Uratic deposits sometimes attain a prodigious size. I have seen them the equivalent of a small hen’s egg. The largest tophi are invariably found in the neighbourhood of some joint, and the upper extremities furnish the most marked examples. But even when of considerable magnitude they may be non-adherent, the skin gliding freely over their surface. As John Hunter wrote: “The chalk shall remain for years without producing inflammation, and seldom produces it at all but from quantity.” Often, however, their presence at length induces irritation of the overlying integument. As they approach the surface the skin assumes a purple hue, becomes thin, and ulcerates. The uratic ulcers thus formed have generally an indolent fungous base. As the deposits extrude or are removed they are continually redeposited, and in this manner ounces of urates may be discharged. The same is followed by great relief and diminution of deformity. Discussing such lesions, John Hunter tells us that “when the interior surfaces are exposed they hardly take on common inflammation and suppuration, healing more readily than a sore of the same magnitude from any other cause; even a joint shall be exposed, yet common inflammation shall not come on, nor shall it suppurate: only a watery fluid shall come out, bringing the chalk with it occasionally, and it shall heal up kindly.” A glance, too, at the preceding footnote shows that Moore also agreed with Hunter as to the absence of common inflammation and suppuration. Moreover, even of recent years it has been suggested that, because gouty tophi do not suppurate even when ulcerated through the skin, the _urates_ have _antiseptic_ properties. But Bendix (_Zeit. klin. Med._, 1902) failed to demonstrate such qualities experimentally. The truth would appear to be that, though gouty inflammation never ends in _suppuration_, yet _abscess formation_ very commonly occurs in the _peri-tophal_ tissues. Such more often ensues in subjects of frail health or of definitely cachectic type. Garrod saw as many as five or six open at one time in each hand, and others on the feet. In his experience they give rise to but little constitutional disturbance. Scudamore, speaking of the same, says the sores produced are “unusually tender, aching, and sometimes very painful as the fit is making its approach.” Ultimately the gouty ulcers thus formed dry up, and this indifferently whether or not the uratic deposits are wholly extruded in the discharging pus. The wound then closes, leaving a small scar, which, however, given a fresh attack of gout, is but too likely to break down, and this process may occur repeatedly. Bursal sacs containing tophi not infrequently suppurate, constituting abscesses containing urates.