BLOOD ANALYSIS 2QI 



Procedure. Give the patient, the first thing in the morning, a standard 

 breakfast consisting of two slices of bread, one egg in any form and one cup of 

 water. Two hours after this breakfast have the patient empty the bladder and 

 then drink 200 c.c. of water. One hour later collect a specimen of urine and 

 one of blood to serve as controls. Then give the patient 1.75 gm. of glucose per 

 kilo of body weight. The glucose is given in 50 per cent solutions. 1 Collect 

 3 or 4 specimens of blood at hourly intervals and analyze for sugar. Following 

 the taking of glucose collect a 24 hour specimen of urine and determine its sugar 

 content. 



Interpretation. In normal individuals blood sugar rises from the 

 normal value of about o.i per cent to about 0.15 per cent at the end of 

 the first hour and returns to normal by the end of the second hourly 

 period. In pathological conditions the curve does not follow the normal 

 course. Hyper thyroidism, diabetes, and nephritis show much greater 

 values, depending on the severity of the disease, and the return to 

 normal is delayed for 3 hours or more. The high sugar concentration 

 in the blood during the test may or may not JDC accompanied by gly- 

 curesis, depending upon the " threshold point" of the kidney. In 

 hypo-endocrine conditions, in which the blood sugar is low ordinarily, 

 the curve of blood sugar during a tolerance test is quite " flat." Curves 

 obtained by Killian in hyper thyroiclism and Addison's disease, together 

 with the curve of a normal case are shown in Fig. 92. 2 For further 

 discussion of the application of sugar tolerance tests consult papers by 

 Hamman and Hirschman, 3 Janney and Isaacson, Bailey, Williams 

 and Humphreys, Allen, Stillman and Fitz, Killian and Macleod. 



3. Determination of Cholesterol (a) (Method of Myers and War- 

 dell). 4 Principle. The blood is dried on plaster of Paris and extracted 

 with chloroform. Cholesterol is determined colorimetrically after 

 adding to the chloroform extract acetic anhydride and sulphuric acid. 



Procedure. For the determination, i c.c. of blood, plasma or serum is 

 pipetted into a porcelain crucible or small beaker containing 4 to 5 gm. of plaster 

 of Paris, stirred, and dried, preferably in a drying oven for an hour. It is now 

 emptied into a small paper extraction shell (4 cm. long) and then inserted in 

 a short glass tube (2.5 X 7 cm.) in the bottom and sides of which are a number 

 of small holes. This is now attached to a large cork on a small reflux condenser 

 and the tube and cork inserted in the neck of a 150 c.c. extraction flask containing 

 about 20 to 25 c.c. of chloroform. Extraction is continued for 30 minutes on an 



Janney and Isaacson (Arch. Int. Med., 22, 160, 1918) administer the glucose in 40 

 per cent solution together with the juice of one lemon and without the preliminary standard 

 meal. Two blood specimens are taken just before giving the glucose and at the end of 

 two hours. 



2 Myers: Practical Chemical Analysis of Blood, C. V. Mosby Company, 1921. 



3 Hamman and Hirschman: A rch. Int. Med., 20, 761, 1917; Bailey: Arch. Int. Med., 

 23, 455, 1919; Williams and Humphreys: Arch. Med. Int., 23, 537, 546, 559, 1919; Allen, 

 Stillman, and Fitz: Monograph of the Rockefeller Institute for Medical Research^No. 

 n, 1919; Macleod: Physiological Reviews, i, 208, 1921. 



4 Myers and Wardell: Jour. Biol. Chem., 36, 147, 1918. 



