It is upon this dictum that we would take our stand, and this without depreciating in any way the pioneer researches of Garrod. For it must be recognised that the increasing differentiation of joint diseases has proceeded apace. How many are now affiliated to specific germs, not to mention the undreamt-of light thrown on their inward characters by X-rays! Scudamore’s work appeared exactly a century ago, Garrod’s in 1876. The conclusion then seems inevitable that many of their alleged cases of _gout_—at any rate, those _unattested by tophi_—would now be relegated to widely different categories. But this zeal for infinite cleavage and subdivision, so characteristic of the modern school, far from diminishing, does but _accentuate_, the _diagnostic_ valency of the tophus. It still remains _the_ infallible criterion of diagnosis, and, for myself, I feel convinced that infinitely more good than harm would ensue if we refuse to recognise any individual as being of the “gouty diathesis” unless he exhibit these objective stigmata thereof. Of course to some such a rigid attitude will spell anathema. I hear them say in oracular tones: “Never forget gout, or awful indeed will be your awakening.” More harm, say they, is wrought by failure to recognise gout than by diagnosing gout where none is. Doubtless they are right in counselling us not to forget gout, but not to the exclusion of all else. For, at issue with them, I hold it better to miss gout than to miss _syphilitic_, _gonorrhœal_, and other forms of arthritis. “A name being so readily found for an obscure disease, the practitioner considers himself as excused from the difficult task of nicer discrimination.” Thus wrote Scudamore a century since, a rebuke and a warning for all time. TOPHI IN RELATION TO ARTHRITIS How elated we are, and rightly, when in an obscure form of arthritis we pounce on these objective criteria of gout, how apt to deem our diagnostic quest as ended, and with what fatal glibness the time-worn “gout” slips from our lips, sure, alas, of ready and almost complaisant acceptance. Fallacious inference, all too prevalent, that the presence of _tophi_ stamps any _concomitant arthritis_ as “gouty.” True, tophi are pathognomonic of gout, but their existence does not confer on their host _immunity from all other forms of arthritis_. In view of the increasing light shed upon joint disorders, who can doubt that (and this not only for our forefathers) the _tophus_ has too often proved a veritable snare, allaying all diagnostic doubts, lulling us into false security? For an individual may, for example, exhibit _auricular tophi_ and be the victim also of an _arthritis_, but the latter is not inevitably “gouty.” All that can be assumed at sight is merely that the joint disorder, whatever its nature, has ensued in a subject of “gouty diathesis.”