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1
MICROCOPY RESC.UTION TEST CHART
ANSI and ISO TEST CHART No 1
1.0 ?
I.I
||jj 2.2
ijZO
II 1.8
1.25 III 1.4
1.6
^ /1PPLIED IMHGE inc
A Simple Method for Determining Vari-
ations in the Hydrogen-Ion Con-
centration of the Blood
K'. I. I. I \ N , \l 1> .
I ( ,^ \< I i\\ X I K I. I, \l i)
\ -. I ■
W M . K I M M \ U k M M I . ,\l D
i; \i.i I \i<H;r
l\,l'iiiii,it /I, 'III till- .h.hii.s iij hili-iiiiil Midiiiiw
J- ^
rni( A(io
\\nPii \\ \lniHM AsWH-IATIOX
I iM Ml M'Ki i» AM' 'liiiKi vl''i\i- VnnTM l>iAmi"i<N 'iHiir
A Simple Method for Determining Variations in
the Hydrogen-!on Concentration of
the Blood
K I, I. i \ \ . \1 l> .
I.. (, i< ' ' W \ ! K I, I-.. M I'
Wii
\\ \1 . K 1 M M \ K U I ' ' T I , M n.
A siMi'i.i-: Mi;iiini) i-( )k i)i:ii;i<Mixi.\(i xariahoxs i.\
■rill-: ini)R( )(,i:x-i( )X Cfixticx ru atk ix oi'
■nil-: r,i.( x )i)*
K I. !.1AA', Ml), I.. (,. RoWXTRI-.l-:. M.D.
AMI
W \l. KIM M ARRK iTT. \l !)
Ilnm.'.ii lildiid, a^ it L'\i~l> in tht- imkIv. i^ faiiilly alkaline in I'L-aciKMi:
that i^, it lia^ a li\ ilr(mn-iMn cdnci.'nlratica; unly slitjlitly k>^ than l!iat
III' piiri.- walLT, and this licyrce df alkalinil\- lend- to he maintained even
when eiin>idcrahle (|nantitie> (it aiid are iruduecd wilhiii the hudy, or
are intrndiu'ed liiini willuiut.
Ill a n.Iati\e iiicrea-e in the acid eiintent of the hodv. the term
"aiidn-i-" i- a|i]ilied. Acidn-i-. euneeixalih'. nia\ he hroiijjht ahont in
iilher way- th.in thu-e ]il-t nienlinned -idr eNample. liv deerea-ed
exereliiin (if acid or h\' In-- uf ha-e- from the hody. Ihe eundition
ha- heeii reei lyni/ed in a \arietv nf wav-, -tieh a- inerea-e in the
anminnia enertieient nf the nrine, deerea-e nf earhiui dinvid ten-inn in
llie ahenlar air. ihe liiidinL; nf ahnnnnal arid- in the hlnnd and urine.
\iv inere.'i-ed alkali tnler.anee and li\' diniiin-lu'd titrat.ahle alkalinit\' nf
the hlnnd -ernni. li\- i-hani;e- in the hentni^lnhin di--iieiatinn eiir\e and
liy aelii.il dele rniinalion nf the hydi'nueii-inn enneentralinn nf the lilnnd.
i 'rndiietinn nt anminnia. low erint,' nf earhnn dinxid ten. -inn in the aheo-
l.ir .lir and in the hlnnd. and exeielinn nf acid- are all ii.ari nf the
i-iini|ien-atnry nieeham-ni nf tin- Imdy, and it i- nnl\- when thi>
nieih,ini-ni hemnie- ii\ertaMil that aiipreekahle change- in the lixdrn-
L,in-inn eniuenlr.atiiin nf the hlnnd neem-. The haind il-elf, nwiiii,'
' hiell\ in the "hnrfer" aetinii nf the earhniiale- nf ihc pla-ma and
]ihn-]ihate- nf the enriiii-ele.-. can i.ake iiji enn-iderahle anmiinl- ni
aiid nr al'^.ili witlmnt nuich eliani,'e in it- re.ielinn. It i- [irineiiialh
due tn the wnik nf 1.. |. 1 lendei'-i m' and hi- eiillahnratnr- that we
h.ive a ele.ir ennee|iliiin nf the mnde nf .lelinn nf lhe-e "ImtVer-." .\n
aiipreeiahle ehant^e in the h\-drnt;en ion eniuenlration nf the hlnoil
iiidieatcs a laihire of the iirnteeti\e meeh,nh-ni ,ind the iire-t'iue of a
-ii;nilieant acido-i-. i lerein lie- the peitiliar \alne nf a delirminatinn
of the hvdrni^ren-inn eoneeiitratinn nf the hlnnd.
"■ l-'i im the IV'ilnitnc ami Mr.lKal Clinios. Juliii- lln|)kiiis Hospiial
1. For a lull i!isci!--Mii. -. r llemlcrson, L. I.; I'.rgebn. d. Plivsiol., 1909
viii. 298.
A liriff wnrd cif i-\|ilaii:ilinn nKi> lie kim" '"i' tlbisr un:k-i'n-li mu'l ici the
physii-iii-luinical imtlioils of cxprcs-iiiH tlic reaction nt a sdhnicii. A -dmii.ti
is acid when it e<.ntaiiis an (xccss «i hyilrogin nvcT hydrnxxl ion-, neutral
when hydrogen and hydroxy! ion* are in e(inal ninnlier-. and alkaline when
hydroxy! ions predominate. An acii! of "tinrinal" strenm!i eonlain-. in one liter,
a gram of hydroyen oap.ililt mi furnnng !iyc!roi;en inn-.' an(! its strength may
!ie ex])res-eil as 1 X, Diinliny -uih a -oliition tin tnni-, ue W(jnld have 1/10
.\ or a solntioti containing l/lD gram of actual or potential liyilrogeii ions to
the liter. Continuing the proce-- of dilution until l/IIMKKl.(«lil normal acid is
obtained, we wmild have in such a solution I/1II,'KHI(XI0 gr.nn <•( hydrogen ions.
Pure water, however, di-sociatcs to form hydrogen ;uid h>drci\.\I ion-, and at
31 C contains approximately l/IO.OiHl.fXKI gram .if h\drogcn ions to the liter
and an ccpiivalent amoimt of hydroxvl ion- 1 that :-. 17 gm.i. That i- to say,
pure water, our stanilard of neutrality, i- l/lll,ll(KMKK) X acid anil also
l/UVKKUHHI X alkaline. To .-.void writing large lignres it i- customary to use
the logarithmic notati(jn and to express 1/10,01H).(M1I) X a- lO'X or, tnorc con-
veniently, as suggested liy Soren-en,' to ilrop the ID and miini- sign and say'
pH7. If we h.-ive K-- than l/Ill,il(H1,PtK) gram of hydrogen ion- to the liter, the
-olution is less acid than water, that is, it is alkaliiie — so. pi IS nuans actually
l/l,00n.0()() X alkali. The higher the exponent the ni'ire .ilkalinc. or what is
-aying the -aine thing, the K-s acid is the solution
To -mn np ;
pill = X/lll aciil.
pn6 = X/!.lKl(Mll'(i acid.
pi 17 = xi-rrh-.u.iry.
,,||S — X/l.oiKl.tHIII alk:ili.
,,1114 = X III alkali.
The rcactimi m' tlu- MikpiI -cr'im \,'irii> .•i|.]iriiNiiiialc!\ licU\ccil
III 17 ,-iii(l pi Is. ilic iH'iilr.-il |inint, |.II7 hciiiL; rc:n'ln'il (Uilx in -cxcrc-
iiticoiniicii-atcij acidd-i-. :nnl ,'i rca.-liim of ]<\\X liciiii;- attainoil |icrhaii-
Miil\ ;i ftcr ailmini-lration I ii alk.alii-.
TIh' tin .1-11 roll lent nf the |il I m' llic lilooil a- i-(iiii]'an.'ii w illi that '>i
innri^aiiic -nlmiini- ina'-ciil - iii.anv ciiltk-ullic-. 'I'ln.' -tainkaril t,';,, ihaiii
cU'iirnniclric nictlaul lia- liccii aiplicl to llic M 1 li\ a mimlicr ni'
iin c-'.i^.atur-. A mil rr\ irw of tlic lilrratiiro tip In I'Mi' ?- tn lie imniil
ill at! .article li\ l'.iii,a//i .Mure ri .1 lU iKicrniiii.itioii- li:i\c ln-cii iii.adc
2. For the -;ikc of -iinplicily wc will cou-idcr here nnly a "-Irnry' acid
ami a.ssumc it to he completely ionized in dilute solution.
,?. Soreiisen : I'.rgelm. d. Physiol., \'\2. xii. 401,
4. C1I7 and (11*) ^ 7 arc synonymous expressions. Intermediate values, as,
for example, lietween pi 17 an<l pH8, arc commonly expresscil in one of two
ways, as 0.25 X 10' or pll = 76. The latter method is used in this paper
The conversion of one exnression into the other i- simple. For 1 xample. log.
0.25 = — 0,602, then 025 X 10 ' = 10" "" x 11'' " ~ 10 '"" -r pll - 7,502.
