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he Influence of Hemorff 
 Unon Metalioli?;! 
 
 rhiiip Boi Hawk. 
 
 
The Influence of Hemorrhage 
 Upon Metabolism. 
 
 BY 
 
 Philip Bovier Hawk. 
 
 Submitted in partial fulfilment of the requirements for the degree 
 
 of Doctor of Philosophy in the Faculty of Pure 
 
 Science, Columbia University. 
 
 1905. 
 
 The Chemical Publishing Co., 
 
 Elaston, Pa. 
 
a? 17 
 
CONTENTS. 
 
 PAGE. 
 
 A. Historical Introduction. 5 
 
 B. First Series of Experiments 16 
 
 I. Description 16 
 
 1 . The Purpose and Plan of the Investigation 16 
 
 2. Articles of Diet. 17 
 
 3. Preparation of the Anesthetic 19 
 
 4. Subject 19 
 
 5. Methods of Analysis 19 
 
 II. Preliminary Experiment 20 
 
 III. First Hemorrhage 21 
 
 1 . Operative Procedure 21 
 
 2. Observations 23 
 
 3. Discussion 24 
 
 IV. Control Experiments 25 
 
 1. Influence of Anaesthesia 25 
 
 (a). Observations 26 
 
 ( b) . Discussion 28 
 
 2. Influence of Anaesthesia-operation 29 
 
 (a). Observations...' 30 
 
 (b). Discussion 31 
 
 V. vSecond Hemorrhage. 32 
 
 1 . Observations 32 
 
 2. Discussion 33 
 
 VI. Third Hemorrhage 34 
 
 1 . Observations 35 
 
 2. Discussion 36 
 
 VII. Fourth Hemorrhage 38 
 
 I . Observations and Discussion 39 
 
 VIII. F'ifth Hemorrhage 40 
 
 I . Post Mortem Examination 41 
 
 C. Second Series of Experiments. i 42 
 
 I. Preliminary Experiment 42 
 
 II. Influence of Anaesthesia-operation 42 
 
 III. Influence of Hemorrhage. 44 
 
 D. Alterations in the Specific Gravity 45 
 
 E. Relation Between Total Nitrogen and Volume of the Urine 46 
 
 F. Discussion of Results. .... 47 
 
 G. Conclusions 49 
 
 H. Bibliography 50 
 
 I . Biographical 53 
 
 J. Publications 54 
 
 374375 
 
A.— HISTORICAL INTRODUCTION. 
 
 The practice of venesection, or blood-letting, is as old almost as 
 tlie practice of medicine. History informs us that even as early 
 as the time of Galen the employment of venesection was quite 
 general. The withdrawal of blood was for many centuries 
 looked upon as the most satisfactory remedy possessed by the 
 practitioner, and indeed in a great number of diseases was con- 
 sidered to be the only means of preserving life. The mere ques- 
 tion of the withdrawal of blood was never debated, the amount 
 being the only question to decide, as it was almost universally 
 taken for granted that some blood must be drawn. Galen himself 
 employed blood-letting to the point of syncope, and his principal 
 treatment for fever was blood-letting and the application of cold. 
 So great was the faith in the "Universal treatment," as it came 
 to be called, that its domain of influence was expanded and came 
 to include the realms of religion and superstition. The desire to 
 do evil was supposedly dissipated by its magic ; and, if the vene- 
 section were carried out at the proper time, astrologically, such de- 
 sirable possessions as a retentive memory, a strong mind, etc., 
 were said to be acquired. The withdrawal of blood was accom- 
 plished by means of the leech, the cupping instrument, or by di- 
 rect withdrawal from an opened vein (venesection), the individ- 
 ual conditions as well as the amount of blood to be drawn gen- 
 erally determining the metjiod. 
 
 The universal practice of blood-letting has, however, long since 
 passed, and although there are today certain diseased conditions 
 in which loss of blood is supposed to possess curative power, the 
 custom of blood-letting is practiced in much narrower limits than 
 in the early centuries of its use. In the words of an eminent in- 
 vestigator "The waste of blood of a not very distant past is, let us 
 hope, gone forever." To-day the greatest losses of blood with 
 which we have to deal occur either as the result of accident, in 
 major surgical operations, or in a few maladies, such as gastric 
 ulcer, which are accompanied by internal bleeding. 
 
 The present investigation was undertaken with the accidental 
 hemorrahge and the loss of blood incident to surgical procedure 
 
especially in mind. The variations in the metabolic activity as in- 
 dicated by the composition of the urine was the principal point of 
 observation, and the changes in the chemical composition of the 
 blood was a secondary consideration. No study of the form ele- 
 ments of the blood was made. 
 
 It is evident that a loss of blood from any organism will cause 
 an alteration in the physical and chemical composition of the resi- 
 dual portion. It is further well understood that certain diseases 
 are accompanied by changes in the blood. The nature of those 
 alterations or changes (whether due directly to the reduction of 
 the total blood or whether arising from an internal pathalogical 
 state) and their effect upon the metabolic functions of the organ- 
 ism are questions of great interest and importance. It was but 
 natural that a method of treatment holding undisputed sway for 
 so many hundred years, as did that of blood-letting, should, with 
 the growth of the spirit of investigation, be made the subject of 
 many scientific observations. As would naturally follow, many of 
 these observations were upon human subjects, while lower ani- 
 mals were the subject of other investigations. Observations of 
 the first order were obviously almost entirely confined to diseased 
 subjects. The field covered by investigations upon the effect of 
 loss of blood as well as upon the influence of blood degeneration 
 through pathalogical agencies is a field of great breadth, and 
 while investigations of the second type cannot strictly be classed 
 with our investigation, yet for a more complete survey of the en- 
 tire subject we have included observations of that nature in our 
 literary review. 
 
