392 HERMAN O. MOSENTHAL 



3. Only in very advanced cases is the acidosis usually so marked as to 

 cause a decrease in the alveolar carbon dioxid tension. This is not true 

 in all instances. 



4. The acidosis of chronic nephritis is due to a retention resulting from 

 inefficient renal excretion. 



It has been detailed under the heading of phosphates in nephritis, 

 how the retention of acid phosphates is responsible for the nephritic acid- 

 osis. Chace and Myers have come to the conclusion that all fatal cases of 

 chronic nephritis with marked nitrogen retention show a severe acidosis 

 sufficient in many instances to be the actual cause of death; the same 

 seemed to hold true for some of the patients suffering with acute nephritis. 

 They found that alkali therapy by mouth and infusion causes the symp- 

 toms to disappear. 



Advanced bilateral cystic degeneration of the kidneys offers the clin- 

 ician a rare opportunity of studying kidney insufficiency in its purest 

 form. In chronio or acute nephritis there usually are degenerative, in- 

 flammatory or arteriosclerotic changes in tissues outside of the kidney, and 

 functional anomalies such as hypertension, myocardial insufficiency, 

 etc. ; any symptom or sign regarded as due to lowered efficiency of the 

 kidney in nephritis consequently demands close scrutiny. The case of 

 bilateral cystic kidneys reported by Means and Roger is therefore of 

 extreme interest (in this patient there was no increased blood pressure 

 such as is often present in this malady). These authors found that the 

 death of a colored man, 46 years old, was apparently caused by acidosis 

 of very marked degree (the carbon dioxid tension in the alveolar air going 

 as low as 6.4 mm. of mercury and the carbon dioxid capacity of the plasma 

 determined according to Van Slyke dropping to 12 volumes per cent). 

 The author has seen a similar case in which the acidosis, while not so 

 severe, was very marked. This patient, during the course of a year and a 

 half, was saved from what appeared to be impending "uremic coma" on 

 three occasions by the administration of alkali. 



From what has been said it becomes perfectly evident that in many 

 cases which die as the result of diminished kidney activity, acidosis is the 

 determining factor which brings about the fatal outcome. The writer has 

 believed this to be true for some years and after observing a good many 

 cases has finally come to the conclusion that the above idea is correct 

 in the majority of cases but is not a universal rule. Recently, a case of 

 secondary contracted kidney, that had been watched carefully for several 

 weeks, died the slow death characteristic of markedly impaired renal func- 

 tion, while the carbon dioxid combining power of the blood was 45 volumes 

 per cent. There were many petechial spots (blood cultures negative and 

 no definite proof of terminal infection) and evidently another immediate 

 cause of death than acidosis would have to be sought in this case. The 



