Search

Despite the fact that scientific investigation of the p H mechanism began more than a half century ago, it is only recently that the interest of practical technologists at large—and rhinologists in particular—has been aroused. The subject of hydrogen ion concentration was poorly defined and lacked a clear, comprehensible nomenclature. With the advent, however, of comparatively new and simple methods for measuring hydrogen ion concentration, it has been possible to awaken the clinician's interest in a type of investigation that has practical application to innumerable and diversified fields. In the realm of medicine, the " p H influence" is intimately associated with general health. More specifically, in the case of blood it is of paramount importance. The " p H influence" is not restricted to blood alone, for the p H of spinal fluid, lymph—in fact all body fluids, including the nasal secretions—has definite clinical significance. It will be recalled that the p H scale, a means

During the past two years data have been obtained from normal infants and from infants suffering from acidosis which permit a comparison of the carbon dioxid tension of the alveolar air, and the acidity of the urine with the plasma bicarbonate.1 TECHNIC Alveolar air was collected by the Plesch-Higgins method as modified by Howland and Marriott. A large number of the analyses were made by the Haldane apparatus, the remainder by the colorimetric method of Marriott.2We have found the latter method to be quite accurate when carefully used and the results vary but little from those obtained by the Haldane apparatus. It seemed evident that any errors inherent in the colorimetric method were less than those associated with the method of collection of the alveolar air. The plasma bicarbonate was determined by the method of Van Slyke and Cullen;3corrections for temperature and barometric pressure were

Numerous reports in the literature 1 reveal differences of opinion regarding human tolerance of the solutions of sulfonamide compounds used in local treatment of the nasal mucous membrane. Recently, as a result of investigations of the physiologic range of the hydrogen ion concentration of the secretions of normal nasal tissues in situ ( p H fluctuating between 5.5 and 6.5) and of the changes in it observed in the course of nasal and sinus diease of man, Fabricant 2 proposed a new basis for the selection of local remedies to be administered intranasally. He stressed that markedly alkaline preparations usually exert an irritating effect on the nasal tissue, impairing the ciliary function and damaging the olfactory lining. The therapeutic problem has been to develop "a nontoxic medication, compatible with ciliary action," of the same hydrogen ion concentration as the nasal tissue and therefore "non-traumatizing to the mucous membrane." Furthermore, this author has stated that

The concept of the relation of even small changes in the hydrogen ion concentration to vital biochemical and biophysical processes has stimulated many studies on the acid-base equilibrium in various body fluids and tissues. The interest of ophthalmologists has been focused mainly on one phase of this relation, that is, the changes in the turgescence of colloids due to a shift in the hydrogen ion concentration. Its possible bearing on the problem of glaucoma was considered by Fischer 1 and was later the basis for experimental work on the p hvolume curve of the vitreous (Baurmann and Thiessen, 2 Duke-Elder, 3 Goedbloed, 4 Salit and O'Brien, 5 von Sallmann 6 and others). No experimental work in ophthalmology, however, has been reported on the relation of the p hof the milieu to the optimal action of various enzymes, such as tissue proteinases (cathepsin and peptidases) and the proteolytic enzymes

The study of the hydrogen ion concentration of nasal secretions in various diseases of the respiratory tract was continued throughout the years 1934 and 1935. In all, 350 determinations were made on 125 subjects. The conditions presented were as follows: Six patients had atrophic rhinitis, 11 came for bronchoscopic treatment, 25 had colds and 83 had allergic rhinitis or allergic rhinitis with superimposed infection. The hydrogen ion concentration was determined with the glass microelectrode. The description of the method and the precautions taken in its manipulation and in the handling of the secretion were given in an earlier paper. 1 Tables 1 and 2 show the p H for tracheobronchial secretions and atrophic rhinitis, respectively. The number of cases for each condition is too small to be used as a basis for definite conclusions, but the trend of the p H is indicated. The secretions are primarily purulent and mucopurulent, and in consequence

IN RECENT years considerable attention has been paid to the question of the hydrogen ion concentrations of nasal secretions as well as to those of solutions used in nasal medication, particularly by Fabricant, 1 Van Alyea, Proetz 2 and others. Interesting studies have been made also on the influence which various drugs have on the ciliary activity of the mucosa of the upper respiratory tract by Lierle and Moore, 3 Proetz 2 and Yates. 4 However, important as these elements are, they should not be evaluated independently but seen rather in their combined relationship to the permeability of membranes. Thus perfusing fluids of the same hydrogen ion concentration would have quite different effects on the permeability of membranes, depending on the presence of calcium, sodium or potassium ions. To stress the hydrogen ion concentration of a solution without recognition of electrolytic activity would lead to gross misjudgments. One cannot therefore list therapeutic agents purely by