5. Bota//i : I )er Ham -owie die uhrigeii .\u--cheidnng(n rnd Ki 1 prrllussig-
keiteli. edited liv (' Xeul erg, Berlin. I''l 1
li.- 1 la^vlh.iKh ami I .umlsijaanl,'' lViii>,' IValc > ul Milroy.'' The
r(.--uli~ iia\f nut inni alici;,'filKT iinif<irm, am. tl-c accuracy of the
inuhnd a^ apiilicil to Mood i~ (Hic-tioiiaMc on accuunl oi' tlic necessary
reduction ol tin i,. liio^IdKin. and ilic inthicncc oi' the I'rotein -nh-tances
lire~ent.
Hie lacl that the ■,'a- chain n.ethod ,,i delerniinini,' the ]i\] ni the
hlood rec|uire> a delicate and e\|ienM\e I'iece of |ih\ -icocheniical apjia-
ratti- a.^ well ti- idn-iderahle technical trainint; ha- heeii -tandint; in
the way of clinical investigation- of acido-i, ihrecth from the -ide of
the hlood, an<l ha- led to the very \aluahle hut indirect method- of
apiiroach, -nch a- tli(.-e titilized in die -tudie- of Sellard.-,'" I'almcr
and 1 leiuler-.m'' and Adier and i'.lake.'-
vxi xciri.i; oi-- i m: m irudii
Meretn'nre the imlicator nietlKMJ lia- nut ], roved of f,'reat \aluc in
the -tiidie- of llvdro;,r^„.jlJn concentration of the hlund, althon,L,di tlic
reaction (jf inor-anic -oltttion- may he determined (|uite acctirately hy
till- mean-.' DilTerenl indicator- -liow their <-olor chan-e- at \aryin<,'
det^ree- of hydr<ii,'en-ion concentration; lor exaniole, the color of
methyl oran-e clian-e from pink to yellow a- the ]d 1 of it- -,,lution
chan^'es from .i to .-. At interme.'iate iioint-. \arious coloi - may he
ohtained and a certain color indicate- a delinite pi 1. >innlarl\ . jiheiioh
lihthalein .hani;e- fn m colorle-- to pink lielween |.liS and idllM and
can he tl-ed for the mea-tirenient of ||-ion concentrations hetweeii
these two point-. In carryin.^ out the indicat.n- method, it is necessary
to have a -erie- of -tandard -ohnion- ,,f knoM, ,dl and an imlicator
exliihitin.tj; ea-ily distinpii-hahte color chan-es at liylrotren-ion con-
centration- apiiro.\imatin,t,' that of the -olutioii un.ler coii-ideralion. It
IS then -imply neces-ary to add e(ni d amoiir.t- of indicator to the -tand-
ard solutiuiis tmd to the solution heint; te-ted and to determine which
of the colors in the standard scilution- mcj-t closely iiiatche- that of the
unknown -olution.
jjaanl : Uiid.. 1'<IJ, xli. 24/.
7. P>I,is: Physinl. Soc. I'rnc , Jamiarv, V44
S. PcalHHJy. I'. W.: Sni.lic- on .\c„lusi- ami Dyspnea in Renal an.) Canliac
l)i<caso, lin; .Xm.nivi- Int. Mi.i, . ici4 ^iv, _'.?fi.
'' Milroy; (Jiiart. .hmr. Kxpt-r. I'liy-inl, I<,14, Mii, U|.
in. Sellard, : Johns Hopkins llosp pull., I'.IJ, xxi.i, 2S'/; il,i,| pJU xxv IDl
II. Palmer, WW., ami Hcn.lerson, L. J; Clinical St.i.lies on Acid Base
i-..|nililirmm and the Natnro of Aeidosi^, Tin, .\i;c mivfs I.nt Mid 19n xii \S3
\2. A.ller, H. M., a, d Ulake. Gerald: I lie detention nf Alkali i,v the 'Kidney
wnh special Reference tn Acidosis, Tm .\k. nivis Int. Mi-:i,., loi], vii 479
l.r For a fnll description of the application of mduators to thi- nnriio-e see
SC,ren-en: l-rL-.rlm d Pliy.;,,l. !':!.\ xi,. ,-!9,l
'Ihi- 111' lliM,l li:.- liron -iu>i " lullv u-v>^ on llic iiriiic l.v llcnder-
~c.ii" au'l !i\- \\ al]inlr,' \- prnUiii- iiUrrlirc w illi tiio lulor- dl" in:iii>
indic.itnr-, ainl :i- l»iili Mii'nl and -iriiiii |i(i-~f~- mlur, ii lias lici-ii
iiii|ii."iMr In apl'lv lln' imili",! ilirctlv m \\w l.lon.l '"
It -iiiiKd |.rol>aliK' that lln' iiidiiaiMt- nullu"! iiii'^lit l.o utili/cl inr
lilon.l, |iru\i.R'd laili.riiiL,' iiiatUT- and iirolrin- muld In' rxrhnlrd li\'
iiu'aii- nf dial\-is,' It 1.1 1 1- dia.|ii.cd int.. riilli.iinii -acs and
dialv/id l"'ir I'lxr iiiinnU'-. llir dialy-aU i- irvv traini prnt^in ami K-i<\,,r-
itiU nialln-. lull i-untains -all-, and i> uvll aijai'Iid In tlic u-c nl indi-
i-atnr-.
>in.\' iilu'iii'l-nlpliniu phlliaKin rxlnliil- .Iri'iniU' \arialinii~ in cuialil)
III' i-i)luf, with \ir\ innnitc dilinciUH- in liu:;-ci'^rii ion i-muHiitfatinn
lulwri-n ii||ii4 and S-1, il wa- adniiliM a- iIk' iiidiralcr in ilii- iiU'llmd
TKI l'\i; \l I'lN (II. slANDAHl) CULdKS
Staiiilnnl phospli^itc mixiim- arc prc|>ariil ai-conliiifr to Si.riMiscn'-" dircc-
lioiis a> follows :
1/15 null, acid or primary potasMum |)lio<pIialc. 5.078 Kram? of tlio pure
rccryi^talli?ed salt (KILPO.) is dissoIv<d in freshly distilled water and made
up to 1 liter.
1/15 tiiol. alkaline or seconilar\' '^odiiim pliospliate. The pure reery^tallized
>alt ( Na.llPO. . UH:0) i-^ exposed to the air for from ten da; s to two weeks,
protected from dil*t. Ten molecules of water of crystallirntion are Riven off
and a salt of the forninla Na 1 1 PO. Jl 1 () is obtained : 11X76 grams of this
is dissolved in freshly distilled walir ml r'n<le np to 1 liter. Tic solution
■honlil Ki\e a deep rose re<l color with plien. idillialeiii. If onU a faint iiiiik
color is olilained, the salt is not snlVicienlly pure.
The soUitiors .in iiiivid in the iiroporlions irdicaled lulow to olitain llie
desired id I ;
I 11
- s-n ji o k 4
rrimiiry I'nm. Pho«
73 i>3 "it
HI ft « i:i.'.' 11 " ■».»» •>'> :t ■-' -.»
Srpoitiliiry SimHiiiii l'Ii*t« .
. s ;:! TT «i siijfl.Rmi.flnI.f !H.4n(l.»l».n
Tlinc I.e. (if c:u-h ni tin- snhitintis ;iR' pl.-n-rd in -iiit.aMf small Ifst
Ittlii's ( PX) 1(» mm . iiisiili' inca-iirciiicnl i l'"i\o dn>]is oi an aiitlcous
14 Henderson: Biocheni. Zl«chr. I'iin. xxiv. 40.
15 Walpolc: Riochcin Jour.. 1910. v, 207.
10 S.iren-en ( Ilioehfni. Zt'chr . I'.W. .xxii, 2.W> has applied the indicator
method to the fdlralc ohiained after precipilalinif lilooil or scrum liy hoilinR
Hith three volume* of dilute h>drochlnric acid. Adier ( .\m Jour Physiol,
1M17, XIX. 1) has tested the reaction of the serum with paper dyed pink with
rosoiic acid. The ohjeiiions to thr-e methods arc ohviou«,
17. Preliminary exp»>rimenls showed that it was impo«sil.le. hv the iii<licator
method, to rilitain cnncorilant re»ull> on dilutions of scrum
IS s, ,.,,...,, |ii,„.h,.-ii 7t-i-hr. inno, xxii. .>52
n.ni per ocnt. -dluiidii of iilioiiol-iilplioiic]ilitlialciii arc addcil tii each
tube. i he Idi),- arc scaled (ilV. '1 lie veries of color,-, reprc-eiuiiii,'
ihllcrcnt 'uncciitralion.- of h\(lrin;cn ion-, con-lituli- the -taiidard- lor
comiiari-on of color in carrviiii,; mu ihc ilclcrniination.'''
I'KI.I'AKA I K p.\ Ol- SACS
One oiiiicc uf ccllniiiin lAmliMii> - ncf;,ui\<- i-.iitniir" is .lis-olvcd in 51K1 c.c.
