130 EUGENE F. DU BOIS 



the new kidney functions tests do not show kidney damage much better 

 than the older methods of urine examination. 



Blood sugars seem to be increased as in other fevers. Roily and 

 Oppermann found between 0.106 and 0.122 gm. per 100 c.c. Hollinger, 

 in most of his cases, found between 0.114 and 0.145 gm. One patient 

 went as high as 0.168, sinking to 0.096 fourteen days after the crisis. 

 John has recently reported a series of analyses ranging between 0.07 and 

 0.18. He obtained excellent results clinically by the intravenous adminis- 

 tration of 250 c.c. of 10 per cent glucose solution. Immediately after this 

 injection the blood sugar was about double its former concentration though 

 it seldom rose above 0.3. 



Acidosis in Pneumonia. The estimation of the degree of acidosis in 

 pneumonia presents unusual difficulties. The abnormal relationships in 

 oxygen and carbon dioxid content of venous and arterial blood, the dys- 

 pnea, the chlorid retention may upset our calculations entirely. The 

 carbon dioxid content of the blood in fever was studied by Kraus and more 

 recently by Peabody(a), using modern methods. The latter made ninety- 

 one analyses in twenty-six cases and found the CO 2 content between 40 and 

 50 volume per cent in the acute stages. He concludes that a diminution of 

 the CO 2 was found in all but a few cases of pneumonia and that it was not 

 necessarily in proportion to the severity of the disease, though the lowest 

 figures were usually found in the severe cases and terminal stages. As a 

 rule it was proportional to the output of ammonia, but bore no relation to 

 the chlorid excretion or temperature curve. The CO 2 might be low for 

 some days after the patient was afebrile. Acetone was found in only two 

 cases. Pick has found a significant decrease in the acidity of the urine 

 and even the appearance of alkalinity occurring 36 to 48 hours after the 

 crisis. This he believes due to a considerable increase in the excretion of 

 sodium caused by the absorption of the exudate. Palmer and Henderson 

 found that during pneumonia large amounts of sodium bicarbonate were 

 required to make the urine alkaline and Palmer (c) ascertained that an 

 inorganic acid of unknown nature was being excreted in the urine and 

 that analysis of the plasma CO 2 combining capacity indicated that the 

 acidosis was seldom severe. Frothingham(a) has confirmed the work of 

 earlier investigators in finding in some cases high ammonia excretion with 

 an increase in the amount of sodium bicarbonate required to alkalinize 

 the urine. One of his fifteen cases showed acetone in the urine. In some 

 the CO 2 content of the alveolar air indicated acidosis, in others the reverse. 



Miscellaneous Metabolites. Much of the work on the inorganic con- 

 stituents of the blood and urine is fragmentary and inconclusive. The 

 careful work of Peabody indicates that during the fever there is a retention 

 of 01, Na and Ca in the body, while there was a normal excretion of K 

 and Mg. The Ca and Mg in the blood were apparently slightly lower 

 than normal. The excretion of phosphates was irregular. 



