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Les diagrammes suivantr illustrent ia m*thode. 1 2 3 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 \iiAmi"i . 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 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,' IValc > ul Milroy.'' The r(.--uli~ iia\f nut inni alici;,'filKT iinif 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, aninnlarl\ . 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'I,is: Physinl. Soc. I'rnc , Jamiarv, V44 S. PcalHHJy. I'. W.: Sni.lic- on .\c„lusi- ami Dyspnea in Renal an.) Canliac l)ii " 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 |)lioalt ( 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'n3 "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 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\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 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-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(lvuu,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 aeip 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.^ 4i.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 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> \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 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 rlo(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 simple, accurate, rapiil ,and well .id.ipted Inr clinical u~e. 2. 'The technic con-i-I- 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-. 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.. Inria 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 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 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.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* 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 al> 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 showeeii- 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 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,