191 1] Herman 0. Mosenthal 323 



tively short periods of absolute anuria to produce a grade of 

 hydremic plethora comparable to that obtaining in renal dropsy. 



By the Infusion of normal saline Solution an extreme condition 

 of hydremic plethora may be produced. Cohnheim and Lichtheim 

 in classical experiments infused rabbits and dogs with large quanti- 

 ties of fluid. They thereby produced ascites, edema of the gastro- 

 intestinal tract and other organs, but the edema of the skin and sub- 

 cutaneous tissues, the anasarca characteristic of renal disease was 

 lacking. Fluid had not passed through the skin capillaries into the 

 interstitial Spaces. It was therefore deemed probable that besides 

 plethora and hydremia, a lesion of the capillary blood vessels is 

 necessary to bring about an anasarca. 



The blood vessels of the skin may be injured by the application 

 of iodine, exposure to the sun and other means. Infusion in animals 

 which have been thus treated results in local edema corresponding 

 in extent to the application of the irritant. Furthermore if a blood 

 vessel poison, such as arsenic, is injected, Infusion will result in 

 anasarca comparable to that seen in nephritis. 



Therefore the production of renal edema may be assumed to be 

 brought about by no Single cause but by a chain of events : 

 Hydremic plethora associated with an injury of the smaller blood 

 vessels and a kidney lesion. The order in which these occur makes 

 no difference, so far as is known. However that all three must be 

 present has recently been shown by Pearce in experiments on rabbits. 

 Injecting a variety of blood vessel and renal poisons and producing 

 hydremic plethora by giving water through the stomach tube, this 

 investigator proved conclusively that not any one or any two of 

 these factors were sufficient to bring about anasarca and dropsy of 

 the body cavities, but that all three must cooperate to produce 

 edema. 



In this explanation of renal dropsy the problem of the influence 

 exerted by the kidney itself on the condition is especially hazy. As 

 was pointed out above, neither hydremic plethora nor a blood vessel 

 lesion will in itself produce edema. The retention of sodium 

 Chloride and other substances normally excreted in the urine bears 

 on the problem only in so far as these substances influence fluid 

 retention and increase the hydremic plethora. These points have 