THAT there is a relationship between emotional factors, the frequency of acute colds and their sequelae and altered nasal function has been recognized, although not yet completely defined, by a number of investigators. It is known that the abnormal, alkaline nasal secretion associated with infection of the upper respiratory tract often excoriates tissue when descending on the skin of the upper lip. If the patient with acute rhinitis remains relatively removed from the routine decisions and frustrations of his working day during the acute phase, when the nasal membranes are engorged and sensitive, with secretion flowing excessively, the nose becomes less painful and the secretion diminishes; so MacAuliffe, Goodell and Wolff 1 observed in their experimental studies on headache and pain from nasal and paranasal structures. Congestion of the nasal mucous membrane, they noted, may occur as an accompaniment of anxiety or resentment. In this connection, the coupling of the effects

Much work has been done by pediatricians and others in an effort to treat cow's milk so that it may be substituted more satisfactorily for breast milk. This work has been mainly in two fields. The earlier efforts were aimed at raising the hydrogen ion concentration or reducing the buffering capacity. It is well known that digestion in the infant's stomach takes place at a p H of 3 to 5, as compared with a p H of about 2 in the adult. Owing to this fact it is important that the milk ingested have not too high a buffering value. Breast milk is ideal in this connection. Cow's milk and goat's milk, on the other hand, are comparatively resistant to a change in p H . As has been pointed out many times, the main factor contributing to this discrepancy is the presence of larger quantities of protein in these

THE WIDE acceptance of a rationalized form of nasal and sinal therapy can be established only in the event of a clear understanding of the manner in which drugs work. This understanding can be assisted materially by studying the effect of nasal preparations on (1) nasal or sinal mucosa, (2) ciliary motility and (3) the hydrogen ion concentration of the nasal secretions and by noting the production or the absence of local and systemic side effects. Nontoxic nasal medicaments that are compatible with ciliary motility, that do not vary greatly in their hydrogen ion concentration from that of normal nasal secretions ( p H5.5 to 6.5) and that are nontraumatizing to the mucous membranes are most useful in the treatment of the nose and the nasal sinuses—for they function on a rational, physiologic basis. 1a Although it may be difficult for physicians to believe in retrospect that they were ever deluded, each

EVER SINCE the beginning of the present decade, attempts have been made to direct the interest of rhinologists to (1) the relation of the p H of nasal secretion in situ to applied nasal physiology and (2) to the importance of the p H factor in the field of nasal medication. 1 Recognition of Fantus' 2 dictum that a hydrogen ion concentration near that normal to the mucous membrane is a matter of even greater importance for applications to the mucous membranes than the matter of isotonicity has provided a firm foundation for rational, physiologic nasal medication. So far as concerns the p H values of local medicaments, valid therapeutic conclusions have been drawn in a variety of clinical fields from measurements of the hydrogen ion levels of various secretions found in their original positions on underlying mucous membrane and tissue surfaces. Intranasal treatment by means of rational, physiologic nasal medication requires not only treatment

A GREAT deal has been written in the ophthalmologic literature about the importance of the hydrogen ion concentration and the tonicity of ophthalmic therapeutic solutions. Much of the published material is not in a form that is readily usable by the practicing ophthalmologist. We decided to investigate the practical limits of variability of these two factors and to evaluate their importance. Our aim is to present here what we believe to be the best solutions, based on present knowledge, for practical prescribing and feasible compounding of solutions containing most of the frequently used ophthalmic drugs. Recently, Swan1summarized the factors known at present which influence the permeability of the cornea by therapeutic agents. He pointed out that the tonicity of the tears, as reported by various workers in terms of the sodium chloride equivalent, varies from 0.9 to 1.4 per cent. He stated elsewhere2that solutions with tonicity

Confusion is evident in such experiments as have been reported for the determination of intranasal p H . The cause seems to lie chiefly in unawareness that within the nasal chambers are two distinct sources of hydrogen ion concentration: living tissue and nonliving secretion. The purpose of this discussion is to suggest a more valid premise for such experimentation. It is hoped that with this premise more accurate and therefore more useful conclusions may be drawn. In the opening paragraphs of his "Introduction to Comparative Biochemistry" Baldwin 1 stated: "In the body of the animal the properties of the perfusing fluid are kept remarkably constant. The total salinity, the p H and the temperature remain constant within very small limits. A large part of physiology is concerned with the mechanism whereby this constancy is maintained." The term "body fluid" embraces both cellular and extracellular fluids, which together comprise the liquid content of the tissues.