"t a mixture o: f(jiial quantities of ether and clli\l ;iKi.Ih.]. The solid swells
tip and dissolves with occasional gentle shakings, in forty-eight hours. As .-,
-ninll amount of liv.nwi s,.,|i,„,.,n separates out at first, the solution -lionl.l
stand tor at last thrci- or four ilays, after which the clear ■-uperiiatant -oluiiou
is rcaily for use."' A small test tube (13! by <) nnn, inside measurcnknt i i-
filled vilh this mixture, inverted, and half the contents jionred out. The tuhi-
I- then riehi.d, and the collodion allowed to fdl the lower half again. .\ -ec.nid
time It is iiuirteil anrl rotated on its vertical asi-. ihe collo,li,,ii Ining draincil
oil. Care mii~l Ik- l.d<iii to rotate the tuhe, in .loUr lo -ecur' a uniform thick
ness througlioul Tlu tiilic i- clamped in llu iii\eited position and allowed
to stand for ten nniiiue-. until tin- odor of elher finally disappears. It is fdled
five or six limes »itli c. 1,1 wattr. or it is alloweil to soak live minutes in cold
water. .\ knife Made is run around the upper rim, .so as to loosen the sac
from the rim of the te-l tube, and a few culiic centimeters of w-iler are run
down between the s,i,- ,-„„| tin- ^|nss of the tulie. liy gentle pulling the tube
is ixtracted, after which it i- pre-erved by complete immersion in water."
Iili >\l
'III ii i\ is;;ii I \ -iiir MI riinii
I lie hloo.l or -inini i- di.ilwcil agalii-t an D.S per cem -odmni
chlorid -Mhitiin],
I'.efore applying the test, it is neces-ary to ascertain that the s.dution is free
from acids other than carbonic. To dcleriiiine this, a few cubic centimeters
of tlic salt solution are placed in a Jena test Inbc ami one or two drops of the
iiulicator addeil, whereupon a yellow color appears. Ou boilinK. carbon dioxid
is expelleil, ami the solution loses its lemon color and takes on a slightly brown-
i-li tint. Ill llie absence of this change, other acids arc present, and the salt
solution i> ilurefore not suitable' If. on the other han.l, on achling the itxli-
cator, pink at once appears, the sobition is alkaline and hence cannot be used
I I ( II MC ' I M M 111 111
i in hihiiic can he c.inud mil on iiihrr miiiiii. pl.iMii.i. whole or
deliliriii.itcd hi I llu woik nm i he done in ,, i ii free frmii ;iiu
tit aciiK ol ,iiiiiiioiii,i.
\'i. The colors may fade slightlv in a month's lime, but mav s|il| be used for
>ompari»on if less indicator iii added to the ••unknown" solinic.n, as Ihc color
i|iiality remains the same.
.11. Obtained from the .\n«co Co., Minghamlon, \ V Thi* contains ,10 per
cent, of water and mu»l be riii>^e(l with absolute alcohol before lieinK <li.ssolved
for use.
JI. Belter sacs are olilained from solutions llial have been allowi-! '•. ■...,.••
in well stoppered bottles for from two lo three weeks.
22. .Sacs that have dried became brittle and impervious.
J.V It is advi«ahle tn kfcp the salt solution in a Jrna glass (la.k and to pro-
tect it from acids in thi air by iiicdiis of u s.h1« time mbe.
8
< iiie li. ihixi.' i',<', (il ck'.-ir siTuiu-' or el Mik"! i- run, In nicanv (if :i
Miliit ]iinnk'il |ii]>ti. inlo a ilialy/ini,' -ac wliirh ha- \k\\\ wa-ln.l in-iilc
aiiil (lUl-i'li' wiih -alt -nir.tiun ami wliicli l - ln-ni K--U''l I'nr Ital>- liv
lillinu Willi ll.c -alt -nhiiioii - Tin' -ar i- lnwcri'il iiiln a -mall tc-t
tiili'-- I liiii l'\' |!i iimi . iii-idc iiKa-umiRiil- I I'lur.aiiniiL; .^ v'a'. '>\ tlu-
-•ail -dlMlinii. until tlif lltii.l (.11 tlu- nut-iilc dt' tin- -ar 1- a- liiL;li a- nii
till' in-i'K'. Itiiiii !ur tn uii niniuti- arr allnwi^l I'l.r cliaK -is,^'' \'\\v
(.(illiiiliii-i -ar i- rniiiiwil ami ' ilfnp- ni tin- iuili(-aliiv are llii ifnUi^liK'
uiisnl with tlk' ilial\-atr Tlir inlir i- ilu'ii n aiii lavi'd with the- -ri'ic^
I'l -lamlafd- until tlir rniTv-|H .n.lmo ii.lnr i- t'liiiial. whii-li inilicali.'^
llu' h\clniL;rn-i(in n nu inlralii m |. result in tlir iliah-ati\
I In -I tr-t- It, r Imu lan'inl nut with .^ r r, nl" I.Iii.hI nr -rruiu
I llr -allir l\'-ttll - atT ulitainr.l \\itli 1 r ..■, nt' IiImihI i,r -rnitn 1 in tin-
iii-iiU" nl tin- -ac. ami with tin- ■inmunt ii 1- iininatrrial whrtlur tluTi-
i- 1 nr .> I' I- lit' -all -nlntlnll nil llu' nllt-iiU'
inMrAKlMi.N III II 1:1.^ Willi M\\ti\K|lS
i nr llii-. a yiiiiil lii^lu 1 natiual 1 n- aitilii iai 1 ami a wliitf harkj^'rouiul
at'.' ri'i|iu'-ili'-.. ivvailiiii;- niii-t lu iiiadr iiiiuuilialiK I Ik- iuIh- uialrli-
illg-' mil-! rlii-il\ i~ viK-.liil ami aln llu lulu- mi nllur -.iiK- ,,f it.
Tlicsi- an- iritiiallx iii-|.r(lril a,i;ain-t a wliilo hacki^niun.l. ( hani^im,'
the oriUr ui tlu- iiiln- ntun uiaki-^ ililYi-n-iu-i-- umri' a]i|iarvni. "
1 "N I 1:1 1| ^ I II III 1: Ml I Ih III
l\i pcati-il ilii]i|uatr ilitiriinnatiiiM- nu llu- -aim -aiii|ilr- nt" lilnml
:inil III -(-nitn liaM- miu inrc-il u- that tlu- limit - 1 il i imr avi \ i r\ -lii^hl :
tnr i-\aiuiiK-. iIk- M-niin linin a ra-c nl" milij ai-uln-i- 1 u-hil; i|nantili(.-v
nl -iriiin \;iryitiij frnm 1 in .^ >■ r. -.iid clialv/iiis^ inv irnm Iim- in
liltcfti minnti'-- ) ii'.iw llu- tolluwiiij; series of ri-ailmy^: 7^'', 7.5^. 7.?^,
7.^^, 7.(), 7.!'!', 7.55. 7.r'5. 7:<^, 7.rr^ Tin- dN.-il.-iioil whnjc h],»»\ frinii
the same case ^ave llu- follnwiii^; reailiii;,'^ iimkr similar c(milili()H> :
7.2^, 7.2r. 7 2?. 7.2r. 7 2. 7 25. 7.2h. 7.S. 7.2^,
/Jr. /dr. / _',"
24. Ilmmljvis ttniN in iiiirc;i«- llu- aiiility nnil inii«t be avoiilcil.
2l< .\ --ac may In- w-vd mure lli.iii (im-i- fur Mcnini. proviili-il it i« thnri)iiKlily
«;i'lu-il.
J(i. Thi- alkali lily nf llu- ilialyiatr im-ri-asc rnpiillv iliititiK llu- lir->i live miti-
iilf* Tlu-rc i-» iiii ,-i|iiiri-i-ialilr chaim,- iturinc llif next t>-ii miiiillcs. I'r(ilcin<i
may ni.i'kr thi-ir a|i|ii-iiranic in tin- <lial>-att- in from ti-n In Iwonty niin-itrii.
27 h mn«t Ik- Iiornj- in niiml thai nnr i« lit-rr m.-ilrliinii thi- qnatiii. ..f i-nlnr
am! not inttn«ily a-* in nnlinary (-iilnrjiiu-lry.
-H. .\ (i-ilnr talliiiB l«-t«(-i-ti two of tin 'tandanU may lie reail. Iiy int(-rt><>la-
lion, 111 aniillicr lit-iimal place. \o effort was e\er maile to reail elo«er than
0.05. I'ttplicatr c'eterniinalioM-i »hfinM lie made in all i-a«e« ulirn «nlVu-ient
matrfia! :s ftvailaMc.
