436 METABOLIC ABNORMALITIES, A UTOINTOXICATION 



an excess of organic molecules that dissociate but little if 

 at all, and hence are not conductors of electricity. Some 

 authors, indeed, have ascribed uremia to the increased osmotic 

 pressure of the blood from the retained molecules, but this is 

 improbable, according to Strauss, 1 who found that a marked 

 increase in molecular concentration may occur without uremia, 

 and that we may have a severe uremia without increased 

 osmotic pressure. 2 



That organic nitrogenous bodies accumulate in the blood in 

 nephritis has been repeatedly demonstrated. Strauss found 

 that the non-proteid nitrogen of the blood, which normally 

 amounts to 20-35 mg. per 100 c.c. of blood, shows a slight in- 

 crease in chronic parenchymatous nephritis, to about 40 mg. j 

 and in interstitial nephritis, a large increase, the total amount 

 averaging 85 mg., being especially high when uremia is present. 

 Urea is demonstrably increased under the same conditions, as 

 also is the ammonia nitrogen, especially in uremia. Erben 3 

 has studied the variations in the normal components of the 

 blood during nephritis, and found the albumin generally de- 

 creased in proportion to the globulin, especially in the case of 

 parenchymatous nephritis ; lecithin and calcium are also de- 

 creased. The decrease in red corpuscles and hemoglobin in 

 nephritis is a well-known feature. By the precipitin reaction it 

 has been shown that the globulin of nephritic urine is derived 

 from the serum, and not directly from the proteids of the food. 

 Rumpf 4 has analyzed the organs as well as the blood in nephritis, 

 and found a distinct retention of organic substances in both the 

 blood and organs ; sodium chloride is usually increased, as also 

 are the other inorganic salts, which are probably partly bound 

 in organic combination with the tissues. (See " Retention of 

 Chlorides in Edema," p. 293.) The reduction of the alkalinity 

 of the blood, observed by v. Jaksch and others in uremia, is 

 attributed by Gottheiner 5 to the presence of abnormally large 

 quantities of lactic acid in the blood. Orlowski 6 found that 

 an accumulation of acids occurs in uremia, but not until just 

 before death, and, therefore, the reduction of blood alkalinity is 

 not the cause, but an accompaniment of the uremia. Further- 



x Die chronischen Nierenentziindungen, etc. , Berlin, 1902. 



2 Stern ( Med. Kecord, 1903 (63), 121) ) notes that the electrical conductiv- 

 ity is reduced by the presence of excessive quantities of non-electrolytes in 

 uremia, and regards this lowered conductivity as a factor of some possible im- 

 portance. 



Zeit. klin. Med., 1903 (50), 441 ; 1905 (57), 39. 



* Munch, med. Woch., 1905 (52), 393. 



6 Zeit. klin. Med., 1897 (33), 315. 



6 Zentr. f. Stoflwechsel u. Verdauungskr. , 1902 (3), 123. 