This latest volume,Modern Trends in Anaesthesia, represents a departure from the earlier purpose of presenting reports at infrequent intervals of progress in the specialty to anticipation of more frequent reviews on single aspects of topical interest. The first four chapters on nomenclature and presentation of pH data, measurement of pH and pCO2, effects of hypercapnia, and hyperventilation are presented rather well, as they have been written by men productive in these fields. The references are well chosen and authoritative. The succeeding two chapters on acid-base balance in hypothermia and acid-base changes due to cardiac bypass overlap are less lucid—possibly because of the contradictory nature of the work in this area. A section on trends in the biochemistry of anesthesia presents a potpourri of adrenocortical mechanisms, nutrition via the intravenous route, and biochemistry of massive blood replacement, the latter two subjects being controversial and still inconclusive. Nowhere is

Medical students, house officers, and practitioners continue to find acid-base metabolism difficult to understand. Part of that difficulty stems from terminology that is confusing and often misleading. One problem has been that the exact laboratory methods for measuring the various factors used in the evaluation of acid-base disorders have had undue influence on the terminology used in clinical acid-base practice. One example would be the use of the term blood pH as opposed to blood hydrogen ion concentration . Other articles 1,2 have dealt with the controversy of whether to report hydrogen ion activity as pH or as hydrogen ion concentration in nanoequivalents, or nanomoles, per liter (nEq/L or nmole/L). The unnecessary confusion resulting from the use of the aphysiologic terms standard bicarbonate, whole blood buffer base , and base excess has been elegantly reviewed. 3 However, another source of confusion in terminology that has not been adequately addressed is the unfortunate

• The extracellular hydrogen ion concentration is maintained almost constant through an interacting series of processes. These include the activities of the chemical buffers, the regulation of the carbon dioxide level by the pulmonary system, and the excretion of acid or alkali by the kidney. Understanding of these basic processes will provide a rational basis for the diagnosis and treatment of clinical acid-base abnormalities. ( Arch Intern Med 1982;142:1019-1023)

(Continued from p 1901.) To the Editor .—I read with interest the report by Barthel et al 1 in the May 1988 issue of theArchivesconcerning the finding of histologic gastritis associated with Campylobacter pylori in 4 of 20 healthy asymptomatic volunteers. Although they reported the age range and median age, the ages of the 4 subjects positive for gastritis and C pylori infection were not mentioned. Other studies have shown an association with increasing age and prevalence of gastritis and C pylori . The authors also report finding fasting gastric hypochlorhydria in the four C pylori -positive subjects compared with the normal volunteers without gastritis. I do not believe such a state-ment is justified in the context of the methodology employed. Samples of fasting gastric juice were endoscopically obtained and the pH was determined, but we are not told if an appropriate glass hydrogen ion electrode was used or

This is a fascinating volume—now, in its third edition, authored by surgeons primarily from Glasgow, but also from other parts of Scotland and England, with one contribution from Australia. It is a welcome addition to surgical libraries that have not seen a surgical physiology volume since Zimmerman's in 1957. There is a particularly good chapter on wound healing with accompanying graphs and micrographs and an excellent one on radiation "injury," about which all surgeons worry. Fluid and electrolyte balance and the metabolic response to injury are clearly and concisely presented with a section on parenteral nutrition. Included in these chapters are sections on the fundamentals of hydrogen ion regulation and on the disturbances of acid-base balance and dehydration. The respiratory system and its functional measurements are well covered, although it is interesting that the acute respiratory distress syndrome is not described as such in this chapter. A section on assisted

Many studies of experimental nephritis are reported in the literature, notably those which concern the injection of the salts of the heavy metals, uranium and tartrates, into rabbits and dogs. There seems to be no mention of nephritis caused by the injection into rabbits of relatively large amounts of monobasic sodium phosphate. In the course of certain experiments with rabbits, injections of solutions of this salt were made and in the examination of the kidney tissue, necrosis of the cells lining the convoluted tubules and the loops of Henle was observed. Other experiments were made to confirm this observation, and in each instance depending in severity largely on the length of time that the rabbit was poisoned by the injections, there are necrotic changes in the cells of the renal tubules mentioned. Blood to be used for determining the hydrogen ion concentration and the carbon dioxid combining power was drawn

Studies in the chemistry of gastric digestion have centered about the acidity and action of the enzymes. It was early shown that in infancy a small amount of free hydrochloric acid is found in the gastric contents of the breast-fed infant, but none in those of artificially fed infants. No great progress was made until methods for measuring the hydrogen ion concentration were introduced. For the last twenty years, this has been the dominant interest in gastric analysis.1 Much of value lies in some of the older literature, a review of which, to 1908, was given by Clarke.2Motility was subject to measurement as soon as the Kussmaul tube was first used for infants by Epstein in 1880.3His observations were confirmed and extended by Leo,4who showed that breast milk passed out of the stomach more rapidly than cow's milk. As a possible correlation, he

