But the reader may say, this dissertation notwithstanding, Where does _gout_ come in? Precisely so, and if his experience tallies with mine, he will find that chronic articular gout localised in _one_ of the _larger_ joints, and one only, is exceptionally rare. Personally, I should never feel justified in making the diagnosis unless I had elicited a history of (1) recurring classic outbreaks in the great toe with (2) an absence of traumatic infective and nerve arthropathies and, on the other hand, (3) demonstrable existence of _uratic deposits in situ_ in the peri-articular tissues, the cartilage or bones as revealed by _skiagraphy_, or in the related bursæ. In conclusion, if all these various pitfalls have been avoided, it will almost without exception be found that the final differentiation in doubtful cases will rest between gout and _osteoarthritis_; and in the vast majority, I had almost said all, it is the latter morbid process that will be found responsible. This all too lengthy disquisition will not have been in vain if it instil caution. For it is in the monarticular types of joint affection that errors of catastrophic proportion occur more commonly than in any other form of joint disorder. CHRONIC GOUT OF OLIGO-ARTICULAR DISTRIBUTION The course of chronic articular gout, as has been observed, may be chequered by acute outbreaks involving three, four, or more of the larger joints. But, apart from this, there are those so-called _asthenic_ and _afebrile_ types of gout in which two or more joints may be the seat of a chronic gouty arthritis. In my experience it is the _knees_ that are most frequently attacked. The joints are enlarged, the seat of more or less effusion, but the distinctive feature is the presence of deformity due to the irregularly rounded or ovoid swellings produced by _uratic deposits_. Enlargement of the patellæ is also present, and they lose their sharp edges, and sometimes they as well as the neighbouring articular ends are studded with small bony outgrowths, but of minimal size compared with those met with in _osteoarthritis_. The related _bursæ_, too, are often the seat of _deposits_, a valuable clue to diagnosis. Needless to say, such marked cases are nearly always the outcome of oft-repeated attacks, the ultimate deformity being the result of successive accretions of urate of soda laid down in the trail of the exacerbations. ITS CONFUSION WITH CHRONIC VILLOUS SYNOVITIS