Ill or(l<r tn tc~l cmi iIr. rlUvt ui i1k' \ -riatidii- i,, the -ac- ii-i'.i. a
minihrr <.i .Ktrrniiiialinii- wrrv iiia.ic ..„ iIr. .,„,k- .ample ui .mini
""'■ 'li^' l'"ll"\vino- iTMih.; (ir.liiiau lliiii sic. 7 .7 \ lliick ^ar. 7 7;
"|'a(itu;. invytilav -ao. 7 7; .ir.lnian ihiii -ac. 7(.-; \tT\ ihi.k sir. 77
A .iTK'- Ml six iinrmal -cnim. wire run thn.unli. ,^ cm-, ami 1 rr, |Hir
tM.n. ln-ini; UmM lor .lial\M. In iwrv in-lanrr i.knl'ual rea.liim. uiiv
itl.taiiK'cl
M'PIJi M hi\ ,,]■ till Ml Til,, I,
llaMni; llin- a^iuvl .iiiVMKr. ,,i ihr arciirarv m1 liie m, tlm,!. ,-,
^'''■"■~ "' ''' '- '''■""! ""nnal an. I pallml, ,o„- ,-a-i- uvrr Mu.liol, willi
llir mI1,,\\ 111- IT. nil- :
1 \.>vuu,l nuliriiliials: i\'.un> li\r cases. ( ,/ ) Srrniii; Tv>rn!\-
Iniir ,,t \\w l«rnl\ fur ,;i.es R;al Ivlunn 7'. ail.l 7S !,i ,„k.
m-laiue, 7 " I- iTiunled :
pll
7.(>
7.fi5
".7
7.75
7.S
Cases
4
' '' ' \\ li"l> lil'iu.l I ,.\;il,ali-,| I ; iinu-Utn iKHTiinn.alK.n.
ri';i(i lilt x\ lAii 7 ) .iml 7 'i :
I'll
7 4
7.45
7.5
7 55
7 ',
llif -!i-litl\ ,i;rralir,ui,li;\ ,,| vvl,,,)^. 1,| | .,, ,,„n|,,,r>,l willi .rniiii
lia- l„rn nv, .i.Mii/iM li\ ,ilin,,-i ,,1| nm -ln;,i!, .r. ni llii. Iu|,l. an, I aii|.i';ir.
'" '" ''"'■ '•' ''i' '•I'-l lii.il li.in,,-l,,l„n. an.l r.|,r, i,,||v . is', l,riii.ii,'l,.l,in.
Iii'liavi's as a wrak .n ni
I el I)i-til.riii,itc,| 111 1 I .,,-lv 1,1 iiii. ,,,„,.^. ,,, i|„. „,„.|^ .kiiknii
•''"' ''' I "•'- ''""I "1 pa'alUl H-nr- unli .irimi ainl (.\.,l,,h,l >,\1|,,U
l«l.«.il. h ua- liimi,! ih.il 111 -iiKT.il. ill, I, Mill, uihk.l 1,, ,,,iia.|„„i,i
to thdsf nlitaiiu,! vMili ihr \\ Imlr Mi., „ i. km ih, i.in-r.ii \.iii,iti.,n w.i-
rallu-r wi.lo: ir,,„i 7 I i,, 7S .\,, .„|,|,i„„mI mhn uliImh ua. nlilaiiinl,
atid the (li'lil,iiii.i!i,.n in. n'l> .crvcl i,, i-..tti|.lualc the pni.wlunv
llcikf it \va. ,kri,k.l In .il,aii<|nii Hr. ,i.f ,,f (kiil.rinato.l 1.1 1 in the
Milisi()iicnl niiirsc of the invcstiRntinn
2. MLurlliiiu-oiis iiinUivl cnsi-s. In ur.jer t.i iletennine «lietlur the
h.vdroRcii-ioii ediuxntratiuii ..f tlie l,l„n(| varies from the iinriiial in
disfasc, a rnllier larye \ariely nf eiiii.liiii.ii. was .tii,h.(| siyu ihi,,
2" Tlu- l.I.-.ul »v«» .•..ll.r,.-,! ,:„ !utH- .....niiMnifK a littlf ,lrv ftowtlcfctl .odiJH.
oxal;ili- (lr»i Iroin iiirli<>iial<->.
10
ikUTiiiinatidii- wcro iiiink' in r2 ra-i'-. ciiiiijiri^iiin the tcilliiwiiiy omi-
ilitinn^: iirplirili^ ( acutr aiiil >linmK'). !_' i.a~i.'~; dialuli-- iiRllitu-, S
ra^c- ; nivdcanlial iii~ulliciiiK\ . 5 i-aM'- ; ^\pliili>. 4 la^o : ilirunii-
arthrili-, .^ la^i.- : iivrnicimi-. aiuniia. J i'a~i'~; ni'urd-c-, ,^ ra-v-. ami 1
ca-c cai'li 111' |i\(.liiiv. i,niii\ciiia, carciin'ina ui mrk, luniunin .id-.
tyjijiiiiil irxrr. |iiR'iiiiiiniia. iiK'niiijidt'iiciu^ im'iiins,'ili-, 1ii1)i.T(.-u1ihi-
nkninyiti-. iln 'lrlithia-i~ i laiiiiilicc ) . ]iiilini Miar\ iiKiiia, > (.Tcln a! Iriii-
c'rrliai;i' uniiiai. tiilnritikni- |)lrnri-\. i'imiI ami nidiilli ili-i.a--r, aiii^in-
lU'linitir <'(K'iiia am! l.raiii Itiinur.
I Ik rr-iill - wriX' a- Idllnw- :
I (M >iruin; ~i\t\ ilim- i!','lriaiiiiiaiii .;i- Si\l\ dl' i1r' -i\i\- ilircL'
ik'li'iniinati.ni- iwad lictwa'in 7.iiaml 7^f<:
1.1 1 Ca-cs
7.6 , 14
7.65 . 4
7.7 I'l
7.75 1
7 S 22
I Ik lliri.1.' csii |iliiiii~ mil . uiiniiL; wiiliin lln'^r liiiiil- unc:
I 1 I \r iii-l.aiKc d|" iraiinialir maita i-i- \v illi a rrailiiK^ i il' 7 '' ' _' i
.\ Uliriif Upliiiiil Willi a iTa'liHL; iil s.ll , .\ \ ,\ > a-i.' ni rlii-nm.
iKjiliriti- \\illi lRniaUiiK-i~ I'lnni an at lUf y.i-trif iiK\r. wiiu-t -.riiin
.ill IT llif iran-lii-ii'ii nf S,-i i ,■.(,■, nf 1iImi.i1, 1i\ i1k' ~\ rinL;i nKlliM,]. i^a\ r
a riadiiiL: "1 7 ' '~.
{ b ] \\ ii. iKMiiM,! I I i\.il.iud I : lliirlv llinr .K u rininaliiin~>. ni' w liicli
lliivl\ mu- ixad IhIwitii 7,1 and 7,ii:
]>il Case-
74 I
7.45 J
7.5 . , , in
7.55 , , , , S
7.6 in
11k 1\\ 1. t,-Ncc|.tiiiii« were inslanocs ui' puimKni- .mcniia llii i;i-l
cnso, iiiinu'.li.iirK In!!. i\\ 111!,; n-.m-hi-mn, L;a\r a la'.idiiiL; ''i' 7 7 mii tlir
whok" liliicMJ. lln- 1u ini; idrnlhal Willi lli.il nii ihe ~c i inn ll '- nl
interest in iiile llial lul'.ia ir.iii-in-iMn llir le.idiiR;- nn llir -iiiiin .uid
ulinic liluiid Were al-d llie ^aiiK', lliat i~. 7ii I la -criMi.l < .i-r ^a\r ,i
reading; nl 7 '.^ in lln' \\ linU' Mdnd. ilii- .ii^.iin In lU'.,; nUiiiii ,d \\ nli ilia I
on the •>! mill
^. .huliisis. I'l-diii the jireeediii^; |-.ar,ijir,i|4i^ it i- eMileiit that the
liy'lr(ii;eii-i(i!i eoiieeiitiatidii of the whole hlood or seriiiii. normally
am! ill a ^reat \ariet\ ol' di'^ease ainditidii-. i- Hdi -nliieet to ^reat
variations \ smalj siTie^ of eases witli clinieal or lahoratdr\ e\ idenee
of aei<lo-i-. i or liotli i has hcen studied, the re^nlts aiii .earing' in Taljie 1.
i'iftci'll deterniinalidii- win in. id. ni iiliIiI rase-
'n, {iftaile'-l rlinira! histories are a{>p<n<k-i| at ih-.- tiit! nf this ji;ij;rf.
\
11
TABLH 1. — Acidosis (Ei(;iit Casks. Fikikkn Di rKRMiNAiioNs)
Case
No.
Date
12/.'6/14
1/ 2/15
1-V 3/14
l/l.l 15
l/-'5/15
1/Jf//15
1/18/15
1/19/15
I s 1 ,-
\/ny\s
H-Ion Concentration
Whn!,-
Si-nim Uln. 1(1
(Oxal.)
7 45
1/28/15
2/18/15
7 s
7J
6
I 22/ 15
"5
7
1/22/15
1/22/15
r.4
7.55
7 1
7.1
7.3
I 'i;iyiio~i^ :u!.l Remark^
Cmiginitnl cystic kidneys; adlie-
rciit pcricarcliuiii ; myocardial
in-iifficicncy : li y d r o t li o rax ;
ascites; nrcinia ; 'plithalcin. trace
in two hnurs; CO.- tension of
alveolar air. 19.5 mm. Us;.