At present the treatment of conjunctival and corneal lesions is almost entirely symptomatic and empirical and, in many instances, thoroughly illogical. Two years ago one of us (G. N. H.) called attention to the frequent misuse of the ointment of yellow mercuric oxide (Pagenstecher's ointment) 1 and stated that much of its reputation for improving all sorts of conjunctival, corneal and tarsal lesions for which it was not originally intended was probably gained in the days when it was prepared by the apothecaries from mercuric chloride and potassium hydroxide. It is highly probable that the washing of the precipitated oxide was often incomplete and that traces of free alkali remained in the amorphous powder after it was dried. Probably with equal frequency there was an excess of mercuric chloride left, and when this went into solution in the tears a decidedly acid reaction resulted. (The p H of

The work reported here was done in 1919. In view of the then prevailing association of a much reduced blood volume with pernicious anemia and the reported decrease in alkalinity of the serum, it seemed within the bounds of probability that if the total carbon dioxid elimination had to be taken care of by a reduced amount of blood, the level of the carbon dioxid in each unit of blood would be raised, and that the increase in hydrogen concentration resulting might in turn tend to maintain a reduced blood volume. I therefore attempted to see to what such an hypothesis would lead by a study of the effect on blood volume of a decrease in the hydrogen ion concentration of the blood brought about by administration of carbonates to two patients with pernicious anemia who had received transfusions of unlike group blood. Changes in the concentration of the unagglutinable

In 1924, Hess and Matzner 1 introduced the modification of cow's milk by means of fruit juices. These investigators added various juices containing natural organic acids in order to render the milk sufficiently acid to counteract its buffer constituents and at the same time to provide a sufficient quantity of antiscorbutic vitamin. The first attempt was made with canned tomato juice, the p h of which is about 4.2. This addition, according to Hess, "although fulfilling its object in regard to providing adequate antiscorbutic vitamin, was found to be insufficient in regard to its acidity; except when used in very large amounts, it cannot adequately increase the hydrogen ion concentration of milk." Attention was next directed to the use of orange juice, the acidity of which ranges from a p h of about 3.54 to 3.71. It was soon learned, however, that as much as 200 cc. of orange juice

Among the latest and most important observations on the hydrogen ion concentration of the human duodenum are those made by Hume, Dennis, Silverman and Irwin. 1 Their subject was a colored man who had suffered a gunshot wound, the cause of which was unknown, and from which a duodenal fistula resulted. Their conclusions were that, "Electrometric determination of the hydrogen ion concentration of the human duodenum made by the insertion of an electrode through a fistulous opening gave a maximum p H 8.23 and a minimum p H 5.91; while the average calculated from 182 readings was p H 7.02. No definite difference in reaction was noted in observations made after the ingestion of meals consisting of fat, carbohydrate or protein." McClure, Montague and Campbell, 2 having obtained their material in a more customary manner, i. e., via a duodenal tube, secured results comparable to those of the aforementioned writers. Their material was obtained from

In this communication, which is of a preliminary nature and therefore bears no claim either to completeness of statement or to any definite and final deducations, we shall present the results obtained by us from injections of phenol in a number of cases of skin disease. This method of treatment, used by us for a period of more than three years in 486 patients, in our opinion deserves interest and more extensvie study. Before describing the methods of application and the results obtained by us, we shall say a few words about phenol itself. Phenol was discovered first by Rűnge in 1839 in coal tar, and then was obtained in a chemically pure state by Laurent in 1840. It represents an aromatic substance and is derived directly from benzene (C 6 H 6 ) by the replacing of one hydrogen ion by the hydro-acid group (C 6 H 5 OH). Consequently

A rapid method for the determination of gastric acidity by means of test papers was recently described by us. 1 Since this description, we have devised a compact indicator set 2 for carrying out the method in clinical work. The apparatus consists of a small wooden case which contains ( a ) six vials of standard buffer solutions ranging in p H from 3.0 to 1.4, each labeled respectively; ( b ) a vial of test papers impregnated with thymolsulphonephthalein solution, and ( c ) a vial of test papers impregnated with dimethylamino-azobenzene solution (Topfer's reagent). The hydrogen ion concentration of a sample of gastric contents is determined by pouring a small portion of the unfiltered material over one end of a test paper. From the table of colors in the accompanying tabulation it is then possible to tell at a glance whether the specimen is hyper, hypo, or of normal acidity. A small quantity of

