Almost forty years ago, Starling (1) measured the osmotic pressure of serum protein and showed that exchanges of fluid between the blood plasma and interstitial spaces could be explained by the diminiution of the capillary hydrostatic pressure of blood in passing from the arteries to the veins and the osmotic pressure of the proteins. Krogh (2) has elaborated this idea and given more precise measurements of the factors governing the physiology of the capillaries.Clinical application of the physiological principles involving exchange of water across the capillaries has been surprisingly slow. Starling's conception of the exchange of water between the blood and interstitial spaces would seem to have occurred to Bright (3) and some such idea was definitely proposed by Sabatier (4) and Solon (5) about a hundred years ago. Although many writers seem to have appreciated the physiological rOle of serum proteins until the end of the nineteenth century, for a time their function was forgotten. However, Epstein (6) seems to have been the first to emphasize that edema of nephritis and nephrosis could be explained by the low serum protein concentration. Govaerts (7), Schade and Claussen (8), v. Farkas (9) and others have made numerious measurements of the osmotic pressure of serum proteins and have shown that edema in renal disease is regularly accompanied by low serum protein concentration and low colloidal osmotic (oncotic) pressure, while in edema of heart disease not accompanied by proteinuria there is usually a high venous pressure.

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