384 HERMAN O. MOSENTHAL 



statement is somewhat as follows: Uremia is any toxic state or symptom 

 associated with a renal lesion; it is tempting and justifiable to add, pro- 

 vided no other cause can be found to account for the toxic state or symp- 

 tom. Since Ascoli's time one large group of cases has been taken out of 

 the category of uremia. The recent intensive study of renal function, 

 coupled with pathological observations, has made it clear that cerebral 

 arteriosclerosis and its attendant changes are responsible for many in- 

 stances formerly considered to be uremia. These facts will be taken up in 

 greater detail a little further on, but this may serve as an example of 

 how the term uremia will gradually be more and more limited until it 

 obtains a definite significance which it does not possess at present. The 

 writer wishes to call attention again to the point brought out in the first 

 paragraphs of this section, namely, that the term uremia has outlived its 

 day and that those conditions brought on by inadequate kidney function 

 should be grouped as renal insufficiency, and those states occurring in the 

 course of Bright's disease, but not accompanied by deficient kidney ac- 

 tivity, should be designated as nephritic convulsions, nephritic vomiting, 

 etc., thus at least making the clinical diagnosis perfectly clear. 



Uremia, as Described by Julius Cohnheim in 1882 



It is remarkable how little progress has been made during many years 

 in determining the etiology of uremia. A good idea of the lack of ad- 

 vance in this direction may be obtained by reading what Julius Cohnheim 

 (a) wrote about this subject in 1882 ; his presentation is interesting, stimu- 

 lating, and does not differ very markedly in many respects from the exposi- 

 tion given by other authors since that time ; it forms a very good starting 

 point from which to note what meager changes in the conception of uremia 

 have come about in a period of almost forty years and will give the reader 

 a much clearer idea and broader view of the question of uremia than if 

 only the latest efforts on the subject, which are largely a repetition of the 

 older ones, are discussed. Cohnheim's exposition given partly in summary 

 and partly as a literal translation is as follows : 



By the term uremia is meant a series of nervous symptoms which may 

 develop suddenly or slowly, that is, may be acute or chronic. In the acute 

 form unconsciousness or epileptiform convulsions are followed by deep 

 coma ; prodromal symptoms, especially severe headache, or vomiting may 

 be present; during the coma there may be a few or numerous clonic 

 convulsions. These attacks may be repeated several times and apparently 

 complete recovery take place in the interval, until at last, the comatose state 

 terminates in death. In the chronic form the course is less stormy; at 

 first, irritability, somnolence and apathy develop; slowly but surely these 

 symptoms increase and a constantly deepening coma supervenes which has 

 an invariably fatal issue. 