 The work of previous investigators may be divided into three 
 general classes and corresponding sub-groups : 
 
 Class I. Observations upon the influence of the loss of blood 
 as shown by direct experimentation upon lower animals. 
 
 1. Variations in the metabolic activities of the organism as 
 shown by (a) Examination of the urine and determina- 
 tion of the body weight. 
 
 (b) Respiratory exchange. 
 
 2. Alterations in the number of red corpuscles or percentage 
 of haemoglobin. 
 
 3. Change in the number of leucocytes. 
 
4- Influence on respiration, nervous system, and body tem- 
 perature. 
 5. Changes in the fibrin content, specific gravity, coagulation 
 rate, and in tlie composition of the blood, serum, gases, etc. 
 Class II. Observations upon the alterations in metabolic activ- 
 ity and in blood composition resulting, in human subjects, 
 from internal pathalogical conditions, (anaemia, leukaemia, 
 chlorosis, leucocytosis, etc). 
 Class III. Observations upon the influence of the loss of blood 
 occurring pathalogically in human subjects, (gastric ulcer, 
 duodenal ulcer, post-partum hemorrhage). 
 Our own investigation would be classified under groups i (a) 
 and 5 of the first class. 
 
 Investigations having for their purpose the study of variations 
 in the metabolic activities of the organism accompanying hemor- 
 rhage as shown by extensive urine analyses are comparatively few 
 in number. The work of Bauer^ is probably the most frequently 
 quoted in this connection. His observations were upon well-nour- 
 ished and fasting dogs, a single experiment being made upon 
 each. A sheep hound weighing about 20kg. was the subject of 
 the first form of experiment. This animal was fed a uniform 
 daily diet until nitrogen equilibrium was attained, and was then 
 subjected to a hemorrhage of 350-400 cc. of blood. Following 
 this hemorrhage the variation in the proteid metabolism as shown 
 by the nitrogen content of the urine was noted. The dog drank 
 water "ad libitum." The urine of the preliminary period showed 
 an average daily content of 16.6 grams of nitrogen. The hemor- 
 rhage caused an increased output of nitrogen and the daily aver- 
 age for the three days following was 20 grams, while the average 
 for a period of five days was 18.9 grams. Thus the immediate 
 eflfect of a loss of blood aggregating about 2% of the body weight 
 of the animal was an increase of 10.2 grams of nitrogen in three 
 days, and an increase of 11.5 grams in five days. From this point 
 the rate of excretion of nitrogen fell rapidly, being slightly below 
 normal at the end of the experiment. The volume of the urine 
 increased somewhat after blood-letting, probably due to uncon- 
 trolled water ingestion, while the animal also gained slightly in 
 body weight. 
 
8 
 
 Experiments on a fasting dog were also followed by a rise in 
 the urine volume and in the nitrogen content. From the data the 
 author concluded that the influence of the loss of blood was much 
 greater in the well-nourished organism than in the organism in 
 the fasting condition. 
 
 As a "check" upon his results Bauer made three control experi- 
 ments in which the customary operative steps were followed but 
 no blood was drawn. These were on well-nourished dogs in a 
 condition of nitrogen equilibrium and from them he concluded 
 that the operation had no influence upon the execution of nitro- 
 gen by the urine. 
 
 Experiments along lines similar to those pursued by Bauer have 
 been made by Jiirgensen,- Maltschewsky,^ and Ascoli and 
 Draghi.* The general conclusions of Jiirgensen are the same as 
 those of Bauer. He states that the increase in nitrogen in the case 
 of the well-nourished animals is absolutely greater after loss of 
 blood than in fasting animals, but that it is smaller in comparison 
 with the quantity of proteid available. Jiirgensen's experiments 
 are interesting but his failure to give his data for the control ex- 
 periments upon dogs in a condition of nitrogen equilibrium is to 
 be regretted. 
 
 Fraenkel'^ takes exception to the conclusions of Bauer and Jiir- 
 gensen, and claims that the increased proteid decomposition fol- 
 lows the diminished oxygen supply, due to the lowering of the 
 oxygen carrying power of the blood. This theory is not approved 
 by v. Noorden,** Jiirgensen and others. 
 
 Ascoli and Draghi, in observations upon bmman subjects and 
 upon dogs, came to the conclusion that there was no increased 
 nitrogen elimination following the loss of blood. The non-occur- 
 ence of a rise in nitrogen after hemorrhage is based on the theory 
 that the organism contains a certain reserve supply of blood which 
 may be removed without detriment to the body (the "luxus blood" 
 of Maragliano). 
 
 Observations upon the variation in the respiratory exchange, 
 after hemorrhage, have been made by Bauer, Lukjanow,'^ and 
 Giirber.^ Experiments by Bauer in a respiration apparatus of the 
 Voit model, using fasting dogs as subjects, showed the excretion 
 of COo to be practically unchanged in the 12 hours following 
 
hemorrhage, while the oxygen absorption decreased about 15%. 
 Forty-eight hours later the amounts of both CO- excreted and O 
 absorbed had decreased greatly. In well-nourished dogs there 
 was an increase of 4% in CO^ excreted during the first 12 hours 
 after hemorrhage and an increase of 22^0 in the oxygen absorbed. 
 After 24 hours the values for both CO^ and O sank appreciably. 
 Bauer concluded that the decrease in CO^ excretion after hemor- 
 rhage showed that the destruction of fat had decreased and point- 
 ed to the storing of fat in anaemic and chlorotic patients as veri- 
 fication. 
 
