A  Hi .  Jour.  Phai'ra.  I 
November,  1903.  J 
Alkalinity  of  the  Blood. 
509 
The  usual  method  of  obtaining  the  results  is  to  estimate  by  mathe- 
matical calculation  the  amount  of  alkali  present  in  the  blood;  but 
this  method  has  always  proved  itself  to  be  both  tedious  and  incon- 
venient, as  it  requires  a  decided  tax  on  the  memory  to  recall  the 
various  estimates  as  a  working  basis.  In  place  of  this  rather  intri- 
cate method,  I  would  like  to  offer  the  following  as  its  substitute: 
I  have  devised  for  this  purpose  a  scale  of  equivalents,  in  milligrams 
of  sodium  hydrate  to  IOO  c.c.  of  blood.  Thus,  should  we  employ 
2*2  c.c.  of  reagent,  the  alkalimeter  tube  would  indicate  an  equivalent 
of  292  mgs.  of  sodium  hydrate  to  IOO  c.c.  of  blood. 
In  enteric  fever  a  marked  decrease  of  blood  alkalinity  is  the  rule, 
a  decrease  in  alkalinity  is  likewise  observed  in  tuberculous  disease 
with  glandular  involvement,  and  also  in  gastric  ulcer,  while  gastric 
cancer  shows  increased  alkalinity. 
The  anaemias  show  a  decided  fall  in  alkalinity. 
In  cases  of  chlorosis  one  very  interesting  fact  was  revealed  in  an 
attempt  to  increase  the  alkalinity  of  the  blood  by  the  administration 
of  enormous  amounts  of  sodium  bicarbonate,  in  one  case  as  much 
as  10  ounces  (in  divided  doses)  per  diem  being  given,  and  this  was, 
that  while  there  was  an  increase  in  the  number  of  erythrocytes,  and 
the  production  of  a  turbid  alkaline  urine,  the  hemoglobin  percentage 
was  unaffected,  and  the  alkalinity  did  not  rise  above  normal. 
The  importance  of  this  observation  lies  in  this  :  that  if  true  of 
conditions  other  than  chlorosis,  it  is  futile  to  attempt  to  alkalinize 
the  blood  by  the  administration  of  sodium  bicarbonate,  it  must  be 
done  by  other  methods. 
As  to  the  exact  clinical  meaning  of  different  alkalinities,  little  can 
be  said  at  present.  There  is  a  more  or  less  constant  ratio  between 
the  color  index  and  the  alkalinity  ;  this,  however,  varies,  because  as 
disease  processes  progress,  the  color  index  changes  with  the  varying 
relation  between  the  erythrocytes  and  the  hemoglobin ;  even  under 
physiological  conditions,  marked  variations  of  color  index  and  alka- 
linity occur. 
In  another  paper  (The  Johns  Hopkins  Bulletin,  Vol.  XIV,  No. 
148,  July,  1903)  I  have  published  a  table  giving  clinical  data  in 
75  cases  of  routine  blood  examinations  made  in  Jefferson  Medical 
College  Hospital,  by  Dr.  John  Funke,  resident  pathologist;  the  table 
presents  a  number  of  points  of  special  interest. 
I  will  not  go  into  technical  medical  details,  as  it  will  not  interest 
