This time-worn hypothesis as to the pathogeny of gout has, perhaps, provoked more controversy than any other etiological problem in the sphere of clinical medicine. Nor, unfortunately, despite the endless laborious research expended upon its solution, the dialectic skill exercised in attempts at its elucidation, can we claim even to-day that its complexities have been wholly unravelled. But, perhaps it will be wiser to postpone decision, pending detailed analysis of the several grounds upon which the theory of the primary renal origin of gout rests. Broadly speaking, the arguments adduced tend to concern themselves with or rather to arise out of certain apparent _abnormalities_ in _uric acid excretion_, currently held distinctive of gout, certain resemblances also suggestive of a hidden _nexus_ between _gout_ and _renal_ disorders, viz.:— (1) _Anomalies in uric acid excretion in gout._ (2) _Uricæmia, a condition common to gout and nephritis._ (3) _Uratosis, a feature also common to both disorders._ (4) _Occasional co-existence of gout and nephritis._ ANOMALIES IN URIC ACID EXCRETION IN GOUT As to the variations in _purin_ excretion that occur in _gout_, it must be admitted that, notwithstanding the magnitude of the researches, no very striking departures from normal have emerged. Such as have been elicited occur in relation to (_a_) the acute paroxysm, (_b_) the excretion of exogenous purin. _The Acute Paroxysm._—Garrod, it will be recalled, claimed that during an _acute_ attack of gout the excretion of uric acid was diminished, and that coincidently therewith the uric acid blood content rose. But these findings in the _blood_ and _urine_, which constituted the basis of his hypothesis that gout was due to _renal inadequacy_, have, as previously noted, been categorically disproved. Turning to the more modern findings upon which such refutation of Garrod’s view was achieved, one point emerges that appears to favour the assumption of _renal block_. It is that, _one or two days prior to an acute attack_, an appreciable _decline_ in the output of uric acid occurs.