 GiJrber, as a result of observations on well-nourished rabbits, 
 drew the conclusion that the respiratory exchange w^as eiit'ected 
 very little if any after hemorrhage, and that the variation when 
 observed was in the form of an increase. Lukjanovv' investigated 
 the eftect of oxygen inhalation after hemorrhage. Two experi- 
 ments were made on rats and one on a dog. In every case one 
 hour after the hemorrhage the absorption of oxygen was in- 
 creased. 
 
 Among the numerous observations upon the alteration in the 
 number of red corpuscles or the percentage of haemoglobin fol- 
 lowing hemorrhage those of Autokonenko,'' Baumann,"' Luzet,^^ 
 X'ulpain.'- Hiinerfauth.^" Buntzen'* and v. Lesser" are of par- 
 ticular interest. All of the experiments of Autokonenko were 
 made on dogs. His animals w-ere always fed a constant diet be- 
 tween 9 and TO A. M. and the operations occurred between 3 and 
 4 P. M. The author concluded that the number of leucocytes be- 
 gan to increase from the first hour after blood-letting, the maxi- 
 mum being reached at the end of the first day. The increase w^as 
 principally in small leucocytes. If a second hemorrhage was in- 
 duced when the leucocytes were still greatly increased a leucocy- 
 tosis more prominent than the first, but of less duration, occurred. 
 A third hemorrhage produced no further increase. Baumann in 
 a series of very complete experiments on dogs observed a general 
 deterioration in the blood and serum following hemorrhage, es- 
 pecially in the former. The quantity of haemoglobin he found to 
 be reduced 21%, the number of red corpuscles 14%, and the spe- 
 cific gravity 1%, The solids, proteids and total nitrogen of the 
 blood and serum underwent a decrease of about 12% each. The 
 
lO 
 
 leucocytes were increased about 40%. Serum albumin was found 
 to have been greatly increased at the expense of the serum globu- 
 lin. Fibrin was increased and the coagulation rate shortened 
 while the ash remained unchanged. 
 
 Luzet, as the result of investigations on pigeons, found a de- 
 crease in red corpuscles and haemoglobin and an accompanying 
 leucocytosis. The work is of interest in indicating the similarity 
 of post-hemorrhagic effects in man, lower animals and birds. The 
 conclusions of Buntzen from experiments on dogs are interest- 
 ing: — I. Red corpuscles decreased 5% in 10 minutes. 2. Dia- 
 meter of red corpuscles decreased. 3. No increase in leucocytes. 
 4. Volume of blood restored in a few hours after a hemorrhage 
 of 1-2% body weight. Loss of over 4% took over 24 hrs. to re- 
 store. 5. Red corpuscles normal, after hemorrhage of 1.1% to- 
 4.4% of body weight, in 7 to 34 days. 6. Percentage of solids in 
 the serum decreased from 11.5% to 10.1% in successive draw- 
 ings. 
 
 The failure of the author to observe any increase in leucocytes 
 after hemorrhage is contradictory to nearly every authentic obser- 
 vation. 
 
 Hiinerfauth investigated the influence of "traumatic anaemia" 
 in frogs, rabbits and dogs. The observations on frogs show that 
 in an hour after a hemorrhage of less than 2% body weight a 
 very noticeable decrease in the number of red cells was seen, and 
 a lesser decrease in amount of haemoglobin. A strong leuco- 
 cytosis also existed. Regeneration was shown to be slow in the 
 frog. Regeneration in the frog was also studied by Vulpain, who 
 found it to be much slower than in man and the lower animals. 
 Six weeks after the hemorrhage the cells in the marrow destined 
 to form new red corpuscles were small and totally colorless. 
 
 Investigations of more or less value have been carried out by 
 Lyon,^'' Bizzozero and Salvioli,^^ Monassein,^^ Tschudnowsky,^^ 
 Rieder,^" and Hayem.-^ Bizzozero and Salvipli claim that a hem- 
 orrhage of 1% body weight produced a decrease of 11.14% ii^ the 
 haemoglobin and that this ratio holds generally. In a series of 
 observations on a large number of different subjects (leech, 
 mouse, mole, rabbit, hare, hen and pigeon) Monassein found the 
 
II 
 
 red corpuscles to increase in size after hemorrhage. He explain- 
 ed this as being due to an imbibition of the diluted plasma. 
 
 Investigations made upon animals, in which the change in 
 the number of leucocytes following hemorrhage was ob- 
 served, have been promoted by Hayem, Rieder, Himmelj- 
 sterna."-- Tschoudnowsky, Virchow,-^ Limbeck,-* and Molas- 
 sez.-"' Hayem observed a leucocytosis which he ascribes as 
 arising rather from the inflammatory process than from 
 the loss of blood. Limbeck observed a similar leuco- 
 cytosis. and also found an increase in leucocytes following 
 simple incision, when no blood was drawn and the wound healed 
 with no suppuration. Tschoudnowsky found such a rapid leuco- 
 cytosis that the ratio of leutocytes to red corpuscles was as high 
 as 1 :6o. \"irchow explained post-hemorrhagic leucocytosis as be- 
 ing caused by the property the leucocytes have of clinging to the 
 walls of the vessels when the other constituents are drawn oft. In 
 a series of experiments on dogs Rieder.observed a variable leuco- 
 cytosis after hemorrhage. In one case the number of leucocytes 
 was double the normal on the third day, while in another case it 
 was very feeble at that period. Himmelj sterna reported the 
 unique observation of a decrease in leucocytes on the first day 
 after hemorrhage. 
 
