Yet both Charcot and Duckworth would have us recognise not only a tophaceous but a _non-tophaceous_ variety of chronic articular gout, for that is what it amounts to. They apparently feel justified in labelling a chronic arthritis as “gouty” even though _tophi_ “may not exist” or “be invisible”! _Deformity_, say they, is its hall-mark, not _tophi_, and its character forsooth, they add, is not only _not peculiar to gout_, but clinically indistinguishable from the similar defacements met with in _arthritis deformans_. Nor is Duckworth alone in his contention, for both Ewart and Luff also recognise what they term “chronic deforming gout.” _Tophi_, I contend, notwithstanding, are essential for the diagnosis of gout. In their absence, the designation of an arthritis as “gouty” is unjustifiable. Either tophi are, or tophi are not the sole pathognomonic feature of gout. If the latter, then gout ceases to exist as a clinically recognisable entity. Holding tophi indispensable for the diagnosis of gout, I maintain that Charcot and Duckworth’s plea for the recognition of a chronic type of articular gout, apart from the _tophaceous_ variety, is untenable. Fraught, moreover, with risk, as I am satisfied that their so-called, “deforming” type is largely made up of the _atrophic_ and _hypertrophic_ forms of arthritis deformans. SUGGESTED CLASSIFICATION OF ARTICULAR GOUT For myself, as to the classification of the articular types of gout, I would divide them into: (1) Acute articular gout. (2) Chronic articular gout. Under the first group I would place not only the acute _localised_ type, but also those acute varieties of _polyarticular_ distribution. As to the second category, I would exclude therefrom, for the reasons cited, the so-called “_deforming_” varieties of chronic articular gout, recognising only the so-called _tophaceous_ form. But I would place a different interpretation on this term in opposition to that generally accepted; for, by most writers the word _tophaceous_ is apparently limited in its application to examples which, so to speak, exhibit _tophi_ of phenomenal size or number. Scudamore was the chief offender in this respect. As a consequence, he found tophi in only 10 per cent. of his cases of gout. Accordingly, he went so far as to postulate for such victims as did present this peculiarity an _idiosyncratic_ tendency to chalk-stones! In other words, he would seem to suggest that there is a gout within gout, that one displays _chalk-stones_, the other _not_. By inference, Duckworth and his followers, by differentiating _tophaceous_ gout, tacitly concur, and so “confusion twice confounded” results.