Knowledge of the chemical reaction that occurs in topical preparations employed for cutaneous diseases is notably deficient. In general, the effect of external treatment depends mainly on the physical properties of the pharmaceutical products. In a paper published recently, 1 a report was made of the results obtained by determining the hydrogen ion concentration of the skin in cases of eczema. Itwas found that in these cases, and especially in the acute ones, the p H was increased—that is, there was a more marked alkaline reaction. We therefore believed that in a rational treatment of the dermatoses it would be valuable to know the reaction of the topical preparations that are used most frequently. A survey revealed that there was a distinct paucity in literature regarding the chemical reactions of cutaneous topical preparations. Previous investigators had determined only the reaction of the watery applications. No attempts had been made to

To the Editor: —In an editorial (The Journal, July 2) in which the work of Chambers and his co-workers (Chambers, R., and Pollack, H.: J. Gen. Physiol . 10 :739, 1927) was discussed and most deservedly praised, it was emphasized that the intracellular hydrogen ion concentration of living cells is remarkably unchanging and uniform except when the cells are injured. Such emphasis may be misleading to those uninformed of previous work in this field of investigation, for it has been clearly demonstrated that such fixity of reaction is not the case, particularly in functionally active secreting cells. In 1924, observations were published (Stieglitz, E. J.: Arch. Int. Med . 33 :483 [April] 1924) clearly describing wide variations in intracellular hydrogen ion concentrations in the secreting renal parenchyma, and it was shown that these variations have distinct physiologic associations. Long previous to this work, Harvey and Bensley ( Biol. Bull . 23 :255, 1912) and

The only pretentious aspect of this book is its title Brain Function and Metabolic Disorders ; in fact, the book is confined to consideration of the neurological effects of changes in hydrogen ion concentration as described in its subtitle. This unassuming monograph is really an authoritative, comprehensive, and critical review of the effects of hydrogen ions and carbon dioxide upon the functioning of neurological tissue from isolated nerve fibers of invertebrates to the central nervous system of man. In the central nervous system there is a further complication in that certain synapses, particularly those in the brain stem reticular formation, are more sensitive to changes in carbon dioxide than others; in addition, changes in blood carbon dioxide concentration alter cerebral blood flow. The author has found it important to insist upon the basic notion that the internal pH of nervous tissue is independent of external hydrogen ion concentration but depends

A single solution that will give a continuous change of color with changes in hydrogen ion concentration over nearly the entire range, from strongly acid to strongly alkaline solutions, may serve a multitude of purposes in the clinical and scientific laboratory. Such a mixture, suggested by Moirs of South Africa in 1917, is marketed by the British Drug House. Great accuracy must not be expected from such an indicator, although differences of p H as low as 0.2 may be distinguished; but for rough approximations or as preliminaries to more exact determinations, it may be found of great value. The following mixture has also been developed for this purpose, as it has a range from p H 1.0 to p H 10.0, with a continuous change of color with change in hydrogen ion concentration: phenolphthalein, 100 mg.; methyl red, 200 mg.; dimethylaminoazobenzene, 300 mg.; bromthymol blue, 400 mg.; thymol blue

INTRODUCTION The pathology of Bichat, more than a century ago, centered about organs and tissues and that of Virchow about cells, while that of today also concerns the contents of later morphologic units. Little is known of the great variety of complex processes and of obscure changes which occur within cells, but it is recognized that the regulation of their hydrogen ion concentration plays an important role in maintaining their normal activity. In contrast to the simplicity of determining the hydrogen ion concentration of the body fluids, it is perhaps impossible to determine it accurately for a part or the whole of living cells. It is a frequent assumption that cells are of the same hydrogen ion concentration as their surrounding medium. That this is not necessarily the case has been shown by Bethe,1Warburg,2Harvey,3and Jacobs4from studies made on sea urchin eggs and plant cells. Jacobs has

The detection of distinguishing structural features that may be relied on to separate the species of amebas, especially of the parasitic amebas in the digestive tract of mammals, is fraught with difficulties. These arise from changes in form in the motile phases due to locomotion, to the extrusion and retraction of pseudopodia, to the presence of cytoplasmic inclusions and to the modifications incident on changes in temperature and in hydrogen ion concentration. For example, a slight increase in acidity, as from p H 7.0 to 5.8, markedly increases the locomotor activity and tends to elongate the pseudopodia. In stained preparations of motile stages, the form of the body and of the pseudopodia is subject to changes due to contraction in smearing and fixation. In the encysted stages, many of these modifications are eliminated, but others arise which disturb the uniformity of structure. Among these are the volume, number, distribution and time

