case has been reported by Cook, Rodenbaugh and Whipple. Recently, 

 Louria has described cases of intestinal obstruction from the Presby- 

 terian Hospital, and has shown that during the period of acute obstruc- 

 tion, the blood urea may be markedly elevated. In those cases that recover, 

 the blood urea returns to normal. In fatal cases, the kidneys have shown 

 no abnormalities which could be interpreted as nephritis. In one of 

 Louria's cases there developed a generalized urticaria and erythema. 



It is highly probable that other forms of intoxication may arise from 

 the absorption of toxins formed in the gastro-intestinal tract, during which 

 there may be such profound disturbances in the protein metabolism of 

 the body that the non-protein nitrogen constituents of the serum are tem- 

 porarily increased and the function of the kidney temporarily interfered 

 with. Such an instance occurred in one of a group of cases reported by 

 Longcope and Rackemann, wherein a violent attack of diarrhea in a 

 woman fifty-eight years old, was followed in five days by an elevation of 

 the blood urea to 295 mgm. per 100 c.c. On the llth day after the onset 

 of the diarrhea, there developed a profuse and generalized urticaria and 

 erythema which persisted for 6 days and was accompanied by a leukocy- 

 tosis of 44,600 with 76 per cent polymorphonuclear leukocytes. With the 

 disappearance of the eruptions, the blood urea fell to normal, 22 mgm. per 

 100 c.c. The leukocyte count dropped to 8,000 but the eosinophiles in- 

 creased proportionately to form 23 per cent of the granular cells. The 

 substances which may produce these forms of intoxication in the human be- 

 ing are as yet unidentified, but from the few careful observations that are 

 on record, they seem to be associated with a marked disturbance in the 

 general protein metabolism and by the accumulation in the blood serum of 

 abnormal quantities of non-protein nitrogen. They are likewise accom- 

 panied at times by urticarial or erythematous eruptions which do not differ 

 essentially from those observed in cases of serum disease. Similar changes 

 have been observed by Schloss in the blood of infants suffering with in- 

 testinal toxemia. In a series of 46 such cases, he found in 33 an increase 

 in the blood non-protein nitrogen from 57 to 232 mgm. per 100 c.c. and 

 of the blood urea nitrogen from 20.1 to 108 mg. per 100 c.c. The condi- 

 tion was accompanied by a lowering of the blood CO 2 which is not due 

 to the formation of ketone bodies but retention of phosphates as was shown 

 by Marriot and Howland and is associated with great loss of water from 

 the body. The excretion of water was diminished to almost nil, and though 

 there was no evidence of actual disease of the kidneys, Schloss concludes 

 that the retention of nitrogenous products is dependent upon faulty elim- 

 ination resulting from the small fluid output. 



Aside from these intoxications, which are associated with disturbances 

 in the gastro-intestinal tract and which may be dependent upon the for- 

 mation and the absorption of some toxic chemical derived from protein, 

 a supposition, no matter how suggestive yet purely speculative, there are 



