We see, therefore, that Aretæus and Garrod were at one in their observation that tophi in their initial stages are betokened by _small red swellings_; in other words, as Aretæus says, they “resemble abscesses.” Garrod also held that uratic deposits probably form during an attack of gout, but occasionally they appear shortly afterwards. Thus, in one of his cases no auricular tophi were found when the subject left hospital, but within ten days, on re-examination, a deposit was detected. “Perhaps,” he reflects, “some fluid was effused during the fit, but being at first transparent, could not easily be distinguished.” That Garrod held the swellings to be _inflammatory_ in nature is clear from his writings. Thus, he says, “When tissues little liable to take on inflammatory action become infiltrated (with urate of soda), but slight vascular disturbance is produced. This is especially the case with the fibro-cartilage of the ear, and although we now and then meet with patients aware of the formation of these little nodules, who experience in fact a gouty fit in the ear, yet in the majority of cases attention has never been directed to the part, so slight has been the inflammation caused by the effusion.” Again, James Moore, whose graphic description of tophi formation is quoted by Garrod, also held that “this process is usually preceded and accompanied by inflammation.” Hilton Fagge, too, says, “it appears probable that the deposition of lithate of soda causes inflammation in other tissues besides the joints. It does, as we have seen, in the ear and occasionally in the skin.” But, he also states, “in the pinna of the ear, in fact, gouty concretions commonly form without any indications of previous inflammatory action. In some instances the patient experiences sensations of heat and pricking, and the part is tender, but more often he is quite unconscious of the fact that such concretions in the pinna are present.” Duckworth also noted that uratic deposits are _not always painless_ during their formation, and he noted that not only may auricular tophi be painful at this stage, but that, following the subsidence of acute gout in a joint, painful swellings may develop in its vicinity, which subsequently proved to have been tophi in process of formation.