That gout and its varied complications are due to toxemia, possibly to uric acid or to other substances which vary in the blood as it does, is generally admitted. Interstitial nephritis, the common renal complication of gout, is so well understood that I need not dwell upon it in this discussion. There are a few points, however, in the course of development of the lesion to which I wish to call attention, for in most text-books and monographs sufficient emphasis is not placed upon them.
It is, of all renal diseases, the most insidious in onset, and it is intermittent in progress. The kidneys are attacked now and again by uric acid or the toxic agent of gout in microscopic areas, which produce active lesions of almost microscopic size. It is true when we examine a kidney which illustrates interstitial nephritis that we find almost the whole parenchyma involved to