HERMAN O. MOSENTHAL 



previous investigators, believes that the inability of the total protein to 

 reach a nonnal level means "internal edema," even though the "external 

 edema" has completely disappeared and that this is also a manifestation 

 of chronic intoxication present in nephritis. Such cases, with persistently 

 low total and abnormal, albumin: globulin ratios have a poor prognosis. 

 The. .chart from Howe on page 317 illustrates these points. 



The effect of feeding in restoring the serum proteins to normal is 

 interesting from the therapeutic point of view. In the first place it must 

 be borne in mind that proteins as such are not absorbed by the intestines, 

 but only their derivatives, the amino acids, are. Hence feeding a par- 

 ticular albumin or globulin to restore these serum proteins to normal is 

 a useless procedure. It was shown by Kerr, Hurwitz and Whipple(a) (6) 

 that in dogs in whom the serum proteins had been lowered by plasmaphare- 

 sis, that a more rapid regeneration occurred on a normal diet, especially 

 a meat diet, than on fasting ; under the most favorable circumstances it re- 

 quired five to eight days to regenerate the serum protein to normal. The 

 effect of forcing protein food in case of chronic parenchymatous nephritis 

 for a few days produced some increase in serum proteins, as shown in 

 Table 2. 



TABLE 2 



EFFECT OF FEEDING PATIENTS SUFFERING WITH CHRONIC PARENCHYMATOUS NEPHRITIS 

 A DIET HIGH IN PROTEINS. (Kahn) 



Epstein (b) advocates not only a high protein diet, but also transfusions in 

 his effort to restore the serum proteins to normal. 



Summary. In chronic nephritis the serum proteins may or may not 

 be diminished; when such a change occurs it is brought about mainly, 

 through a reduction of the serum albumin; the serum globulin is nearly 

 always relatively and at times absolutely increased. These abnormalities 

 may be entirely or in part caused by the action of some extrarenal toxic 

 substance of unknown nature. Such deviations from the normal occur 

 most frequently in the types of nephritis associated with edema. The 

 relation of the edema to the deviations from the normal of the blood pro- 



