336 IIEXEY A. MATTILL AXD IIELEX I. MATTILL 



Disturbances in Mineral Metabolism Accompanying 

 ^v Pathological Conditions 



Fevers are usually accompanied by a retention of chlorids. Snapper 

 (a) (c) and Peabody have shown that the blood chlorids are below normal, 

 and the retention is due not to a failure of kidney function but to a change 

 in cell permeability. A similar retention of chloride in fever produced 

 artificially by injection of B. pyocyaneus in dogs has been noticed (Griiu- 

 baum). Such chlorid retention is not always accompanied by water re- 

 tention (Leva(fc)). 



Tuberculosis is accompanied by an abnormal loss of calcium (Croftan; 

 Voorhoeve(&) ; Sarvonat and licbattu). 



Typical hereditary hemophilia is not associated with deficiency in 

 blood Ca, or with irregular Ca metabolism but there is a type of hemo- 

 philia "calcipriva" in which the blood calcium is low and in which an 

 increased Ca intake changes a negative to a positive balance with bene- 

 ficial effects on the blood coagulability (Hess). 



Leprosy seems to be associated with a disturbance in Ca metabolism 

 (Underbill (p)). 



The kidney insufficiency in some types of nephritis is marked by re- 

 tention of chlorids (Gluzinski; Ceconi). 



In nephritis without acidosis the inorganic phosphate of the blood is 

 normal, but with acidosis it may rise to 8-23 mg. per 100 c.c. (Denis and 

 Minot(<7) ; jMarriott and Howland(a) ), due to a specific disturbance of 

 kidney function which prevents the elimination of phosphates; at the 

 same time there is a marked reduction of blood calcium. Ingestion of 

 calcium salts, thus diverting the excretory function to the intestine, is 

 recommended as a therapeutic measure. 



Attempts to prove an interdependence of mineral metabolism and the 

 endocrin glands have not thus far produced proof of any very definite 

 relationships (Droge) with the exception of a well-established connection 

 between the parathyroid and Ca metabolism. Underbill, and McCallum 

 with Voegtlin and with Vogel found that the tetany resulting from thyreo- 

 parathyroidectomy was accompanied by decreased calcium in the blood and 

 that injection of Ca lactate would temporarily abolish the tetany. "Nu- 

 merous researches have shown the important relation of the Ca salts to 

 the excitability of the central nervous system. Their withdrawal leaves the 

 nerves in a state of hyperexcitability and tetany may be regarded as an 

 expression of hyperexcitability of the nerve cells from some such 

 cause. The mechanism of the parathyroid action is not determined, but 

 the result, the impoverishment of the tissues with respect to calcium and 

 consequent tetany, is proven." Injections of Ca or Mg salts check the 



