316 HERMAN O. MOSENTHAL 



nephritis. Epstein (6) believed that in chronic interstitial nephritis the 

 blood serum proteins were normal but that in chronic parenchymatous 

 nephritis the serum protein was much diminished at the expense of the 

 albumin fraction while the serum globulin was relatively, as well as actu- 

 ally, increased, in summary it may be said that, as the question stands 

 to-day, there may be a slight diminution of the total serum protein and the 

 serum albumin, accompanied by a slight rise in the serum globulin in 

 chronic nephritis and that these changes may become very marked in the 

 types of nephritis accompanied by edema. The' whole problem is in a 

 somewhat unsatisfactory state because the methods for the determination 

 of albumin and globulin are not generally accepted and because the 

 separation of these two forms of protein is based upon rather arbitrary 

 grounds. 



The significance of the above findings have been interpreted in widely 

 divergent ways ; none of them are as yet conclusive though they are of con-; 

 siderable importance in shaping future studies in regard to the nature and 

 treatment of nephritis. It is believed that certain toxic substances cause 

 changes similar to those recorded in nephritis. Thus Whipple and Cooke 

 showed how similar variations occurred in the serum proteins of dogs with 

 intestinal obstruction or closed intestinal loops; they believed this phe- 

 nomenon to be brought about by a toxic proteose ; the latter when isolated 

 from the intestines and injected into animals was followed by exactly 

 similar changes. Furthermore Hurwitz and Meyer in their studies on the 

 serum globulins in bacterial infection and immunity have concluded that 

 the increase of globulins occurring during the process of immunization is 

 the result of the action of some toxic factor and is not a part of the proc- 

 ess upon which the development of immunity depends. These two types 

 of poisoning, intoxication from intestinal absorption, and from infection, 

 are particularly stressed because they may both be associated with the 

 production of nephritis. The deviation from the normal of the serum pro- 

 teins of the nephritic may be an expression of the severity of a toxic effect 

 upon which nephritis depends and not the direct result of the nephritis 

 itself. 



The reason for the association between the more evident changes that 

 occur in the serum proteins of the edematous, as compared to the non- 

 edematous, case of nephritis has been interpreted in various ways. Rowe 

 rather inclines to the theory that a dilution of the blood serum, a hydremia, 

 is responsible for the diminution of the proteins ; this of course does not 

 explain the relative and in some cases the absolute increase of the globulins, 

 which, not only by Rowe but also by other authors, is ascribed to the 

 effect of some unknown toxin. All the changes are accounted for by the 

 latter theory by many observers. In view of what is now known of the 

 action of proteose and bacterial poisons this assumption certainly has much 

 in its favor. Epstein believes that the loss of albumin in the urine is 



