656 LEWELLYS F. BAEKEE 



colorimetric method of Levy, Eowntree and Marriott), the carbon dioxid 

 capacity was measured (method of Van Slyke), and the calcium content 

 was investigated (method of Lyman). In summary, it was found that, as 

 a result of the fall of the alveolar CO 2 tension from overventilation, there 

 is (1) a reduction in the H-ion concentration of the blood, (2) a reduction 

 in the CO 2 capacity of the plasma, (3) a change in the reaction of the urine 

 to the alkaline side, (4) a decreased output of ammonia in the urine, and 

 (5) a slight increase in the calcium content of the blood serum. The graph 

 of the experiment, of which the protocol was given above, is reproduced in 

 Fig. 14. It shows the synchronous changes in the alveolar air, the blood, 

 and the urine. 



Interpreting their findings, Grant and Goldman believe that the forced 

 respiration, by washing CO 2 out of the alveoli, reduces the CO 2 content of 

 the blood, thus tending to make the blood more alkaline than normal. As 



a result, there is in the blood a disturbance of the 2 * ratio upon 



which the H-ion concentration depends. On the reestablishme-nt of this 

 ratio, NaHCO 3 passes out of the blood plasma into the tissues, some of it 

 being excreted by the kidneys. But the CO 2 is washed out of the blood 

 more quickly by the overventilation than can be compensated for by reduc- 

 tion of the amount of the NaIICO; } (by excretion or otherwise), and so the 

 alkalinity of the blood is actually increased. The body tries to compensate 

 for the increased alkalinity of the blood by reducing the amount of 

 ammonia formed, and the lowered acidity of the urine depends partly upon 

 increased excretion of alkali, but principally upon a retention of acid 

 radicals. 



These authors conclude, then, that, on overventilation, a true "alkalo- 

 sis," in the sense of an actual change in the II-ion concentration, develops 

 in the body; and the alkali reserve undergoes a reduction, owing to the 

 elimination of the XaIICO :{ from the body fluids in the effort to maintain 

 the II-ion concentration at a constant level. In "acidosis" there is also a 

 reduction of alkali reserve, and, as Grant and Goldman point out, the 

 coexistence of increased alkalinity of the blood with a reduction of alkali 

 reserve reveals the 1 inadequacy of the terms "alkalosis" and "acidosis." 



On discussion of the etiological relationship of the alkalosis to the 

 tetany produced, Grant and Goldman comment, first, upon the two prevail- 

 ing views regarding the conditions of metabolism that can be responsible 

 for tetany, (1 ) the view that tetany is due to calcium deficiency, and (2) 

 the view that it depends upon a disturbance of the acid base equilibrium in 

 tho body. The calcium content of the blood was slightly increased in their 

 experiments rather than reduced, but they suggest that this fact might 'be 

 interpreted as due to a mechanism that tries to compensate for a loss of 

 ''active" calcium. The calcium was not, however, precipitated in the blood 

 in their subjects, for the analysis was unaffected by centrifuging the serum. 