Dull; <lro\vsy; 'phtlialein. -till
iinl> a trace in two lioiir>.
.\ciite and clirmiic nepliriti'^;
hypertension : uremia ; 'pI't'i'T'cin.
trace in two hours; Sellards'
te*t. complete decolorization on
evaporatiim.
I'.chimpsia ;* mild toxemia.
(•'clamp-ia ;* severe I n n e m i a.
XII. nitrogen in iiriiie. IS jier
cent.
Thirty-six hours after lahor ;
alkali therapy ; iloing well.
Sarcoma of kidney and antrum ;
acidosis; sudden onset of aci-
dosis with "air luniRer" : Sel-
l.irds' test, complete ilecidoriza-
tinn on evaporation; .acetone
and diacetic acid in nrine.
.\fter large doses of alkali; bet-
ter ; Sellard^' test, faint pink
color before complete evapor-
ation.
Mure alkali: no dyspnea.
Kespirations asain deep .i ii d
ii'ii-y ; .acetone in urine.
Recnrreiu vomiting; no fo.id re-
tained for three days ; acetone
and diacetic aciil in urine.
.Mimentary intoxication.
.\ftir alkali therapy; ilealli next
d;i;.
\ciiti' and chronic nephritis; my-
"Cardial insufTicicncy (slight^:
anasarca; tlyspnea ; "pl'tl'^'cin.
.55 per cent, in two hours ; ace-
tone in nrine
Much improved; CO; tension of
alveolar air, 4(1.1 mtti. 11k.
* We are mdehted to Dr. J. \\liitridg( William- for permission to -tudv ihe-e
eases iicctirring in his -ervice.
i;i\Ni;l.> l\ nil. IIMi|;ui,|;.\-|,,\ . (,\. IM |;.M |,,x ,,| Till 111.
IN I MM.KIMl.NT Al. I I'.NDI 1 |,,.\s
An (.•lldV! Ii;i~ luTii ur.ttlv tn -ic if Miiiilar rlum.-r^ in llic pi I 1,1 llir
'iliiii'l .-nitl -tviini VMM 1k' 'lrin..ii--tr:iti-.l m I'xprrimml.il aciiin-i^ in 'li ^j ~
\nnn,il~ wrrc inir.-tr.! iiiira\ (.-inin-l;,- with .liluir li\ .In hIi1( .ric ari.i.
l'nitn,i,K ,•] i\\(i rxprrnnuit- aiv i;urn in TaMi-- _' ami ,v
T.\l;[.|-. _'-!'K,,T(«o,, ,,r IC.XIMK'IMI.NT l-tXlKVM.Xnls LxjlCTIOX i,l S/^ II W^kuUlLOUK
Acid Into a Dog» (1-emalk, Weight 7.3 Kc.)
I line
11. 111.
.\nit, ..1"
IICI
Iniii-ti .1
1 1 I. '11 t'c.iuH iiir:ilh.Ti
>ii inn
\\li..K>
l!ln,,.l
lOxal.)
111.. 0,1
I Iran II
I )ir(.ctly
lull) Sac
K(.iiiark>
.5 44 .5 4'
4.11(1
4 14
4.17-4.'.?
4..'(,
4.5(1-4.=;).
.'-'1 5..'ii
.=;4.^
4<i
7.(1
■45
7.4.
7.4.^
■45
7.45
7 4
I'.n .illiiiit; i;..rMialK
\" .-^iiUial iliaimc 111 ciiiiiliti.iti.
r..«ar.l rii.l ..| mirc-li.iii. rc-pi-
rati. II- -1..U ail. I .In].. 14 |ht
minmi .
.Marki-il ".iir Iiuhlut" ; rtsjiira-
tiiin.'i. 1 1 \<ir niiniilr ; piiUf. 31
I" '4; regular.
Ki'«I)irations still ~1,.\\ l.nt ^lial-
l.iwor; animal 111 iairly hi.ikI
I'liiiilitidii.
\t 5 2ft vcs|iirali..ii' 11 per
iiiiniite
Ktsilcss; i-tniKKliiiw.
< MT laMc: no "air hiiiiKor" : Ijintj
rl.iwii in nd apfiarcMt <li«coni
flirt; rcidvcrid.
- Inu.Minii. nia.l, m part int.. .niKnlar. in part Jiii., U-k vein. Mloo.l for .•xaminalinn witli-
.Irawn eitlicr trnm jngnlar »r Un wm uii ,,pp„sit,. >i.U-. HCl ma.lc np in 0.,S per cent, salt
(II-..M u \i. ni.^i'is.sidx
ill iinliT l<. iKlcrmiiu- tlu- ,1. iii.il liv.ln.mn i..n . ..n.inlrati. .11 n\
llic tiliM.il a- it <xi-i. in ilic l„„ly. ii ,, luvc-siry llial nu a-niviiu 11;-
l>c niailc at Im.ly liiiiinTatiiri' ami iimUT llic carl.i.n .li..xiii ir'iMnii
vsislitit; ill ihu vi>>.i.K a- -Imun ],\ an.il\M- n\ tlu- aKc.lar ait M.i-l
III" till- jmlilislu'rl R'siili> <l(, mil luliil tlu'^i- lu., ri(|iiii(.imiii- and iIktc
fori' lid not nivi- the rciutiini. a- I .ninlsf-aanl'' ivxprosis it. .s7»i',7/>\v/(ij,.
Sl-IISII.
M Lwt\~u-::it,\ : Rinihim. J^i^chr.. m. \V,. 247.
1.3
In a ^Hiil> 111' ari(l(i-i^, Iiowomt, iIk'-c CDii^iilcralinii^ arc <if ara-
ik'inic rather lliaii "f iliiiiial iiii]" irlaiui.-. ^iiicr w r arc ccHH-cnK-il with
\arialinn-. in the pi I rather than with il- aelual \a!ite.
lilt- more feeeiit eli'etrunietrie niea-iireineiit^ lia\e heeii earrieii n'lt
at tile earhuii diuxid leii-imi existiiii; in ihe aKenlar air and in niui
ca-e- at n.inii teini'eratnre ( IS C, ). Sn Innu a~ the iiiea-iirenieni ~ are
niaile at a enii^tant ten-iuii (jf ratimn dicixid and at a enn-tam teiii
piTalure, the re-iilt~ are iil' \alue idr eiiiniiarali\ e iiur|iii>e>.
T.MU.F. ,^. — Protuciil ui I'm" nimi nt 2 - [nth wi nnis Inhxtmn ,ik X/2
I iMiRuellUiRlC .'Mill Imi; a i)(i,, (l-IMALl. Will, Hi 7 K(.. I
Time
,IJ1
Anil i.i
IlLl
Injecieil
n I I ft lull
liemui.
.? ?l 1
' n c c. liave
lirt'll i 11 -
leeteil.
.r.'ii
1 n i ertion
. 11 .1 e il;
1 5 c. c.
4,(1(1
have been
injected.
4,(K)
H-Ion Concentration
Serum
(,'>
Whole
r,i 1
(dxal.)
Iveiiiark-
<>.'>
6')
Seniiii IihIu 1 elli'W . elea:
l;i.i;iiiniiiK 111 linallie lieepl) ami
.-lowly: heart- aetion very
forceful ; regular.
"Air huiifjer" marked ; respira-
tion-, 28 [ler miiiiiie. I lean-
action foreetiil : regular; -i rum
.•illows moilerale amount of
heniolysi-.
In oNlrcmi-; ga-pinK for hreath ;
heart still Keating -irotigly;
-eriini -how- marked henioly-is.
("ea-ed lirLatliiug; heart stopped
heating; artiticial re-piration
and intravennns injection of 5
per cent, solution of -ndiiii'i
bicarbonate unax ailing.
111 the iiietlmd de-erilu-l in thi- painr, hi 1 i- exjin-ed In the .air
sn lli,il the e,irh.in dinxid teii-iiui i- l.iw . hill a]'|iarentl\ , I'airU emi-
-taiil. Ihe uhieeliiin niii^hl he iii.ide that the |dl wmild lUjiend nn
the .anii.iiiii lit eailiiio d.i..v.i.l \thieh h.i- e-ea."ed I'riini the hlmid nr
^eiitni ihe inlli i\\ iiiu e\|unnieiil- indie.ite. Imweu'r, that the pi I i-
iinl dependent, within rea-mialiU- liniil-, m; the lime el.ip-iny helwei'ii
the lakniL; ni ih,' hlnnd ;ind the de|etaiiiiiatii>n d the i IL iir.i\ided the
14
tuiic r<mtainini; l>lo(nl i> kcpl .^luppiTcl .iii.i on icc, a- will be .-rcn fruiii
tliL' h)ll(j\\ iiii^ ;
Strum ()NalatL(l I'.lood
ImiiKili.itilv r 7; ; ;;
After -"/li,,iir> 7,;5 7 Vi
Alter I'* huur- 7,7? 7 V^
\ftiT _'4 liMi,,-. 775 7'5';
ll, iinutxrr. hi. mm] i, drawn .iiivrlly ini,, a ~ac iiiiiin.T-Ccl in a lube
01 valt >nitition and the rea.hitL.' c.^niiiared witli ihial :niiii the bldcid
drawn aii.l dclefiniind in ihr 11-nal inaniKr, -h,-;hi xarialiun- arc
cin-dnnlcred 1 -ec h".\|nriinent 1)
l'.> llinr.,iiL;hly diakin- ibe hi 1 ,.r -enini in liu ;iir, il- ah^ahnitv
i~ iiUTca-rd. ThriTl(.iv, diakin- ^M.nld. ni -rneral, h. a'.ni,l,Mh unk--
it i- di-ired id detrrnnnr the |dl at a /(.m (i i_ lenMcii, Such --UKlii-
iia\r hern carried ..n liy I )r. 1 ). \\ . \\ ih,,n.