 Henle,-'' Remak.-' W'oltersom,-* Conheim,'^ Massart and Bor- 
 det,-'-' Gabritschewsky,-''^ Afanasiew,^- Leber,-''^ Roemer,^* Buch- 
 ner,-"-'' Escherich,-'*' and Foster "' all report the observation of a 
 leucocytosis of greater or lesser intensity following hemorrhage. 
 Afanasiew reports an increase in the leucocytes amounting to 15 
 times the normal. 
 
 The influence of the loss of blood upon the nervous system has 
 been investigated by Leichtenstern,^^ Kussmaul and Tenner, ^^ 
 Naunyn and Quinke,*" and Gies."*^ Leichtenstern observed that 
 immediately after hemorrhage a temporary decrease in the num- 
 ber and depth of the respirations took place. After severe hemor- 
 rhages the frer|uency of respiration ultimately increased. Kuss- 
 maul and Tenner observed convulsions due to a decrease in the 
 aterial blr)od supply of the brain. These convulsions did not occur 
 in slow hemorrhages. The authors showed the central origin of 
 the convuslions to be in the region l)ehind the optic lobes. This 
 
12 
 
 investigation of Kussmaul and Tenner, as well as others by Jolly ' 
 and Bonders, has shown that the statement that the loss of blood 
 does not alter the blood supply to the brain is without foundation. 
 In experiments on toads, frogs, rabbits and dogs Gies induced 
 anaemia of the brain by means of perfusing solutions. He ob- 
 served that rapidly induced anaemia was followed by convulsions, 
 whereas an anaemia brought about gradually was unaccompanied 
 by any such phenomena. 
 
 Experiments upon the variations in blood pressure after hem- 
 orrhage have been made by Worm-MuUer,*- Volkmann,*'' Naw- 
 rotzky,"* Magendie,*'^ Nawlichen**^ and Hayem,*' while observa- 
 tions upon the variations in body temperature after hemorrhage 
 have been made by Marshall Hall,** Traube,*^ Spielman,-''*' Frese 
 and Charaszewski,^^ and Wunderlich.^- 
 
 The fibrin content of the blood has been made the subject of 
 investigations by Biicke,^'^ Nasse,''* Jiirgensen,^^ and Mayer.^** 
 Briicke found a decrease in fibrin proportional to the amount of 
 depletion. His observations were made upon several samples, 
 drawn consecutively. He attributed the decrease in fibrin to the 
 fact that transuding fluids had diluted the blood. Nasse, by draw- 
 ing the blood at intervals of 48 hours, showed an increase in fibrin, 
 and Jiirgensen by similar procedure on fasting dogs, confirmed 
 this observation. Baumann and Mayer found the same. 
 
 The rate of coagulation has been studied by Vierordt," 
 Briicke,'^^ Nasse,^^ and Baumann.*"' Vierordt and Briicke 
 reached the conclusion that in uninterrupted hemorrhages the 
 coagulation rate gradually shortened. Nasse, by drawing his 
 samples at intervals of 24 hovirs, found the coagulation rate to 
 lengthen. Baumann after an interval of a week found the coag- 
 vilation rate shortened. Probably much depends upon the individ- 
 ual organism and the amount of blood drawn. 
 
 Observations upon the specific gravity of the blood have been 
 made by Sherrington and Copeman,"^ Otto,"- Jones,*'-^ Bizzozero 
 and Salvioli,"* Woltersom,*''* and Baumann.''" In every case the 
 specific gravity was observed to fall after loss of blood. 
 
 Variations in body weight after hemorrhage have been noted 
 by TolmatschefT,"^ Bauer,"'* Jiirgensen,"'' Lister,'^" and Hiiner- 
 fauth.'^^ An increase was generally observed. Tolmatschefif in- 
 
13 
 
 duced six hemorrhages upon one dog in a period of 70 days and 
 observed an increase in body weight up to the fifth hemorrhage, 
 when a decrease occurred. His hemorrhages were from 1.1% to 
 2.8% of the body weight. In experiments already quoted upon 
 nitrogen metabolism Bauer and Jiirgensen observed a slight rise 
 in body weight. Lister mentions the fattening of calves in Eng- 
 land through frequent blood-letting. Hiinerfauth observed in 
 dogs an increase in weight during the week after hemorrhage. 
 
 The rate of the urine flow after hemorrhage has been investi- 
 gated by Frederick Goll.'- Dogs narcotized by opium were used 
 as subjects. Ureter cannulas were inserted and the normal flow 
 of urine was observed for one-half hour when a hemorrhage was 
 induced and the variations in the flow of urine and in blood pres- 
 sure were recorded. In every case the urine flow was greatly de- 
 creased after hemorrhage, and this decrease was accompanied by 
 a fall in blood pressure. The author concluded from his obser- 
 vations that arterial pressure had an important influence upon the 
 excretion of urine. Jiirgensen observed an increased urine flow 
 after hemorrhage, especially in the case of fasting dogs. He of- 
 fered two suggestions for the increased volume: — i. Extra water 
 needed to remove the accumulated urea. 2. Tissue fluids contain 
 less proteid and more water than the blood. By transudation 
 after hemorrhage the blood would contain more water than nor- 
 mal if it were not removed in the urine. 
 
