394 HERMAN O. MOSENTHAL 



Nephritic Toxicosis 



There u a form of poisoning accompanying nephritis whose main 

 characteristic is found in signs and symptoms brought on by an irritation 

 of the central nervous system. This has been variously called sthenic 

 uremia, convulsive uremia, epileptiform uremia, eclamptic uremia, etc. 

 The appellation uremia is absolutely incorrect inasmuch as this symptom 

 complex is not necessarily accompanied by an increase in the amount of 

 of area in the blood. It is invariably associated with B right's disease in 

 the minds of all. However, it must be acknowledged that similar clinical 

 pictures occur, for instance, in cerebrospinal meningitis. Under the cir- 

 cumstances there is a peculiar state of affairs that confronts the physician : 

 a symptom complex whose most prominent feature is convulsive phe- 

 nomena, has no definite cause; since nephritis often accompanies it, it 

 has been termed uremia. It is not at all certain that this condition, sthenic 

 uremia, is a sequel to changes in the kidney ; it is extremely important to 

 bear this fact in mind. It is much more probable that the same unknown 

 poison is responsible for both the nephritis and the nervous manifestations. 

 There are a number of cases in which the convulsive seizures have occurred 

 previous to any signs of renal disease, which sequence could only be ex- 

 plained on the supposition just expressed, that the same toxic material 

 is the cause for either change and one is in no way dependent on the other. 

 The term nephritic toxicosis is much more expressive of what is really 

 meant by this condition ; uremia as just explained is an utter misnomer ; 

 if the individual symptoms of this state are to be described it would be 

 best to designate them by the term nephritic, as nephritic convulsions, head- 

 ache, etc. This has already been discussed under the heading of introduc- 

 tion and definition in this section on uremia. 



The greatest progress in clearing up the situation has been made in 

 the so-called toxemias of pregnancy. Even here the advance has not been 

 very great, but at least it has been recognized that the diseased kidney 

 is not at fault in every instance and that there are lesions in the liver that 

 may have some etiological bearing. In a search for the specific cause of 

 nephritic toxicosis two directions have been followed: the one ascribing 

 it to mechanical factors, the other to some chemical poison. 



Edema of the brain, as suggested by Traube, has already been taken 

 up in discussing the older views on uremia, up to 1882. Cohnheim at that 

 time could not substantiate Traube's claim and nothing of note has been 

 added to the discussion since that date. From all the personal reports 

 the author has been able to gather neither spinal puncture nor decompres- 

 sion has any influence on relieving the symptoms; this would indicate 

 that the increased intracranial pressure, resulting from a possible cerebral 

 edema, was not a factor in the nephritic toxicosis. 



