42 ANALYSIS OF DISTUKBANCES OF METABOLISM 



amount of nitrogen administered in the food), in concluding that the cause is 

 deficient excretion of nitrogenous products of albumin metabolism (Fleischer,^ 

 V. Koorden and Eitter^). 



Because of this fact, as well as because days with increased K-excretion 

 often follow these periods of decided N-retention, the N-elimination in nephri- 

 tis is in a very " unaccountable and bizarre state which, according to v. Noor- 

 den, characterizes the metabolism of renal patients." 



But we are here dealing wholly with disturbances of excretion; there are 

 no changes in the amount of albumin metabolism (no toxogenous albumin 

 decomposition). 



In investigations of the metabolism of gouty patients we are often con- 

 fronted with irregularities in the excretion of urea, apparently in consequence 

 of functional insufficiency of the organs of excretion, which is natural if we 

 remember that renal disease often complicates gout (Vogel,^ Schmoll*). 



It is interesting to note that Rosemann ^ lately found ia a healthy, or appar- 

 ently healthy, young man during a long investigation in metabolism carried 

 out for a different purpose, a decided N-retention with subsequent increased 

 excretion of urea. In this case there were no sufficient grounds for the assump- 

 tion of any renal disease. On the other hand, the person experimented upon 

 had suffered for years from a cutaneous affection (occasional attacks of urti- 

 caria), and it is conceivable that, in consequence of this, the excretion of 

 water through the kidneys had in the course of years become diminished in 

 favor of that through the skin; and that, therefore, the IST-elimination by 

 means of the urine had suffered. However, the excretion of water in the urine 

 during the period of N-retention was never so slight in this case that the 

 urine could not have excreted more nitrogen. Eosemann, therefore, expressed 

 the opinion that a prolonged ingestion of iodin was responsible for the dis- 

 turbance of JST-excretion (the person experimented upon had suffered from 

 a cutaneous affection for years, and up to within fourteen days of the test 

 had taken potassium iodid), but at the present time proofs are wanting that 

 the secretory activity of the kidneys can be thus influenced by the use of iodin, 

 even for a long time. 



I believe that every one who has made many quantitative researches in 

 metabolism has occasionally met with healthy persons in whom, in spite of 

 the most careful regulation of the amount of the food, it was impossible to 

 attain N-equilibrium. In such persons the daily IST-excretion constantly 

 varies up and do^sTi when we are attempting to get at the average figures. Oc- 

 casionally there are periods of relatively low excretion lasting several days 



1^ Fleischer, Klinische und pathologisch-chemische Beitrage zur " Lehre von den 

 Nierenkrankheiten." Deutsches Archiv f. klin. Med., vol. xxix, p. 129. 



2 V. ISloorden und Ritter, " Untersuchungen iiber den Stoflfwechsel Nierenkranker." 

 Zeitsohr. f. klin. Med., vol. xix, p. 197. 



3 Yogel, V. Noorden's Beitrage zur "Lehre vom Stofifweehsel," 1894, Heft 2, p. 113. 



4 Schmoll, " Stoffwechselversuche an einem Gichtkranken." Zeitschr. f. klin. Med., 

 vol. xxix, p. 510. 



5 Rosemann, " Ueber die Retention von Harnbestandtheilen im Korper." PflUQer's 

 ArcMv, vol. Ixxii, p. 467, 



