Dr. David Pfaff, Senior Assistant Resident in Medicine, Jewish Hospital of St. Louis, and Assistant in Medicine, Washington University School of Medicine: A 48-year-old white man was admitted to the Jewish Hospital for the second time on Feb 3, 1968, for evaluation of a rising serum cholesterol level. Thirteen years earlier the patient was hospitalized for abdominal pain, was found to have cholelithiasis, and underwent an uneventful cholecystectomy. In 1964 he was first admitted to Jewish Hospital with a ten-year history of slow formation of nodules on the elbows and knees. The family history did not include diabetes and several siblings and an only child had normal serum cholesterol values. Physical examination showed a well-developed, well-nourished man in no distress. The temperature, pulse rate, and respiration rate were normal. The blood pressure was 130/90 mm Hg. Results of cardiopulmonary and abdominal examinations were unremarkable. There were numerous large, yellow sessile,