The acne bacillus is a gram-positive, diphtheroid organism found in comedones, in the contents of acne lesions and in seborrheic filaments. In 1893, the bacillus was first noticed by Unna1in smears from comedones, but he did not cultivate it. In the following year, Hodara,2working in Unna's laboratory, succeeded in obtaining slight growth of the organism on agar plates, but was unable to transfer it. In 1897, Sabouraud3isolated it on a special acid glycerin agar by planting the central portion of seborrheic filaments on the surface of slants. Contamination with staphylococci always occurred, but these organisms were disposed of by allowing the cultures to stand several weeks or by heating them for ten hours at 65 C. In 1899, Gilchrist4obtained the organism, often in pure culture, directly from acne nodules by planting the gelatinous contents on an acid glycerin agar. He demonstrated that

To the Editor: —InThe Journal, July 30, appeared a communication from Dr. Edward J. Stieglitz in which he expressed the opinion that the editorial inThe Journal, July 2, commenting on intracellular hydrogen ion concentration of living cells (Chambers, R., and Pollack, H.: J. Gen. Physiol. 10: 739, 1927) is misleading. Dr. Stieglitz cites his own work and that of Harvey and Bensley to show that considerable fluctuation in hydrogen ion concentration may be possible. This problem has been under intensive study in Dr. Chambers' laboratory, and we find that where such changes have been reported we are dealing with one of at least two conditions: The cell when injured becomes acid, and when killed loses its independence from the environment of maintaining its own hydrogen ion concentration. The dye may accumulate in intracellular granules and vacuoles which are secretory and excretory products of protoplasm, and register a color

The application of the principles of physical chemistry to biologic phenomena has elucidated a great many physiologic and pathologic processes and has often led to rational and successful therapy. A noteworthy example of this is the derivation by Henderson from the classic law of mass action of the well known equation which expresses the relation of the bicarbonate and carbonic acid concentration of the blood to the hydrogen ion concentration. In this way was furnished the key to the behavior of the buffers of body fluids under normal and under pathologic conditions. Another illustration is the experimental demonstration that physicochemical laws explain certain phenomena which occur in vitro in a tissue, such as rachitic cartilage, which is bathed in serum containing the slightly soluble salts of calcium, the phosphate and carbonate. Thus the clinical problems of acidosis and alkalosis and certain phases of the complex process of normal and metastatic

It has been established that the anaerobic metabolism in oligemic shock is the product of decreased perfusion through nonvital tissues and is demonstrated by increased blood lactate-pyruvate ratio, and excess lactate as measured by Huckabee.1This is accompanied by a metabolic acidosis. Attempts at preventing this metabolic acidosis have led to the use of vasodilators to increase nonvital tissue perfusion and buffering systems. Neither of these adjuncts attack the biochemical defect which is the anaerobic production of lactic acid and the disassociation of lactic acid to produce the hydrogen ion. Exton and Park2demonstrated that the rate of conversion of lactate to glucose is diminished in perfused livers of adrenalectomized rats, and gluconeogenesis is enhanced when exogenous corticosteroids are instilled in the perfusant. This suggests the possibility that corticosteroid-stimulated gluconeogenesis from lactate may be utilized to decrease the amount of lactate in anaerobic tissue. Furthermore, corticoids in pharmacological

The injection of dextrose parenterally has become a recognized therapeutic measure, notwithstanding the fact that at times its administration is followed by unpleasant reactions. Williams and Swett, 1 in a series of studies on the hydrogen ion concentration of various fluids commonly administered intravenously, found that the P H of a solution of dextrose became acid on autoclaving, and they attributed the untoward reactions to the injection of this fluid. The same authors, in conjunction with Mellon, Slagle and Acree, 2 advocated the addition of buffer solutions to the autoclaved dextrose as a means of maintaining a neutral solution. This method has been widely adopted, and the results following the use of solutions so prepared seem quite satisfactory. However, the preparation of the buffer salts is a laborious and time-consuming task and has been relegated to those commercial laboratories that supply buffer salts with ampules of 50 per cent dextrose

Because intravenous infusion solutions have been criticized as being "acid" solutions, we compared pH and total acidity of several commonly used commercial solutions with solutions prepared in our own laboratory. The pH ranged from 4.2 to 7.1.—a 1,000-fold difference in hydrogen ion concentration. Titratable acidity varied only between 0.063 and 0.363 mEq/liter—a fivefold difference in acid content. Heat-sterilized dextrose solutions had a lower pH and slightly higher titratable acidity than did other solutions. Although pH ranged from 5.4 to 7.0, titratable acidity was similar for all solutions when they were sterilized without heat. Certain commercial solutions had greater than ten times the acid content of other solutions. Excluding commercial solutions in which pH is adjusted, we conclude that pH is far more variable than acid content.

