It has been suggested that there is some statistical evidence that “acute rheumatism” has declined in frequency since the introduction of _tonsillectomy_. In the same way, I cannot help thinking that the growing infrequency and attenuation of gout is in part due to increasing appreciation by the laity and the profession of the vital importance of _oral hygiene_ and timely and radical treatment of _local foci of infection_. The fact that in _children_, victims of so-called _infantile gout_, the _purin metabolism_ may show those same derangements held typical of the subjects of gout, is surely an indication that the disorder begins betimes, and that we too must not tarry if we would prevent these evil potentialities coming later to fruition. Now, if there be nothing _specific_ of gout in the “dyspeptic” derangements held _prodromal_ thereof, the reader may well ask the pregnant question, Are there any symptoms or signs that will enable one to identify the victim of these minor discomforts as being “actually” or “potentially” a “gouty” subject? In attempting to answer this reasonable query one would emphasise the fact that _tophi in the ears or at other sites sometimes antedate articular outbreaks_. Now given that an individual exhibits _auricular tophi_, one or many, can anyone deny that he is “gouty,” nay more, that he has _gout_, this even though he never has had, or may never have, an _articular_ outbreak? In truth, the eruption of a _tophus_ in the _ear_ is as essentially a “fit of gout” as if it had occurred at the classic site, the _big toe_. How vivid the light then thrown upon the import, the _etiological_ significance, of otherwise inexplicable _functional_ derangements! How grim the potentialities of, _e.g._, “dyspeptic” symptoms as revealed by detection in the subject of a _tophus_! Whether viewed from the _diagnostic_ or _prognostic_ aspect, its importance cannot be overestimated. For let us not forget that the _tophus_ is the one incontrovertible token of the “gouty diathesis.” This morbid localisation is the sole outward expression of the inward and dominant pathological trend. The great Charcot did not despise its aid. He narrates the case of a man thirty-five years of age, a sufferer for some months from “acid dyspepsia,” in whom he predicted a fit of _gout_ from noting an _uratic concretion_ in one _ear_. Is not the moral obvious that in an individual complaining of gastric or hepatic disturbances, etc., we should, at any rate, examine the ears for _tophi_?