I be mlhienee ni the leni|iei-alure nn the readini^- ba- been deter-
innieih and the re-nU- appear in tijc aee..iniian_\ ino- tahiikitidn.
TMUJ 4.- \-Ai(iA]iu.\> ,x llvimdi.i.x lux Cnci n tkai ion IXa; to Cii.iNCks
IN TlMPIHATlklC
\\1"''' I'.l I Whole liloo.l
li-riiperaunx' Situni (iKal.l Si riitii (Oval)
•^" ^ ■ "Si 7,5 7N 74
^' C. 79 7.05 7.9 745
I hi- elleet ni leinperalttre lia- hi'en reen-m/id In prexi.in- worker-.
'' '- ^-^i'lenl ih.al m dr.kT In nhl.iin e. mip.ir.alik' re-nb-. teniperaliire
;-(intn.l 1- neees-ar> , 1 Inr nie,a-.ni enieiil- ha\e been ni.ide lieUveen '( 1
an.l .M (■
■| he di:d\-,ile ..!' the hi. km] ..r -enini i- di-bliy nii.re a.i.j than lla>
on-ni.d ni.itrn.al. i' ..ne .an nid-e fr..ni e\; eri n.'iiN .-.irrie.l mil will
ilihite MiilniM hie.irhi.n.iie -.ilnli.iii- ei Mil.ainin;' e.irhi;ii .li..\i.l, .and pb,,-
(ibatcs (if .ippr.iMin.alely ihe pi I ;nid ,-. ;iu-eiilr,ali, m ..i bl.ni.l. d'hal
llie \.arian..ii .S ,1 .■..iiM.anl ..lie 1111. ler llie ,-. .n.lil 1. .11- .,f llie nielhii.l i-
-'■""" ''.■' 'li^' 'l''-^' ■•.i^i-eeinenl ..f .hipiieale .leterniin.ali. .11-. ulii.b b,-;-
beeii nierre.l li. pia'\i..iid\ in llii- j-aper,
i'.v .a e.iiiii i.len.a-. the re-llll- ..hlaineil fi.,111 the .ii,il\-,ile fnnii llie
"ll"!' ''1 1 ■H"l ''""111 -enini e.irre-p..ii,l \rr\ .l...el\ l.i lli..-i> ..hl.iine.l
.lire.-ll\ by die ele.iri.-.al nielli. i.l wlun die l.iller ii|.;i-iireiiieiil 1- in.i.l.'
•ll !^ < ■ ■■ni.l .11 I .Mrh.iii di.i\i.| ien-i..ii ni ti 1 nun II-,
I in- ai;rt.iiienl in re-iilt- 1- pn.hahly ,lne I., the aiil.i-. mi-ne eh.ar-
aeler .1 the iw.i 111,1111 -.mree- .if > rr..r iii\..l\e.| in llie iiielli...! ..f dial-
\ -1-. naiiul\. I..-- ni eafb.in .li..M.l ten.lin- 1 , oi^j. hi-her. tb.il 1-. nmre
.ilk.abiU' le.i.hiiL;-. an.l di-pn .p. .rii. nnie .lial\-i- ni .aei.l an.l h.a-i,- ei.n-
-ti.ii.i.i, » ^..1.11.).. 1..,, .... .1., * ;. , „-, ., .; I „ 1- 1. ....
- ■ •■■■ I-.lie.reai.itl leat!;:;;;., ;■ . .r .aillk ,ii |.iir-
15
l)oses, particularly the >tiuly of acido.sis, the iiK'thoil of dialysis is (|uite
as aiiplicalile as tlie electrdiiietric method, aiul yield', results in rreneral
coni])araliie willi tlm-e ni ilial iiietli(p(l. It ha- the aihantayes nf .siui-
plieity and ra])icHly.
(■( iNCI.rSKl.NS
1. The indicator nuIJKjd (if dctcrniinin;,' Ildun cnnccntration is
ma<le ap|ilicahle tn hhidd and -t'rnni hv utilization of dialysis throu_i;h
a collodion nienihranc. \\ hich exclude'- the disturliinf^ influence^ of color
and ol jirntein-. The nictlioil i> simple, accurate, rapiil ,and well
.id.ipted Inr clinical u~e.
2. 'The technic con-i-I- <if diaU/ini,' .^ c.c. of hluod or -eruni ,it
room tcpiper.iliu'e ;is„'.-iiii-t .i c.c. of OS jier cent, --alt -olutinn lor li\e
minute,-, addin;^' an indiiator ,-inil comparini,' with colored -tand:ird
phosiihate mi.\lure- of known ll-inn coiicenli.-ition.
.1. 1 'llciiiil-ulplioneplulialein i- eniph i\(.'d a- the indicator in this
method. ll i- lunnd to exhihil ea-il\ di-tini;in-h;ihlc \.iriatinn- in
(|nality of culnr, widi nnnule diffevuice- in ll-inn concenlration
helwcen the limit- pllod .and pi IS. 4.
4. ( )\;d,ilcd lilnnd from norm.'d indi\ i'hi.d- t;i\e- a dial\>ate with
•a pi 1 \.nyinu' from ".4 to 7.i<. while th.it ui -eruni rani;e- from
7.(1 to 7.S.
.^, \ .iri.ilicio- frnm the-e liu;ure- toward the :icid -i.le were encoun-
tered onl\ in cnnditinn- which clinicillv . .-md fr^m the -tandpoint of
the lalKjr.-nnrv hndini;-, e\iilenccd an acidn-i-.
<i. In ,1 -ni.dl -erie- nf clinic, il acidn-e-, the -erum- \aried from
7.rr tci 7 2 anil llic uxalated lilnnd frnm 7..i In 7.1. In cspirimental
;ii'idn-i- in dn^-, ,•[ pi I nf i<'> ha- liecn uicnnnlcred in Imih -ennn .and
lilond jn-l lictni'i- de.-ilh.
Kl- I'l iKT I ll' ( ASl'S
Cx-i i li S (Mt'ilir.il \.. ,11441 I, a ulnt. hi.lii. a.ucd 4.!. Uiagnosis:
ciir.m iiil.al ry-in- kl.|nc'\ -. ailluri lit |'cru-.'ir4unii, niMnurilial iiHiiliicii'iu-y, t-denia
of lungs, hydrotliuiax, mikI iiri'iiiia. .\ilmitt< d Dec. 12, 1^14.
The patifiit had ^ond general liealth unlil ten yuar^ asn. He had nin-ciilar
rlu'utnatism at eight. I'.ightcon years ago he liad an attack ni "acute Mnght''-
di-easc," uiiich ounliiied him tn liod fur two ui'd<-. Ten year- agn. .'i Uiinp
uas discoviTed in thi' I-.ft tl.iiik. l-lx|il.iralnry opfratioi; revealed congenital
cystic kidneys .md .'i l'< w nt llu c\-ls in the right kidney were pinictnred. Five
years later the left kidney aNu heeanic palpahle.
The prc-ent illness began live months hefore the patiMit'- admis-inii. uith
attacks of noctnnial dyspnea, which f^rnihially luciiiu' wnr^f Thri r ui'iks
ago swelling of the legs appeared.
i'!\aniiiia!ioii showed an iinileriionrished man. dyspneie and orthnpneic. Signs
iif lliiid uire present in both pleural sacs, with biilililing rales over the lower
lobes. Tbt'r- w.i- m.irkid cardia;- enlargement and systolic retraction of inter-
spaces lateral In ,i;i,\ llroadbent's sign was present. ;»lso a protodiastolic
i^rillnji I hero was a f.'iint -y-;to|io blow :it the rijiex. which was trattsmitted to
the axiila Ihc pnliuonic second soniul w;i-. accentuated. The abdomen was
16
ni-iiii.l>,l \Mili lliii^I. A laryi nla-^ >-.vriMl uiili b.wsc- u.i- palinl.K- in each
llaiik. Till' ln(i- u,,- iiilarycil ami ttiickT, l-aliriia nf Ki;, v\a- ii(jUc!.
Kipi-.iU.I l>li«i aKulplioiuplillialciii trsts vli.intcl tile iNrr.li.n ,,f only a trace
111 l\V(i li'iiir>.
