In like fashion, an habitually intemperate man may pass through life without incurring gout. Another, handicapped by his heritage, though he be strictly abstemious, yet falls a prey thereto. Even a total abstainer, when coming of gouty stock, may develop gout, haply through overeating. To my mind, the only supposition deducible from these facts is that some individuals are born with a tendency to gout, and that this tendency may never assert itself as actual disease; that in others the dormant proclivity, under the influence of alcohol, forthwith becomes manifest; lastly, in some again, so nicely poised is the equilibrium of their _nuclein_ metabolism, that the most venial alcoholic indulgence suffices to evoke an outbreak. I incline, therefore, to the view that alcohol _per se_ is not a cause of gout; in other words, alcohol will not, in the absence of a _gouty heredity_, produce gout. On the other hand, given an innate proclivity thereto, alcohol, especially certain forms of it, will almost infallibly evoke the disease; this often though the subject be conspicuously moderate in its use. That alcohol will produce the disorder even more swiftly and surely if reinforced by _overeating_ also, cannot, I think, be gainsaid. As to the _modus operandi_ of alcohol in inducing gout, I believe that it acts _indirectly_, viz., by slowly sapping the protective mechanisms of the body, and so paving the way to _infections_. Much stress has been laid on the fact that certain _occupations_ conduce to gout; but, if we exclude _plumbers_, _painters_, or other workers in _lead_, no other callings in life can be held to entail a specific predisposition to its development, save in so far as they promote _overeating_, _overdrinking_, and _inactivity_. It is well established that workers in _lead_ are specially prone to develop gout. I take pride in noting that two of my predecessors at the Royal Mineral Water Hospital, Bath, William Falconer (1772) and Caleb Hillier Parry (1807), drew attention to the frequent occurrence of gout in those exposed to the action of _lead_; nevertheless the major part of our knowledge of lead as a predisposing cause of gout we owe to Sir Alfred Garrod (1854). This authority noted that at least one out of every four gouty patients that had come under his care at King’s College Hospital had at some time in their lives been the subjects of _plumbism_, and for the most part were plumbers or painters. Out of 136 undoubted examples of gout, Sir Dyce Duckworth noted that of these twenty-five males showed signs of lead poisoning, and were either plumbers, painters, compositors, or workers in lead mills. My colleague, James Lindsay, out of a total of 482 instances of males afflicted with gout, found that 108, or 22·4 per cent., were workers in lead.