1913] -E- E. Smith 245 



in health and with conditions unknown to us in disease. Moreover, 

 we did not recognize it as a causative factor in the many diseases to 

 which this role was assigned by Haig, but rather regarded its in- 

 creased elimination as a result of the morbid condition. Horbac- 

 zewsky's work did not come to our attention tili after the publication 

 of this first paper. 



The study of epileptics led to the conclusion that, in some cases 

 of so-called idiopathic epilepsy, the onset of the seizures was deter- 

 mined not by a uric acid accumulation, as claimed by Haig, but by 

 a toxemia of gastro-intestinal origin. Indican, which had received 

 scant attention from clinicians up to this time, was found to be a 

 valuable index to the condition; as was also the elimination of phenol 

 and ethereal sulphates. The occurrence of these products in undue 

 quantity seemed to bear a direct relation to the onset of the seizures. 



As was natural, there followed an elaborate study of the gastro- 

 intestinal conditions in other diseases, especially those with marked 

 neurotic manifestations ; and the conclusion was reached that the neu- 

 rotic exacerbations in many conditions were due to a gastro-intes- 

 tinal toxemia. An entirely different line of study was the presence 

 of lead and its distribution in cases of chronic lead poisoning. The 

 results of these analyses were never published. 



Investigations to which was devoted a very great amount of 

 work and which covered a very wide scope, as well, were the studies 

 of the causes of uremic intoxication. The many theories which had 

 been elaborated to explain this condition were each in turn subjected 

 to investigation, involving extensive animal experimentation as well 

 as intricate chemical research. The work covered several years and 

 the results were of very great interest to us, and certainly influenced 

 Herter's later work, but they were never published. 



During this period, there was a striking lack of activity in re- 

 search in chemical pathology in New York; indeed, this was only 

 the time of the awakening of general interest in the most active Cen- 

 ters of medical science. Aside from Herter's work, only a single 

 paper presented at the Academy of Medicine in that period comes to 

 my mind ; and that was so glaringly f aulty that one hesitates to con- 

 sider its sincerity. 



Von Noorden's Pathologie des Stoffwechsels, which appeared 