Ill- I I I.. I<ii-i..ii ,.1 alwnlar air \,a-: Dirmili.r ICi. .M ,1 nini. lit;; I ),crnili(.T
IN. I'M iniiK llu
I'll, ln.li-.iurii li.'i (.■'inr(iitrat|..n .'l 1,1 1 ua^: Drreinli. r -'d. « Imlv i,l,„„l,
7.1 ; Jamiary _'. ~i i mii, 7.4
'l"lu- ncMliu-Mt.ni iiitr.Mjin ..f the M 1 ua- 11,-^ my. ]<i-f hiin^lrnl cailiio c.iili-
iiu-ti-rv 'I'lu' 111 I pri--iirf r.iiiycil iinm 1,-,=^ i,, \}^ nim. II" ---li^lir llli t,. 7^
.liasl.ilic
Till' iirinr wa- pak- ami cKar vvitli ,i -pioiiic Kra\ity oi l.lins p. IdlJ, A
trace I.I allmniin and liyalinr ca-l- ueii dli-crvcil. .\i-ftnno was |iri-int on
-oviM-al oi-ca-innv 'I'lu- p.iticiit «as cliM-hari;, <l Jan. 11, I'll,^. -..iiiruha! iin[irovcd.
Cs.-i --C. () P. i.Meilieal .\.i .W„?S,^i. a ulntr man ai;..l 4,1 1 lia..;nosis ;
artiri.i-ckToM~. acnte and .-lirnnic liciibritis liypcrtensiun and nroini.i .\iliiiitt<d
Di-c. 1. 1<;14. TIr' patient Iiad liyplnli-. twenly years a.nn ,ind ua^ triati 1 liy
intermittent cour-es of nit-renry ut I'nnr \ear- 11. had nne.implieaied nplmi.'l
fever t«emy-tlirer year- an" and fr..iii I'liS i,. p 1_' drank luaviK,
The present illness hei.;an two year- as., uilli -, \ rre lieadaehe-, u.Miallv coni-
ini,' on in the early iiiorninK hour- and heeoiniiiL; Ljradua!l\ more severe. Pnl>nria
and nycturia -oon f.illnue.l. Ihrec month- .a.i^o he had an attack of -luhkn' 1 .--
of conscionsncss with ,i ueiier.ali/ed conMiNion lastin.i; live or -i.\ minute-, .ind
folkiwed hy prnfn-e \ ..initin.i;. Me was in Led fur four day-. There ua- no
paralv-i-. laKlit weeks hefore his a<lmi--ioii M ,,1 was di-co\er<d in llie mine.
Ill' w.a- pnt to lied and has remained there -in,e. Iw./ in.inlh- a.i;,' his eye-
sight hegan P, f.iil ; In i- imw iinalile Im reail,
I'.xaminalinii -hnwed a fairl.v iiomi-lud m.in wiili ii.i-ly cnmplexion and
decidedly anemic appearand, dlie hea-t \v,i- nndn .itil> enlarged. There was
a presystolic gallop, with nmmri.iis e.\lra-\ -i..U -. j'hr -econd aortic -oniid wa-
loud and ringing. The radials anil brachials were dilTiisely thickened; th, -,1111-
pnrals tnrtnoiis and sclerosed, .\dvancid .•iHMimimiric retiniti- w.i- nitnl. uiili
fie-h hemorrhage in liotli eyes.
The III. .oil count showed red iil.i.iil cell- .l,-_'i i.l 1 11 1 ; while 1.1. ...1 cell-. 11.4(111;
lu 111. .uL.liin ( S;ilili 1 <<5 pir cent
l'..\ Ilie phenol-iilplioiieplithalein te-t, e\creti.,ii 111 |«.. |i,.iir- ..n iiiinier..ns
occasions ranged fri.m a trac. to 16 per cut. Dec. inker ^. llu iiali.iii was
V. uniting and helchiiig a' frei|r,.iil interval- aii.l wa- \ei-.\ .lr..w-v.
.Sellard'- test on the I1I0...I -eniiii -h..we.| c.ini|ilete decilori/ati.ni .111 e\ap..ir-
i/;iii..ii; 111. c.ilor on ad.Iitioii ..f w;itir
111. h.Mlrogeii-ion conceiilratiiin of the sermii w;i- 7. J. 1 iiiriiii; the patient's
-ta\ 111 the ho-pital the likiod pressure ranged fn.m Jd.^ t.. 174 -v-t..lic; I,i6 to
lii,'^ .li:i-t..lic.
11.1 tirine in fpi:mtity wa- l,!L'.s 1.. .-.{L',s cc m tw riii\ -f,,nr li,.m-; its spe-
cific gravity, l.l'll.s t.. I.IIO''. Siimk;, :it lir-1, it lucinie cl.ar Willi th.' polyuria,
then hlo.idy again. l-'rom 2 to .s gr;iin- ..f .allniniin p. r liter wi.e pre-cnt.
Ihaline, granular and Mood casts were ohservcl. The ,)alum rrf .-ed tr.
remain for treatment .iiid ua- di-charged tinimprov. .1, 1 )ec, .'_'. I'd4.
C.\si .1.-1 W ( ( thstetncal Service), a colored girl, aged l!^. was admitted
Jan. 8, I'l.r I )i;iaii..sis ; pre-edamptic toxemia; po-tpartiim eclampsia, d'he
girl was nine month- pregnant. On the day hefore adnii--ii.n, :dl.iimin an.l
casts were found in the urine, and the patient wa- a.Ki-.d to enter th.' ho-pilal.
I)uring the cottr-e of the next few days she ci.nipl,iii-..il .if epigastric di.scom-
f.rt ami frontal headaches of increa-iiig severity 111.' ->-t..lic hlood pressure
w,i- I'd mm. Ilg. ^>u January 12, -light edema of the leg- ,ipp.;ir. .1
I'll January ]^. at 7;.i.^ a. in„ spontanenus lakor occurre.l Ten minutes .ifter
the hirili ..f tbv •Jidi! the palienl !lad a l.^p;cal eclamptic convulsinn of mo. k late
^i'\i'nl> lii-tiim luii niiii'.iir- llic i. III. Ill |irr--iiri' i-wtnlii'l ,'it tin- linn' ua- 15(1
mm. lly. Tlu'ri- ucri' lun niurr i-i.iivr.l-inn- that ila>. i^'nllnw mi; lilrciliiit;,
piiriuiinK ami '•weatiiiL;. a iininial iinnali -iiiur iii-iuil.
'I'lic li'.ilriiyrii-ii.ii i-nm-ctitratinii nf tile -mmi I'litaimil at vvnt-i\'tiiiii was
Tlir 111 ii^iii-iitrm iiiiriium iii llir Mi ml ua- 4_' iim pir Inil i-.c.
.I.MUiar> -'4. llir iihrri'l-iilnliiii!r|iliilialiiii ir-t -linucil 53 per cent, c \rriti.iii
iti tun Iniir-.
Tlir .mitiiiiiia iiitrii^rn m ihi.- iiriiu' :
January H ;= 5 per i-int
January 14 = ') \n-r it iit
Jaiuiar\ Id = 7 [u-r n ii;
C\si 4--.M, K. I ( ll.-trtrir.'il SirviiTi. a uliitr unman, a(.;ril I'', ua- ai!milt.:il
jjii J.-i. 1"I.^. I liai;iii 1-1- : (■i!am]i>ia ; -pi mtaiu mi^ lalmr.
I 111- paluiit ua- a -irmiu. ucll-ia mn-luil pvmiipara, niiir niiiilli- prr.miant.
'i'lu- pi'iiinaiicy hail !naii iii:r\ laitfiil nnlil llir mnrniiiK ol' Janiiar\ J5, ulirii.
at 4 a. m,, slu- lnuan tn havr -iaiit hrailarlir. naii>-ca and M.imtmt; Shnitly
al'li I'uarij -lu' hail nni- emu iilsimi. \\ In n M'cn in thf out-patiint -i i\ kc -Ik
ua- i-iiii-i-iii;i- lar, ilmu-y. Hhiml piT--urr (-y-tdlic) was 150 inn. lit;; tlii-
pul-r Sll pir miniiti' Tlu' iiriiu' -linunl S grains nt alliiimiii pc-r liter.
