An interesting fact noted by Garrod was that so long as such abscesses were discharging freely the subjects enjoyed comparative immunity from overt gout. But, given healing of the same, in several instances he had seen it the signal for a sharp outbreak. Duckworth, too, states that “whenever ulceration and flow of tophaceous matter occurs it is rare to meet with paroxysmal attacks anywhere in the body. With the cessation of the discharge renewed fits may intervene.” While they tend to aggregate themselves round the joints, yet tophi sometimes invade the _integument_ of the _limbs_. They have been seen in the skin over the _ulna_ and _tibia_, and commonly over the _olecranon_ and _patella_. Pye Smith recalls the instance of a man in whom a number of small ulcers, discharging urate of soda, formed in the middle of his _thighs_ and _legs_. The case is not an isolated one, but the incidence of subcutaneous uratic deposits in the limbs, save over _articulations_, is exceptional. In the _palms_ of the _hands_ and the _pulps_ of the _fingers_, the knuckles and phalanges, tophi are found not infrequently; and Trousseau tells of a lady of sixty in whom the cutaneous _palmar folds_ of both hands were “marked with radiating white lines such as are seen in those who have long been employed in tempering plaster.”[38] Similar deposits have been noted in the _plantar surface_ of the _feet_. Reverting to the _trunk_, uratic deposits have been found in the _scapular_ region, also in the _perineum_. I have twice seen tophi in the _corpora cavernosa_ of the penis. In the face, apart from the ears, they have been found in the _alæ_ of the nose. In the _eyelids_ Duckworth noted uratic deposits in streaks resembling xanthoma; they were chemically tested, and proved to be of this nature. Speaking of “gout in the eye,” Garrod states: “I have witnessed many cases in which conjunctivitis and sclerotitis appear to be distinctly connected with the gouty diathesis, and in two cases there existed _deposits_ of _urates_ on the surface.” As before stated, we recognise only one type of gout, viz., the tophaceous variety. But even so it must be noted that in some instances the process of tophus formation is greatly accentuated. In other words, the tophi may not only be of prominent size, but of unusually widespread distribution. Indeed, poetic exaggeration has it that one Baylas and one Acragas were entombed while alive in their own uratic deposits. But, apart from such imaginative flights, there are unquestionably some cases in which tophi are most widely diffused. Thus Plater tells of a patient whose whole body, even the eyelids, was studded with them: “ex toto corpore, per poros, adeo ut etiam palpebræ oculorum non exemptæ fuerint, ejusmodi materia gypsœa, circa poros cutis mox in tophos mutata, prodisset.”