392 APPENDIX 



sponded closely with the results of the test. Again in 30 nephrectomies the condi- 

 tions found were in accordance with the results of the test. The general opinion of 

 those who ; have used the test is that it is more reliable than cryoscopy and far easier 

 of application. The technic is as follows: One c.c. of the phthalein solution 

 containing 6 mg. is injected intramuscularly or subcutaneously. The drug can be 

 bought in ampules ready for use. About twenty minutes before injecting the drug 

 the patient is given from 200 to 400 c.c. of water to drink. After the injection the 

 bladder is emptied with a catheter and the time is accurately noted when the urine 

 which subsequent to the emptying of the bladder and being allowed to drop into a 

 test-tube containing one drop of a 25% sodium hydrate solution first shows a pink- 

 ish tinge. This is recorded as the time of appearance of the drug in the urine and 

 normally is about 10 minutes. The catheter is then withdrawn and the urine that 

 is passed in the first hour collected and subsequently that passed in the second hour. 

 To each hour's specimen sufficient 25% sodium hydrate is added to give a purple- 

 red color and the entire amount is then poured into a liter flask and made up to 

 1000 c.c. A similar treatment is employed for the urine of the second hour. The 

 amount of drug eliminated in each hour is then determined by a colorimeter. 



Cabot has proposed the use of a series of ten test-tubes containing solutions of 

 the drug representing from 5% to 50% of the drug dose, each tube containing 5% 

 more than the preceding one. These comparison solutions may be made up with 

 the patient's urine obtained at the time of emptying the bladder so that the con- 

 fusion which may obtain when water is used is avoided. It has recently been pro- 

 posed to make the standards with water and use a piece of yellow glass for match- 

 ing. The urine to be tested made up to 1000 c.c. as previously described is then 

 poured into a test-tube of similar size and matched. 



In normal cases Cabot got 46% of the drug eliminated in the first hour, the 

 average for the second hour being 17%. The quantity of urine secreted in either 

 hour has no relation to the test, which is the percentage of drug eliminated. In 

 cases with serious kidney disease the amount of drug eliminated in the first hour 

 may range from 5 to 12%. 



When the question of the kidney involved arises, the urine must be taken by 

 ureteral catheterization or by a separator. 



F CHEMICAL EXAMINATION OF GASTRIC CONTENTS. 



The test breakfast ordinarily used is that of Ewald (one shredded wheat biscuit 

 or two small pieces of toast with 400 c.c. of water is what is usually given). This 

 Ewald breakfast is a low-grade stimulant to acid production. It is given in the 

 morning on an empty stomach. If at supper, the night before, the patient partake 

 of raspberry jam the finding of the characteristic seeds in the stomach contents 

 the next morning would be evidence of lack of motor activity. The Fischer meal 

 which contains a 4-ounce Hamburg steak in addition to the water and toast of the 

 Ewald is withdrawn after three hours. 



The stomach tube is more easily passed if it be thoroughly chilled in ice water 

 without the use of any lubricant. 



The stomach tube should be passed one hour after the Ewald breakfast and if 

 more than 50 c.c. of fluid be obtained it indicates stasis or hypersecretion. 