 "Fatal hemorrhage" has been the topic of investigations by 
 Schramm, v. Kireefif,'^ Hayem,'^ and Noll.'" Schramm placed 
 the limit as varying between 3.91% — 5-77% of the body weight, 
 while Hayem placed the value at from 4.34% — 5-55% depending 
 on the individual, v. Kireeff ascertained that a loss of between 
 56% and 95% of the total blood was necessary to cause death, 
 whereas Xoll foimd that a hemorrhage of -A, the total blood was 
 fatal. 
 
 Infusion experiments of various forms have been promoted by 
 Kronecker," Ott.''* Maydl,''* Schramm,'"' and Prevost and 
 Dumas. ^' 
 
 The influence of iron feeding u])on blood regeneration follow- 
 ing hemorrhage has been investigated by Skvortsov,"^ and De- 
 bierre and Ij'nassier.'*'' The results of both observations showed 
 
14 
 
 an increase in haemglobin and red corpuscles after iron feeding 
 was begun. An increase in lymph formation was obtained by 
 Emminghaus^* after hemorrhage. 
 
 Proteid decomposition in patients suffering from various mala- 
 dies has been studied by Fleischer and Penzoldt,^^ Lipmann- 
 Wulf,**' Ketcher,*' v. Moraczewski,*** and Eichorst.*' The obser- 
 vations of Fleischer and Penzoldt were concerned with conditions 
 pertaining in Leukaemia patients. Normal persons were used as 
 controls and were fed the same diet as the patients. The urine 
 was analyzed for nitrogen, sulphur, phosphorus and uric acid. 
 The data showed that all four of these constituents were increased 
 in leukaemia. Lipmann-Wulf in three cases of chlorosis observed 
 a gain of nitrogen to the body varying from 0.06 to 0.71 gram 
 per day. However, the nitrogen content of the food was deter- 
 mined by calculation, and the feces was not analyzed. Eichorst, 
 on the contrary, claims to have observed an increased proteid de- 
 composition in pernicious anaemia. He simply makes his deduct- 
 ions from general indications as no food analyses were made. 
 
 The effect of the inhalation of oxygen in diseases where a path- 
 alogical blood condition maintains has been investigated by Bur- 
 zhinski,^° Sticker,^^ Albrecht,^- and Hayem.^^ The observations 
 of Burzhinski show an increased nitrogen metabolism in leukae- 
 mia patients. Uric acid in relation to urea was also increased. 
 Studies by Aibrecht on anaemic children who inhaled thirty litres 
 of oxygen daily showed increased respiration, pulse, body tem- 
 perature and weight. The red corpuscles were increased in di- 
 rect ratio to the amount of oxygen inhaled and the haemoglobin 
 value was also raised. 
 
 Post-hemorrhagic observations of leucocytes have been made 
 by Rieder,''* Hayem,'^'' Samuel,'"' and King.^^ Rieder observed 
 that the leucocytosis following hemorrhage in man did not differ 
 from other forms of leucocytosis. He found nucleated red cor- 
 puscles and a decrease in haemoglobin. Hayem failed to observe 
 any post-hemorrhagic leucocytosis in human subjects. The red 
 corpuscles and haemoglobin were decreased. Samuel observed 
 that the number of the leucocytes was increased after hemor- 
 rhage, due to the large number which were brought by the lymph. 
 
 Post-operative leucocytosis was observed in several instances 
 
 i 
 
by King-. The operations were of various kinds of the major 
 order. The maximum leticocytosis in the majority of cases oc- 
 curred within twelve hours after the operation and was very 
 transient. The author's observation of leucocytosis following 
 operative procedure agrees with those of ]\Iolassez, and Hayem. 
 These latter investigators however were inclined to believe the 
 leucocytosis was due to suppuration or inflammation, whereas no 
 such condition was present in King's experiments. 
 
 Mosler,'-'* Lowit,^'' and Miiller^"" have observed conditions in 
 leukaemia. Low it claimed that the large nimiber of leucocytes in 
 the blood in leukaemia was not due to increased production of leu- 
 cocytes but to a lessening of the formation of polynuclear cells 
 from the mononuclear, as well as to the diminution in the destruc- 
 tion of pol\nuclear cells. Miiller believed the increase in leuco- 
 cytes was due to increased cell proliferation. 
 
 The observations upon the influence of the loss of blood occur- 
 ring pathalogically in human subjects are comparatively few in 
 number. Such losses would ordinarily occur from accident, in 
 rupture of aneurism, in post-partum hemorrhage, or in cases of 
 ulcer of the stomach or duodenum. Osler"^ mentions an instance 
 where /JX pounds (3375 grams) of blood was shed into the 
 pleura from the rupture of an aneurism. In a case of hemateme- 
 sis the same authority mentions that a loss of 10 pounds (4500 
 grams) in one week was followed by recovery. The author states 
 that even after very severe hemorrhages of this order, the num- 
 ber of red corpuscles is not reduced so greatly as in forms of 
 idiopathic of pernicious anaemia. Thus in the above instance 
 after a week of bleeding the red corpuscle count was as high as 
 1,390,000 per cubic millimetre. Regeneration goes on rapidly and 
 sometimes the blood is normal as regards volume and content of 
 salts and proteid constituents, in a week or ten days. This regen- 
 eration may, however, take weeks or even months, Osier says, be- 
 fore the corpuscles reach the normal standard. The haemoglobin 
 is restored more slowly than the corpuscles, and there is a mod- 
 erate leucocytosis which diminishes during recovery. 
 