Slu- ua- ailnnttt-il tn llir uaril .at 7 \i. m. mu-nii-cinn-. i-\i\ailinuly rr-tlc--,
anil haMiiLi tNpiral. nimU-rairly -r\,-rr i-clainptic onnviiKiuiis at intir\al- nl"
ihrri'-qnarli r- nl" :iii Imn;-, Tlu- hlnnd pia'--nrr ( .■ivstolic') was ISH mm. lit:
Tlu-ia- u.a- iin il^-pma ami \aT\ -liijh! i-ilcma nf Inui-r U-i;- Slu- had ^c\rn
i-ninin-iiiii- in all. tlu- l.a-t niauirraii; at 5 a. in. mi the ninrniiu; ■•> Jaimarv J'l.
illnnd Iiir lljiiromT. mn dctt-rminatinn. nlitaim-d ,iMrr tlu- third d iiiMil-mn. t;,a\c
a rt-aclini; uf 7.5 on ibc scrum; 7 .'• nii tin ulinK hi I
l-V-IIouinR vciK-cctidii. pnriiatinii and -uintinj. and tlu- ,-idniiiii-tratiiin nf
41) ^ram- of fo<litim hicarhmiati li\ -tni.i.-udi-tiilK-. tlir i'iin\ iil-mns lii-allv r<a-nl
.•imi ■■nn.icii'iisiu -s rcliirned mi tin- ninniiiiK nt Jann.arx Jii ( )ii Jamian, JS a
lUad child wa- Imni -puniaiu mi-ly. 'I'lu' piu rpi-riinii \\,i- nM-\ i-ntlnl.
riu- amnim-ia ritri-mii --■■ -.iriiu- dnriiu.; llir tlirn- d.n - |ua-oi-i|iii-.; iU!nar_v
r.iiu^ti', trnin 1,'< !n Id pn-
Janii.ar> 2'i. tlu- liMlrni;i-i ci nu'riitratimi nl lilnnd u.-i- fur tin- svriim. 7 S ;
fnr ilu- Uhnh- hlnnd. 7.5-
Casi. 5. I.. (' (ll.-irrii-t Lane ll'inu- \n. ii.5.'Si. .i ulme l.ny. a:;od ^. ua-
admittc-d Jan l.l i' 15. Diagridsis: .sarcmiM nf ilu kidiu > anil aiitrnni ; .-u-idn^i-
Thr l:n\ had lu-cii .'i nnrin.-il. hoalthy I'hild up tn ilim- mmirhs lutnrc admi^
-inp. ulii-n. fnlliiu ini,' .'i trauma tn tlu- lai'i . a -m '' ml -urlliiu; appt-.-ircd mi
the li-ll clu-ck, suh>(.-ipU'ntl> pii-him; tlirmmh In ih, -nf nf tlu- iiimith. ■riimii.ih
painless, this swcllint; had i;railiiall> ymun lar.ci-r.
l-'.xaiiiinalioii shnui-d a ucll-i'i-vi Inpi d. will rmtri-hid rhild Tlu-ri. ua> a
firm ma-- in tne U-fi clu-rh. apparently ari-ini; m th.- antrnm. and pii-hiiit; dnun
the left .side of tile h.ard [lalate in the mouth. There ua^ a nmiular. 'irni nia-s,
the size of a man's t'ist. in the risht nmhilieal reHimi.
January 16: Breat'rni; w.is rapid ami deep.
Ja-iuar\ 17; There u:i- niirked dy-piiea; the re-pir:ilimi- ueri 4l) per
minute
January IS; Uespiratim;- nnK-ii:ill\ d<ep. uitli ;irtii:il "ini- liniim r." The
uritie ciiiitaineil aeelr-n'- and duueiii- aeul.
Sellat'd-' te-t -linuiil cnlnrli-- mi rnni|ileie e\apnratinii Tlu- liydn lieii-ion
oonceiitral nil ni the sc rnm u.is 7 2. ( Ine hundred and -i-\ eiit\ -ii; a- e e. of a
? per cent, sulutum of sodium hicarlmnate was given hy the .Murphy methnd
Till- was followed hy 175 c c. of a 4 ]ier cent, solution nf -ndinm hicadimiate
iiitr;n eiuui-ly Alter the lir^t 5ll c c. r<'spirations heeame nmieeahly le-'^ Iiliored.
.ii'il -linrtly .litrr the cninpletimi nf the injeeti(iu the child was f|uite ci mfori-
.,1.1,. s;,„.i11 ,1,,-..; .,.• l,;.-,rl.,.i,-it,. >.r.r.. r, ,nf I ■ . .>, ,1 l.t „>.,., tli
IS
19:
Scllanl-' ti-t shout'd
a faint jiink iclur luforo coiiijik'te
4? I Ik- child un^
.laiuiarv
(.■vaporatiirii.
Tllc liyclrciiini-ion cunrrmratinii of tlu '(rum was
liroatliiiii; nuriiially, tlioiigh im'iitally rallur ilitll.
During ill'' siiccccdiiii; weeks several radiiiiii treatment- ueie administered
and i; was Iiclioved lliat the abdominal nia<s had grown somewhat smaller.
On I'eliriiary 1>* the respirations became suddenly deep and niii~y. The chilil
seemed drowsy. The nrinc showed a trace nl acetone, Imt no diaeetic acid.
The patient «as Kiven alkali by nioiitli,
rile li>ilr('nen-ion concentration oi the sernin was 7.,V
Ijn lebruary 25 the patient was discharged, lircathiii'.; auain wi- iinrmal
though the general condition was tailing.
Cn.sk 6. — .\. McK. (Harriet Lane Home), a uliui l)n\. ,ii;ed (>, \\a- admitied
.1.111. Jl. I'd.^. Diagnosis: recnrreni vomiting.
The boy had been a normal child except that hv li:i.l ;du,i\> luid ;i "ueak
stoniacii." Three days before a<lmis.:,ion. following :in imliscretion m iliet. he
coniplaineil of abdominal pain. Next (lay he began to \.imit :i]id since then
had not retained any food except a little orange juice. IK ^united without
any apparent etTort. and after vomiting seemed tiuite well.
liximination showed a -sparely nourished chibl. apparent!) ipiitc i^riiKiI in
all res])ects. The urine contained acetone and <liacetic acid. I lie In dniyeii-iou
concentration of the blood scrum wa- 7 5. I'ollowing a «ell-M gulated dieiary
regimen, he rapidly improved ami wuit hinie
C.vsi; 7.— \'. D. ( Harriet Lane Home \'o. 6,028). a white girl, aged 2 months.
was admitted Jan. 22, 1915; du i Jan. 2,^, I'llS. Diagnosis: alimentary intoxica-
tion.
The patiiiit wa'- a fnll-lerm. apparently he.ahny. child. Sixteen days before
admission she began to vomit after every feeding and had frequent green stools.
The vomiting and diarrhea persisted up to the time she was brought to the
ho-pital.
F.xaniin:ilion showed a -ni:dl. moderately well iioiii i-lud baby, conscious and
crying fretfully. Slight cy:inosis was |ire-ent I he n spirjiiory r:itr w;is
increased, the rc-liiratmn^ being full ancl deep White bbiod crll-, 2J.ir(i The
stool, large, green and watery, contained nuicns and food rc-idtii.
Scllards' test showed no color on evaporation or on addition of di-tilled
water after evaporation.
The hydrogen-ion concentration of the serum was ".4.
Intensive alkali therapy was given, both intravonou>l> and >iibctUaneonsly.
The respirations nuproved a little, b.ccoming sh.-dlower, Tlun wa- one slight
convulsion and con-tant convulsive twitchings of the f.icc and extremities.
The Iiydrogcn concentration of the -eriiiu .after inti:i\enous injections of
sodiiun bicarbonate was 755.
The respirations gradually became shallower and more infrcfjucnt and the
baby died at 4:55 a. m. on January 23 There ua- complete anuria during the
stay in the hospital. Partial necropsy showe<l only enlargement of the iue>eii-
tcric lymph nodes.
Casf. S — M 1". I Medical Service), a white man. ageil 211. was admitted
Jan. 7. 1915. Dia;jno-i>: acute and chronic luphritis, hvperlension. and myo-
cardial insntTicicncy.
The patient had frequent sore tliroats. Eighteen months ago he began to
have morning headaches. For three months, dyspnea on exertion was noted,
beconiiug progre-sively more marked. Six days before admission the feet and
ankles began to swell, and the abdomen and face lia\e -irce become edematous.
Anorexia, dizzy spells and cpistaxis have occurred during the past week.
Hxamination showed an ovcrnonrished young man, dy.spneic, sallow and
pale. Marked oral sepsis was present; the tonsils were large and ragged.
Crepitant rfile- were heard at the left base. The heart was marked.Iy enlargei!
10
Tlic liver was enlarged aiul tender.
There was a moderate secondary
01 i-xcrt-tion in two
7,4, Tlic- nonprotein
There \vn^ a -nappiiiR aortic secoml .~ounil.
Edeina ot I'ect and aiil<le> was pn sent,
anemia.
The W'asserni.mn tc -t wn-- neuativi
The phenolsnlphoneiihlhulein test showed 55 per cent
honr*. The hydrogen-ion concentration of the sernin wa>
nitrogen of the blood was 3() mg. per IIXI c.c.
Jann;ir\ Ji': The hwlroyen-ion concentration of the scrnm was ".6: whole
blood, 7.5. '1 he C<-1.. tension of alveolar air was 40.1 nini. Hg,
The uinif ii; i|"'in'i'y uas 1,500 to 2.000 c.c. in twcnty-fonr honrs. The
specitic gravity w.is l.ulJ to 1,013. There were 1.5 to 2.75 grams of albnmin
per liter. On admission, red blood cells and acetone were observed, which subse-
qnently disappeared. N'nmerons granular casts were foimd.
The Iilood pressure rangeil from 170 to 1,311 nmi. Hg systolic; 110 to 65 dias-
tolic. The patient is somewhat improved, lie i^ still in the hospital I.April,