The present work was undertaken to determine the P H of the meconium, as compared with that of the stools of normal breast-fed infants; to follow the transition, in case of any significant difference, from the P H of the meconium to the P H of the stools after breast milk feeding, and to see whether, under similar conditions, large or slight variations occur in the P H . An attempt has been made to show the significance of meconium to the metabolism of the new-born infant. For a long time, it was customary to observe simply whether the stools were acid or alkaline to litmus and other indicators. Breast milk feeding gave acid stools; cow's milk modifications resulted in alkaline stools. Langstein 1 determined the acidity of a number of infants' stools in terms of normal acid or base required for neutralization. The results varied with the indicators used. Titration

The chemical and physical constitution of the cerebrospinal fluid does not furnish any basis for the conception that the reaction of this fluid might be different from that of the blood. The inorganic components, 1 chiefly chlorids, phosphates, and carbonates, occur in almost identical amounts in both the blood serum and cerebrospinal fluid. The organic constituents 2 vary considerably, but are generally less in amount than similar substances in the blood, and the presence of amphoteric amino-acids and proteins would tend to preserve a neutral reaction in this fluid, as emphasized by Robertson. 3 The quantities of these substances, however, do not indicate their influence on the reaction of the fluids in which they occur. Their molecular concentration and ionic dissociation are the important factors. Even the physical properties are approximately the same in both the spinal fluid and blood serum. As measured by cryoscopy, the blood serum

About ten years ago Best and McHenry discovered that certain organs of the dog, particularly the gastrointestinal tract and the kidney, contained a substance capable of inactivating histamine. 1 To this material they attributed the characteristics of an enzyme, and they suggested the name histaminase. They found that it could be prepared in the form of a stable powder so that chemical and physical properties were more readily studied. These investigators found that certain optimum conditions were essential for the maximum activity of histaminase, namely, incubation with the substrate for twenty-four hours at 37 C. and a hydrogen ion concentration of 7.2. Under these conditions detectable destruction of histamine occurred only after an incubation period of four hours. Best and McHenry also defined a convenient unit of histaminase as the amount necessary to destroy 1 mg. of histamine under the aforementioned optimum conditions. Using a commercial preparation, 2 Felix 3 was

Wolf and Crowder's "programmed learning" text, An Introduction to Body Fluid Metabolism , was marketed in the spring of 1964. "Programmed learning," and its place in medical education, remain insecure although popularity is growing. Its efficacy has not yet been evaluated by controlled educational experiment. The text was read by a home-trained rapid-reader in eight hours but accompanied by a disturbing number of errors. Three first-rate medical students read the text in 12-14 hours making about the same number of mistakes. Cold comfort! Chapter headings include water and fat relationships, water content, compartments and spaces, nomenclature of solutions, osmotic pressure relationships, water balance, clearance concepts, renal function, water excretion and diuresis and isorrhea, whatever that is. The book is arranged in ten lessons; notably absent is the treatment of hydrogen ion concepts and regulation. The book is well-written with good sentence structure and, with a few exceptions, communicates ideas and concepts

Autolysis is one of the many pathologic processes which may occur in the retina. It may be defined as the self-digestion of the tissue which results from the action of enzymes that are naturally present in the tissue. Autolysis is inhibited in alkaline tissue, but in acid tissue its rate is determined by the hydrogen ion concentration of the tissue. If the autolytic changes become irreversible, the end-result is atrophy. The term autolysis does not include the effect which is produced on the retina by the action of enzymes from nonretinal tissue, leukocytes, bacteria or fluids entering the retinal tissue. The effect on the tissue resulting from the action of extracellular enzymes is called heterolysis. The autolysis of the retina has been only incompletely studied. Galante 1 followed the rate of formation of amino-acid during proteolysis of the tissues of the eye by means of the formaldehyde titration

Dr. Filley, who states that his book is for "medical students before and after graduation," presents clearly his own approach to acid-base and blood gas problems, and suitably accents most concepts by simple illustrations. Since physicians and medical students have an intrinsic fear of numbers and of technical terminology, Dr. Filley utilizes terminology understood by all and feared by none; ie, "the escaping tendency of carbonic acid, the bicarbonate reserve, the intensity of acidity." He stresses the concept that the efficacy of the carbon dioxide transport system is due to the transfer of hydrogen ion from one system to another. In addition to a concise overview of the field, the text is notable for its section on "conclusions," which guides the student on what to order and what to consider in interpreting blood gases. A large appendix clarifies confusing terminology and eases the student through the concept of base excess.