 Nitrogen metabolism during gastric ulcer was studied by v. 
 Noorden,'"^ Xeusser,'"'* and Kalisch.'"^ v. Noorden observed in 
 two cases, where the loss of blood was large, that no considerable 
 
i6 
 
 increase was noted in the nitrogen elimination, either on the day 
 of the loss of blood or on the following days. The patients took 
 no food and the nitrogen output was from 6.2 to 8 grams per day, 
 an amount which was about normal for the organisms during 
 inanition. From this the author was inclined to doubt whether 
 the increase in nitrogen observed by Bauer, Jiirgensen and others 
 w^ould hold in the case of man. 
 
 B.— FIRST SERIES OF EXPERIMENTS. 
 
 I. DESCRIPTION. 
 
 I. The Purpose and Plan of the Investigation. — The purpose of 
 this investigation was to study, in dogs, the effect of external 
 hemorrhage upon the general metabolic processes of the body, 
 particular attention being paid to the changes occurring in the 
 volume of the urine and in the course of the nitrogen, sulphur and 
 phosphorus output. It was also proposed to study the variation in 
 the chemical composition of the blood following hemorrhage. 
 Alterations in body weight were also recorded. It was deter- 
 mined to use one subject for a series of experiments and to study 
 the influence of repeated hemorrhages extending through a long 
 period of time, and later to check these results upon a second 
 animal. 
 
 After the first dog was brought to a condition of nitrogen equi- 
 librium by means of a preliminary experiment, the initial hemor- 
 rhage was instituted. Following this, after the dog. was again at 
 nitrogen equilibrium came the control experiments. These were 
 followed by four more hemorrhages of varying intensities and 
 separated from one another by periods of different lengths. The 
 first, second, third and fourth hemorrhages were made with the 
 animal practically in nitrogen equilibrium, w^hereas in the case of 
 the fifth hemorrhage no attempt in this direction was made. We 
 fully appreciate that at the time of this last hemorrhage the or- 
 ganism was somewhat abnormal and that therefore the results are 
 
I? 
 
 not strictly comparable with those of the earlier hemorrhages. 
 However, as long as we were able to get the organism in a condi- 
 tion of nitrogen equilibrium we hold that no great abnormality 
 could obtain, and that therefore we are justified in comparing the 
 data from the first four hemorrhages. 
 
 General data for the first series of experiments are given in 
 Table XII. 
 
 2. Articles of Diet. Beef. — This consisted of lean meat (round 
 steak ) carefully freed, as far as possible mechanically, from all 
 traces of fat and connective tissue. After being finely hashed in 
 a meat chopper the meat was thoroughly pressed in a hand press, 
 carefully mixed and samples taken for analysis. This sampling 
 was done by taking small portions from various parts of the mass 
 during the mixing process and weighing by difference in tubes 
 previously freed from moisture by means of filter paper. After 
 being pressed and mixed the beef was made into small balls and 
 placed in air-tight glass jars. These vessels contained, at most, 
 only enough nieat for two days' use, thus necessitating the open- 
 ing of any single jar but once. 
 
 The meat was prepared in quantity sufficient to last several 
 weeks, and for preservation was placed in the "cold room" where 
 it was frozen, thus insuring uniform composition from day to day. 
 Proof of this uniform composition after the lapse of time was 
 shown by the duplication of analytic results three weeks after the 
 beef had been placed in the jars. We feel that this method serves 
 admirably for the purpose intended. The beef is at all times fresh 
 and palatable and eagerly eaten by the animals under investiga- 
 tion. In any experunents where use is made of fresh meat and 
 where freezing facilities are at the command of the investigator, 
 we highly recommend this method of meat preservation and 
 preparation.' 
 
 Cracker Dust. — Ordinary cracker dust purchased in quantity 
 from a wholesale grocer, thoroughly mixed and placed in large 
 air-tight anatomical jars. 
 
 Lard. — Pure leaf lard and containing nothing of a vegetable 
 nature. 
 
 Bone Ash. — Obtained from a well known firm of wholesale 
 
 ICies : American Journal of Physiology, 1501, V., p. 235. 
 
i8 
 
 chemists. The feces of dogs hving upon a meat diet are ordinar- 
 ily passed in large quantity at intervals of several days and being 
 of a very soft character are extremely unpleasant to deal with. 
 Feces of this order will invariably become distributed over a 
 great portion of the interior of the cage and frequently mix with 
 the urine, thus making impossible accurate deductions regarding 
 the nitrogen content of either the one or the other. In order to 
 cause more regular defecation of feces 'having a more desirable 
 consistenc}' it was determined to feed the animal ten grams of 
 bone ash daily. With this amount of ash in the diet the animal 
 defecated eighty times in eighty-four days or approximately once 
 a day, and with two exceptions the stools were invariably of a 
 hard character and easily removable. 
 
 Water. — Ordinary city water heated to about fifty degrees cen- 
 tigrade. The water was taken at this high temperature in order 
 to offset the low temperature of the frozen beef and at the same 
 time form a tempting" mixture. When added to the solid ingre- 
 dients of the diet this warm water formed a rather thick soup 
 which was decidedly appetizing. The food mixture as finally 
 prepared possessed a temperature of approximately twenty-three 
 degrees centigrade and was always eaten by the dog with great 
 eagerness. 
 
 By referring to Table I, the quantity of each of the articles of 
 diet fed during the various periods may be observed. This diet 
 containing 10.271 grams of nitrogen, was given the beast at 5 
 o'clock every afternoon. It was of course very desirable, from 
 the nature of the investigation, that the subject should ingest the 
 same amount of nitrogen daily the entire experimental period. 
 Therefore, when the original preparation of beef was consumed, 
 enough of the new preparation was fed to give the same amount 
 of nitrogen daily. Thus the different beef preparations were fed 
 as follows : — 
 
 Preparation No. i. — 250 grams daily from Nov. 2 to Dec. 4. 
 
