3IO Fischer' s Theory of Edema [Dec. 



lished, directly or by methods o£ exclusion, that nothing occurs in an 

 edematous part but the production of organic acid to account for an 

 increased affinity of the colloids for water? Has Fischer duly con- 

 sidered, in this connection, the effect of pathocolloidal coordinations 

 in cells, in response to various prevaiHng influences in incipient 

 edema ? Does it follow, because acids increase colloidal hydrophilia 

 and because lactic acid production is increased by suboxidation in 

 tissues as edema is there inaugurated, that the edema is caused or 

 initiated by the resultant lactic acid? Have the possible influences 

 of hydrolases been duly considered? Is it improbable or impossible 

 that such enzymes are even more important factors in the develop- 

 ment of edema than the acid which is produced and to which Fischer 

 attributes the whole hydrops? May not enzymes of this kind — 

 aided perhaps by organic acids or acid salts or both — cause such 

 changes in the normal intracellular colloidal coordinations and in 

 the colloids themselves as to result in increasing the total affinity 

 for water by the parts involved ? 



Are the hydrostatic phenomena of certain edemas clarified by 

 Fischer's conception of directive colloidal hydrophilia? Does his 

 theory account for the great diversity in composition of edematous 

 fluids? Repeated severe hemorrhage, on a free diet, is followed 

 by the urinary excretion of lactic acid in exceptional quantities but 

 there is no visible anasarca.^^ Why not ? ( See page 302. ) What is 

 the explanation of the absence of general edema in diabetic 

 "acidosis"?27 



Do all observers agree that " the fluid of an edematous tissue is 



" Fischer accepts in general, as I do here in particular, the results of Araki's 

 determinations of lactic acid (lactate), although Araki's studies should be re- 

 peated with improved methods. If the special excretion of lactic acid signifies 

 suboxidation, as Fischer assumes, the conditions after several severe hemorrhages 

 without restricted diet appear to be favorable, in Fischer's view, for the causa- 

 tion of edema. 



" If general edema fails to occur in diabetes because of neutralization of the 

 " diabetic acids " or if the acids of diabetic " acidosis " merely neturalize abnormal 

 basicity, in what material respects are these neutralization and inhibitive effects 

 different from those that normally prevail in practically all parts of the living 

 body? Surely, since large proportions of non-electrolytes are practically without 

 inhibitive effects on colloidal attraction for water in the presence of free acid, 

 " diabetic sugar " would not cause the observed difference. 