In this fourth edition, Black has adhered to his original tenet of brevity and generality with commendable tenacity. Furthermore, the clarity and conciseness with which he discusses fluid balance leaves one with the feeling that the 150 pages he used were precisely sufficient to cover the waterfront. The book is packed with protein and sprinkled with wit, but it is easily digestible. The chapter on "hydrion," or hydrogen ion, is, I judge, new to this edition. The Bronsted-Lowry nomenclature is used throughout, but the chapter is more than just a rewording of an old concept. The emphasis has been changed in keeping with the title. The result is a succinct, understandable, and up-to-date treatment of a subject that has been improperly presented for too long a time. The book should be of great value to the student interested in a comprehensive introduction to problems of fluid and electrolytes; to the

This 78-page paperback on hydrogen ion regulation is well bound and tolerates usage well. There are 26 succinct chapters, some only two or three pages long, written in splendid scientific English, rendering comprehension of the movements of hydrogen ion in the body exceedingly clear. There are many such books available on the market today, but this reviewer has seen none as well written and free of verbosity as this one. Beginning with the problem of nomenclature, proceeding through respiratory, renal, and buffer regulation of hydrogen ion, the author proceeds to the application of clinical circumstances, though not in terms of specific clinical cases. There are some minor objectionable points. Sodium is given credit for regulating osmotic pressure; the chemical activity of water accounts for osmotic pressure. Hydrogen ion regulation seems a better term than acid-base regulation. The so-called paradox of excretion of an acid urine in potassium-depleted patients continues to

Ionization in solution or electrolytic dissociation is a conception of the late nineteenth century that promises results of increasing importance, not only in the fields of pure physics and chemistry but also in industry and biology as well. Since Arrhenius first presented his electrolytic dissociation theory, there has developed about the concept "acidity" a new nomenclature, with new and interesting procedures for the determination of degrees of acidity. Since this paper concerns itself with the application of these new procedures and names, new at least to the special field of dermatology, it seems necessary to explain the several principles underlying the observations hereinafter recorded. Many solvents, especially water, effect, on solution of many substances (the solutes), a splitting of these substances into electrically charged units called ions. Thus, hydrogen chlorid [HC1] in dilute solution is H + — Cl -; for, when hydrogen chlorid dissociates, the hydrogen gives up a negative charge

Recently a quantitative study was made of the hydrogen sulphide content of some of the lotions used in the topical treatment of acne. This research gave reason to believe that the old lotio sulphurata held fewer sulphide ions than the new. In other words, the effectiveness of lotio sulphurata depends on the presence of sulphide ions, which in theory was conceded to depend on the hydrogen ion concentration of the solution. From these experiments, it was thought that a knowledge of the hydrogen ion concentration would be of considerable aid in the preparation and storage of lotions employed in the topical treatment of acne. Prof. Abraham Taub of the College of Pharmacy of Columbia University did these determinations. He used the quinhydrone electrode potentiometer. The possibility of error with this type of electrode is conceded, but such error is held to be constant for the tests reported in this article.

The hydrogen ion concentration of the skin has been the subject of a number of studies in recent years. On the basis of regional and pathologic variations in the acidity of the cutaneous surface, certain hypotheses concerning the physiologic significance of these have been developed, and attempts to treat certain dermatoses by changing the surface acidity have been made. In the present study, in which a simple and rather different method has been used, we have attempted (1) to obtain further data concerning the variation in the hydrogen ion concentration of the surface of the skin, (2) to determine accurately the effect of the skin on the p h of acid and alkaline solutions coming in contact with it, (3) to determine the threshold of irritability of normal and scarified skin, so far as the hydrogen ion concentration of the contact substance is concerned, and (4) to check the clinical

In a previous communication, 1 it has been shown that the cardiac output of the dog's heart is increased during an ether anesthetic. This change was associated with an increase in the hydrogen ion concentration of the blood. Boothby 2 first suggested that the H-ion concentration regulated the cardiac output of the heart. Douglas and Haldane 3 reached the same conclusion from studies on man. A similar view has been expressed by Means. 4 Harrison, Wilson and Blalock 5 found that the production of respiratory obstruction and the injection of acid were associated with an increase in the H-ion concentration of the blood and an increase in the cardiac output, and that the injection of alkali resulted in the reversal of these two functions. They concluded that the changes in the cardiac output of the heart were dependent on alterations in the H-ion concentration of the blood. The object of

In a report on lead poisoning published in 1925, Aub, Fairhall, Minot and Reznikoff 1 drew the following conclusions: Most of the lead absorbed into the body is deposited in the skeleton, where its behavior resembles calcium in many respects. Stored lead is apparently harmless, but the skeletal deposits may be released by a slight change toward either the acid or the alkaline side of the usual hydrogen ion concentration of the organism. They proved that abnormalities of diet or certain pathologic conditions bring about such changes and so release the rather unstable deposits of lead, flooding the organism with soluble lead. The mechanism of acute toxic attacks which occur in lead poisoning as a result of infections or of acidosis is at once apparent. This study of lead in relation to multiple sclerosis was inaugurated in November, 1932, by the discovery made by one of us (W. C.) that