 Preparation No. 2. — 256.4 grams daily from Dec. 5 to Jan. 2. 
 
 Preparation No. 3. — 241 grams daily from Jan. 3 to Jan. 24. 
 
 Apart from the beef the amounts of the constituents of the 
 diet fed daily were unaltered during the entire experimental 
 period of eighty-four days. 
 
19 
 
 3- Preparation of the Anaesthetic. — The ether used in all oper- 
 ations was the purest product obtainable on the market. This 
 presumably chemically pure ether was dehydrated by fused copper 
 sulphate for several days, and after being subjected to a series of 
 three distillations the final product was that used as the anaes- 
 thetic in our operations. 
 
 The chloroform was also the best obtainable and was used as 
 purchased. 
 
 4. Subject. — In all long metabolism experiments upon dogs 
 where so much of the success of the investigation depends upon 
 the subject it is evidently of great importance to secure a dog 
 that will eat his food regularly, be contented in confinement, and 
 possess an amiable disposition. Where the income and outgo of 
 nitrogen are studied it is also desirable to use a short-haired dog, 
 as in the course of a long experiment much nitrogen is lost by 
 way of the hair. In the present instance three beasts were tried 
 before a suitable subject was found. The third animal, however, 
 a very active short-haired dog weighing about 17k. was entierly 
 satisfactory. 
 
 5. Methods of Analysis. — The nitrogen determinations were 
 made by the Kjeldahl method, the preliminary oxidation being ac- 
 coir.plished by sulphuric acid and a small amount of copper sul- 
 phate.^ The chlorine content of the urine was determined by 
 Mohr's- method. Sulphur and phosphorus were determined by 
 the fusion method."' The specific gravity of the blood and urine 
 was determined by an urinometer. 
 
 The analyses in every instaiKe were made in duplicate. 
 
 The analytic results were further controlled by the preparation 
 and analysis of composite urine samples for each experimental 
 period. In Table XIY are given the data from the analyses of 
 these urines. 
 
 Xothing except the [)urest chemicals available were employed 
 and these were always examined and "checked" before use. 
 
 1 Marcuse : Archiv fiir die gesammte Physiologic, 1896. LXIV., p. 2.^2. 
 
 2 Neubauer and Vogel : Harnanalyse (Modification of Neubauer and Salkowski), 1S98, 
 p. 709- 
 
 'Hawk : University of Pennsylvania Medical Bulletin, i<;o,s. XVIII., p. 7. 
 
20 
 
 n. PRELIMINARY EXPERIMENT. 
 
 In all investigations where a nitrogen balance is attempted it is 
 of the first importance to bring the organism to be used as sub- 
 ject to the point of nitrogen equilibrium before any accurate study 
 of the specific problem shall be attempted. To this end, the dog 
 mentioned on page 19 was selected as a subject and preliminary 
 feeding of the animal begun on Oct. 29, 1902. During the first 
 few days no analyses of excreta were made but the animal was 
 given the regulation diet. In the course of this period his body 
 weight fell from 17.23k. on Oct. 29 to 17.02k. on Nov. i. Be- 
 ginning Nov. 2 full analytical data were collected. 
 
 This preliminary experiment embraced a period of twelve 
 days. In that time, upon a regular daily ingestion of 500 cc. of 
 water the dog excreted an average daily volume of 489 cc. of 
 urine. Making allowance for the evaporation which must of 
 necessity have been several cubic centimetres daily we see that 
 practically all of the ingested water was recovered. It will be 
 noted that the body weight of the animal was wonderfully regular 
 during the early days of the experiment and even at the twelfth 
 day showed but a slight decrease. 
 
 For this preliminary period the average nitrogen output was 
 9.673 grams daily (Table III). The reaction of the urine was 
 acid throughout the period. For the purpose of direct compari- 
 son with other data the last five days of the experimental period 
 are alone taken into account. Naturally the first days of the ex- 
 periment when the dog was among totally new surroundings and 
 being fed an unaccustomed diet, the collected data would have 
 comparatively little value. However, as he became accustomed 
 to both diet and conditions the organism would gradually assume 
 a definite nutritional plane and nitrogen equilibrium would result. 
 Our data make it evident that from the eighth to the twelfth day, 
 inclusive, the animal was rapidly approaching this condition. Dur- 
 ing these five days the average daily volume of urine was 517 cc. 
 It will be noted that the average urine volume for the first seven 
 days was but 468 cc, indicating an evident retention of water by 
 the organism. Therefore the increase in volume during the fol- 
 lowing five days was to have been expected. During this same 
 five day period, upon a daily nitrogen ingestion of 10.271 grams. 
 
21 
 
 I0.023 grams was eliminated, thus showing a gain of but 0.248 
 gram daily (Table IV). This then afforded a very satisfactory 
 starting point for our study of the influence of hemorrhage. 
 
 III. FIRST HEMORRHAGE 
 
 In determining the influence of the withdrawal of blood upon 
 metabolism it is in many ways desirable to take the fluid from a 
 small vessel supplying a comparatively unimportant area. At 
 first thought the facial vessels seem to ofifer many advantages in 
 this direction. The ligation of these vessels, taking their course 
 as they do along boney structures, would naturally occasion less 
 disturbance of the metabolic activities than the ligation of vessels 
 of the same calibre in many other parts of the body. It was as- 
 certained, however, by means of a preliminary examination of 
 these vessels in another animal, that it would not be expedient to 
 attempt to draw any large amount of blood from this locality. 
 Therefore, after due consideration, it was determined to make 
 use of the femoral artery somewhere along the lower portion of 
 its course (Saphenous branch). 
 
