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?s-~h3 m I- WORK ON TOXIC PSYCHOSES Investigations that have been just completed on 138 autopsies of patients th«t died in uremia have shown that there are.three aspects of uremic poisoning as demonstrated by correlation ofthe pathologic changes in the heart with the blood chemistry prior to itoth, Tn one group of cases the toxic effects are caused by acidosis and these effects are not dependent upon the level of the nonprotein nitrogen or potassium levels in die blood. In a second group of patients with elevated serum potassium definite.focal damage with death of myocardial tissue Is found In the heart and these patients died of potassium poisoning. In the third group of patients, who presumably died of the accumulation of toxic nitrogenous substances in the blood or related compounds, the ffgvdige damage is associated with unusually high nonprotein nitrogen levels in the blood anr> the heart shows a definite inflammatory reaction with the appearance of Anitschkow's cells. We have reason to believe from the histologic study of the pathologic changes that these toxic nitrogenous compounds are diamino derivatives of aromatic nuclei. The work on uremic toxic states is being pursued by the analysis of the cerebral spinal fluid of patients with uremia, and by the production of uremia in ^ experimental animala by three methods: (a) Nephrectomy; (b) ligation of the ureters; _ (c) poisoning of the kidneys with derivatives of naphthalic anhydride. - Since it has now been demonstrated that there are at least three components to the uremic- state (1) acidosis which changes the blood pH, (2) elevated potassium — levels, and (3) elevated nonprotein nitrogen levels, it is possible to go back in the histories of these patients and correlate the depth of uremic coma and its duration with the dominant, component in the blood changes in each individual case whether it be .m * .f -is e . > i • *. I*' -t..' „ . * * jl_ -_*j