_, both of them under _ten_ years of age. But Scudamore states that he never witnessed more than one example of a first attack before twenty, or any after sixty-six. For myself, I have never seen a case under thirty-five years of age, and am sceptical as to the occurrence of _infantile_ gout of _regular_ type, believing with Scudamore that “the commonly asserted cases which represent the existence of the gout in very early youth are really examples of _rheumatism_.” Nor am I less but more inclined to cavil at the claims of Comby and others, as to the frequency in _children_ of _irregular_ manifestations. As Osler dryly observes, “The tendency in some families is to call every affection gouty. Even infantile complaints such as scald-head, naso-pharyngeal vegetations, and enuresis, are often regarded, without sufficient grounds, I believe, as evidences of the family ailment.” To sum up, the majority of cases of gout ensue between thirty-five and fifty years of age. But, given a strong _hereditary_ taint, it may break out in _youths_ and _young adults_, or haply even in _children_. But such, in my experience, are phenomenally rare. Indeed, it may be said of gout that only exceptionally is it met with at either extreme of life; though Garrod records several examples in which the initial attack was postponed until nigh eighty years of age; while in one instance, a lady experienced her first classical attack of podagra in her ninety-first year.