Gout, indeed, has taken its full toll of the “Intellectuals.” Thus Scudamore tells us that “The late Mr. Pitt and his father had gout at a very early period of life. The father was never a votary of Bacchus, and neither of Venus (as we are told), but both were _ardent students_.” Probably, in many instances, however, the evils of immoderate study are reinforced by more reprehensible excesses. The ancients insisted on sexual debauchery as favouring outbreaks of gout. Whence the Latin verse: “Ut Venus enervat vires, sic copia vini, Et tentat gressus, debilitatque pedes.” Doubtless, in some instances of this supposed origin, a _gonococcal_ arthritis was confused with gout. Doubtless sexual neurasthenia with diatetic excess favours the onset of gout. In the same way grief, anxiety, and other depressing emotions are provocative of gout in that they impair the digestive functions, lead to hepatic torpor, and sluggish bowels. SUMMARY In conclusion, we have now dealt with those factors currently regarded as _predisposing_ causes of gout. Personally, as I have before said, the differentiation of the foregoing from the so-called _exciting_ causes of gout is purely arbitrary. Thus even those who countenance such division are forced to admit that many of the predisposing causes will, “if at any time suddenly increased,” immediately excite a fit of gout. In other words, the difference is _quantitative_ rather than qualitative. Thus, a moderate drinker, if perchance he exceed his usual limits, pays the penalty by an outbreak. Another habitually addicted to the fleshpots eclipses himself, and a similar retribution is exacted. Or, he exposes himself to a chill, with subsequent gastro-intestinal or hepatic functional derangement. Yet again, the cessation of wonted exercise, and more often the taking of it when unaccustomed, may determine the onset of a paroxysm. But far more arresting are the numerous and well authenticated instances in which local _trauma_ not only determines an outbreak but also its locality. How frequently, too, have blows, strains, sprains, _fractures_, _dislocations_, or other trivial or severe injuries, been the signal for an attack. Now, as we hope to show later, _local foci of infection_ are extremely _common_ in the _gouty_. Such are especially frequent in the _teeth_, _tonsils_, _naso-pharynx_, etc. Is it not then extremely probable that organisms may, _viâ_ the _blood-stream_, find their way to a _joint_, the resistance of whose tissues has been lowered by a _trauma_, however slight its degree? This I apprehend to be the true explanation of the undoubted intimate connection between traumatisms and arthritic outbreaks of gout.