Arterial disease is respected as an inevitable as well as the most serious complication of gout. Barring accident or other common hazards, the patient afflicted with gout will die directly or indirectly of changes in his circulatory apparatus. Formerly, gouty lesions were ascribed to arterial changes; this opinion is no longer held. Hyperuricemia is not believed to be the cause of the vascular changes. Instead, the underlying, unknown cause of the other manifestations of gout is thought to induce the arteriosclerosis. Discovery of urate in the arteries or in the heart adds specificity to the cardiovascular changes. Urate crystals in blood vessels or in the heart were reported by the earliest writers. The authenticity of these reports has been doubted, notably by Minkowski. Deposition of urates in the vessel walls and in the heart valves is regarded not as the cause of the tissue changes but rather as an accompaniment