METABOLISM IN NEPHRITIS 383 



regarded as one depending solely upon the amount of fluid and solids ex- 

 creted in the urine. It was supposed that if there was retention of waste 

 products a certain series of symptoms ensued, on the other hand, if the 

 urine was sufficient nothing was to be apprehended. The clinical observa- 

 tions of the last few years, especially the results obtained by numberless 

 blocd chemical determinations, have given this -long entrenched conserva- 

 tive theory a rude shock. Through these efforts it has developed that the 

 so-called uremic complex may occur whether the urea and many other 

 constituents of the blood are increased or normal. The name uremia, 

 however, remains even if the facts which it implies have been proved to 

 be incorrect. 



This retention of a term that has long outlived its significance is most 

 confusing. The term uremia ought to be confined to that state in which 

 the blood urea is distinctly increased. Renal insufficiency followed by the 

 accumulation of waste products in the blood entails a fairly definite symp- 

 tom complex that may be grouped as uremia. Even if the meaning of 

 the word is thus limited, it is doubtful whether uremia should be retained 

 as a term, since it is certain at the present time that the blood urea is 

 only one of a considerable number of substances that the kidney fails to 

 eliminate. It would bs much better to speak of the rather well defined 

 syndrome accompanying marked oliguria or anuria, which will be described 

 subsequently, not as uremia but by a name which actually states the facts 

 as they are, such as kidney insufficiency. 



If the term kidney insufficiency is used to cover part of the meaning 

 usually conveyed by the word uremia, how shall the remainder be desig- 

 nated ? A curious contradiction has arisen as time has passed by. By 

 some authors and clinicians, those toxic states, accompanying Bright's dis- 

 ease, characterized by convulsions and other signs of irritation of the nerv- 

 ous system have been called uremia, whereas those in which drowsiness 

 and somnolence have predominated have not been put in this category. 

 Yet it is the latter state in which the blood urea is usually high ; and it is 

 the former condition in which only a comparatively slight increase in the 

 blood urea and frequently none at all occurs that has had the name of 

 uremia attached to it. Such toxic symptoms accompanying Bright's disease 

 without renal insufficiency are very variable and their clinical picture can 

 not be adequately summarized by one word. It would avoid confusion if 

 these manifestations were described as nephritic headache, nephritic con- 

 vulsions, nephritic vomiting, etc., whenever the diagnostician believed 

 them to be secondary to the diseased process in the kidney. Janeway in a 

 similar way some years ago successfully designated a certain form of head- 

 ache as hypertensive headache. 



Ascoli has given the most satisfactory definition of uremia. It is a 

 succinct statement of fact and does not attempt to evade the issue that 

 there is no clear cut. conception of what the uremic state really is. His 



