-------------------------------+---------------+---------------- | | Uratic deposits | No. of cases. | in joint or | | joints. -------------------------------+---------------+---------------- Marked granular kidney disease | 26 | 20 -------------------------------+---------------+---------------- If of the sixty-seven cases there be selected only those described as “markedly granular,” or “typical granular kidneys,” the incidence of uratic deposits in the joints, as revealed by the second table, reaches no less a figure than 77 per cent. Another authority, discussing the frequency of incidence of uratic deposits in the joints in cases of chronic interstitial nephritis, states that, at post-mortem, from 50-80 per cent. show their presence—this, moreover, in cases _known not to have had gout_. DIFFERENTIATION OF URATIC DEPOSITS IN GOUT AND NEPHRITIS Uratic deposits, it is true, occur in both these disorders. But it is with a difference. In gout the uratic deposit assumes the form of _tophi_, whereas in nephritis it is not so. In the latter the uratic deposit is in the nature of a passive deposition—an uratic incrustation of the articular cartilages. Again, in gout the deposition is _sudden_ and associated with an acute paroxysm; while in nephritis it is _gradual_ and unassociated with inflammatory reaction. In gout the uratic deposits are overt, manifest as _tophi_; in nephritis, occult and unrevealed (ante-mortem). Uratic deposits in the form of tophi occur in gout, in the absence of clinically recognisable interstitial nephritis. But tophi do not occur in nephritis if uncomplicated by gout. In conclusion, the mere fact that uratic deposits affect such widely disparate forms in these two disorders is to our mind a sure indication that their mode of origin and formation is equally diverse—the one vital, biological; the other passive, mechanical. CLINICAL ASSOCIATIONS OF GOUT AND GRANULAR KIDNEY It cannot be denied that gout and granular kidney are frequently met with in close association. But neither can it be disputed that in these disorders, as in many others, their outward affinities do but hark back to inward disparities. The occasional overlapping of the two affections, the trenching of the one upon the clinical or pathological territory of the other, must not blind us to the essential distinctness of the two morbid entities. Doubtless to the earlier advocates of the renal theory their not infrequent _co-existence_ bespoke some hidden _nexus_, and at least seemed confirmatory of their views as to the pathogeny of gout. But, even if we allow that the connexion between the two disorders seems superficially intimate, it cannot be gainsaid that it is neither constant nor essential. For we have to recollect that— (1) Some gouty subjects never develop granular kidney.