But, the reader may observe, surely this is very reminiscent of _acute gouty polyarthritis_, with its serial content of acute paroxysms?[36] Quite so; but there is this difference, that, although such may last six weeks or three months, still there is a period put to the sufferings. A respite of months or years of immunity, and relative health may then supervene. Not so, unfortunately, when such paroxysmal waves sweep over the subject of long-standing or _chronic gout_. Not only do the recurrent acute outbreaks occur with _increasing frequency_, but also with _increasing length of duration_. It is here no longer a question of the intercurrent acute attack lasting days, but _weeks_. Also during such exacerbations either four, five, or six joints are simultaneously attacked, or in such rapid sequence that before one joint is free another is involved. But a word here as to the variations in _distribution_ of the _articular lesions_ in _chronic gout_. The well-marked _penchant_ of _acute_ gout for the _great toe_ continues throughout the life history of the disorder, the predilection for this site being equally a characteristic of the _chronic_ type. As to the subsequent articular involvement, Garrod held the sequence to be as follows: _heels_; _ankles_; _knees_; the smaller articulations of the _hands_; lastly, the _shoulders_ and _hips_. It has never been my lot to see either the shoulders or hips involved; but I have seen _osteo-arthritis_ of the _hip_ in _men_ displaying _auricular tophi_, and I am inclined to think that, in the presence of the latter, it has sometimes been assumed that the hip mischief was of _gouty_ nature—the “hip gout” of the older authors. Moreover, the _order of sequence_ is by no means invariable, for oftentimes a local circumstance, _i.e._, _injury_ or _sprain_, determines the location. Again, chronic gout is very erratic in respect of the _number_ of joints implicated. In some almost all the joints may be affected, while in others, no matter how ancient the disorder and how oft its recurrence, it remains localised to but a few joints; or it may progress after a leisurely fashion, with each attack invading different joints in succession. Naturally, if the disorder confine itself to a few joints, and these, and these alone, are the seat of the oft-recurring attacks, permanent changes sooner or later make their appearance. Nor are the morbid effects limited to the joints, but they invade the continuity of the limb, for the oft-repeated inflammatory reactions lead to engorgements of persistent nature. The contour of the affected members is distorted by the œdematous tumefaction, which, more pronounced at the level of the joints, extends in lesser degree beyond their confines. The skin, too, especially over the fingers, undergoes a change in texture, often becomes smooth and glossy, and through its dusky pink subjacent uratic deposits may be discerned.