BLOOD, RESPIRATION, CIRCULATION AND DISTURBANCES 301 



The organism is carefully provided with mechanisms to maintain 

 the neutral state. [This is not in accordance with present views. 

 In American clinical literature this is at present usually expressed 



H7, p H 7 or p H 7 = neutral. In normal blood p H = 7.4, while in 

 advanced acid intoxication, p H 7.2. Tr.] Every abnormal excess 

 of H or OH ions influences the condition of swelling in the tissues 

 and may thus give rise to grave disturbances. Although 0.37 X 10~ 7 

 represents the normal H-ion concentration of the blood, 1.00 X 10~ 7 nH 

 indicates an advanced acid intoxication. 1.00 X 10~ 5 nH damages 

 the red blood corpuscles according to L. MICHAELIS and D. TAK- 

 ABASHI just as do traces of NaOH. We know from the inves- 

 tigations of H. J. HAMBURGER and HEKMA* that the functional 

 activity of the leucocytes depends on the normal concentration of 

 H and OH ions. To maintain this condition, nature has provided 

 a double safeguard and surrounded neutralization with a double 

 line of defense. The outer wall is the serum salts, which are so 

 skillfully combined that the concentration of the H or OH ions is 

 unchanged by the moderate addition of acids or bases. This prop- 

 erty of the serum salts is of great importance in the metabolism, 

 formation and removal of C02, in the formation of lactic acid, of 

 ammonia, etc. ; it is even to a certain extent increased by the artifi- 

 cial introduction of acids and bases. Circumstances may arise 

 when these outworks are overcome and the inner line trenches have 

 to bear the defense. 



Severe poisoning with acids or alkalis are dangerous not only 

 because of the burns they cause, but especially because of the danger 

 of disturbing the balance between the H and OH ions. We must 

 especially consider the acid intoxication in certain diseases, as in the 

 fever of many of the infectious diseases and in diabetes, associated 

 with the over-production of oxybutyric acid. Under these circum- 

 stances the inner though weaker line of defense must be the proteins, 

 which, because of their amphoteric character, are able to bind acids 

 as well as bases. It is not a matter of little consequence when the 

 proteins have to be invoked for neutralization. We have seen 

 from pages 152 and 153 that the addition of alkali or acid increases 

 the internal friction of albumin; that albumin ions have a much 

 higher viscosity than the albumin molecule; and further that in 

 media that are not neutral the blood corpuscles swell. Therefore, 

 under circumstances where there is a higher ionization of serum 

 albumin and parallel with it a swelling of the formed elements, we 

 may expect that the blood will show a higher viscosity and that 

 greater demands will be made on the organ of circulation, the heart 

 (see p. 310 et seq.). 