 I. Operative Procedure. — The subject of this experiment was a 
 17k. dog which had been on a fixed diet (See page 55) since Oct. 
 29 and was now, after sixteen days feeding, approximately in 
 nitrogen equilibrium (See Table IV, p. 58). 
 
 In order to make impossible the loss of urine should any be 
 voided during anaesthesia, the beast was placed in a large zinc- 
 lined tray. Urine passed under these conditions could easily be 
 recovered by means of a pipette and filter paper. At 8.10 A. M. 
 the administration of the anaesthetic was begun. From the very 
 fir.st the beast struggled in a very violent manner, necessitating 
 the combined efforts of three men in order to administer the 
 anaesthetic at all satisfactorily. At the end of eight minutes, as 
 the animal still possessed much of his original vigor, a small 
 amount of chloroform (5 cc. ) was added to the ether previously 
 administered. This chloroform-ether mixture had the desired ef- 
 fect and the dog was soon in a semi-unconscious condition. 
 Ether was now continued and at 8.45 it was plainly evident that 
 it had been administered to the surgical degree. The ojieration 
 
22 
 
 was begun at this time, and precautions were taken throughout 
 to keep the conditions strictly asceptic. 
 
 Before laying bare and clamping the artery the following 
 arrangements were made : A cannula previously coated on the 
 interior with an extremely thin layer of mutton tallow, tO' 
 prevent the blood from clotting, was adjustetd to a rubber 
 tube of appropriate length and calibre. In collecting the blood use 
 was made of a 25% solution of sodium chloride, as it was desir- 
 able to prevent clotting as far as possible. A large beaker con- 
 taining 273 grams of the sodium chloride solution (244 cc.) was 
 accurately weighed, after which both balance and beaker were 
 carefully supported in a position very near and somewhat below 
 the operating table. The balance was placed in this position in 
 order to make the length of tube leading from the cannula to the 
 beaker as short as possible and in this way further guard against 
 clotting. It had previously been determined to withdraw an 
 amount of blood approximating 3% of the animal's body weight, 
 or about 500 grams. To accomplish this accurately a 500 gram 
 weight was added to the weights of the beaker and salt solution 
 and it was then arranged to allow the hemorrhage to continue 
 until it was evident from the movement of the balance pan that 
 approximately the desired amount had been collected. As soon 
 as possible after the completion of the above arrangements the 
 artery was laid bare and the blood drawn. 
 
 In forty-six minutes from the time the anaesthetic was discon- 
 tinued the dog was entirely himself, stood on his feet, and al- 
 though he was somewhat weak from loss of blood and the effect 
 of the anaesthesia, he appeared in fine condition. At no time after 
 the operation was there any inc.lmation to vomit, and the appetite 
 of the animal continued excellent throughout the period. 
 
 Time Schedule. — 8.10 A. M., anaesthesia begun (ether). 8.18, 
 trace of chloroform given. 8.35, beast placed on board. 8.45, 
 operation begun. 9.26, incisions made, artery laid bare, and 
 ligated, cannula inserted and slow hemorrhage commenced. 
 10.00, commencement of more rapid hemorrhage. 10.12, return 
 to slow hemorrhage. 10.14, hemorrhage ended. 10.20, wounds 
 sewed up and administration of ether discontinued. 10.21, beast 
 removed from board to cage. 10.25, evidence of returning con- 
 
23 
 
 sciousness. 10.55, sat up in his cage. 11.06, stood on his feet 
 and moved about. The blood drawn at this hemorrhage weighed 
 492.9 grams (Table II). 
 
 2. Observations on the Influence of the First Hemorrhage. — 
 The first observation following the hemorrhage was the failure 
 of the dog to urinate as frequenth' or as large a volume as former- 
 ly. The experiment started at 8.10 A. M. and the first urine was 
 not passed until from 16 to 24 hours afterward (Table V). The 
 urine volume for the day of the operation was therefore the low- 
 est of any day of the investigation up to that time. Now in our 
 control experiments we have seen that under the influence of the 
 anaesthesia, in each case, the first urine was passed in from 7 to 
 8 hours after the operation. It is also seen from our data that 
 on the first day of the control experiments the maximum volume 
 of urine was eliminated. Therefore this very low volume after 
 hemorrhage is all the more significant when we consider that the 
 same force (anaesthesia) was acting at the time of the hemor- 
 rhage as was at work when we secured the very large urine 
 elimination on the initial days of our control experiments. The 
 onlv new factor is the iiemorrhage. Hence the influence of the 
 withdrawal of blood is much greater than appears, for in order 
 to so delay the flow of urine that the first elimination should not 
 occur until from 16 to 24 hours after, the hemorrhage has been 
 forced to overcome the diuretic influence of the anaesthesia which 
 would have caused a large output of urine in from 7 to 8 hours 
 after. 
 
 The nitrogen content (6.33 grams) of the urine on the first day, 
 was also the minimum outi)ut up to date. The body weight of the 
 dog fell 0.51k. on the first day. On the second day some radical 
 changes occurred. On this day the dog passed an unusually large 
 volume of urine, having the maximum specific gravity for the ex- 
 periment, and containing the second largest content of nitrogen. 
 The body weight of the dog continued to fall somewhat. 
 
 Notwithstanding the rather high volumes of urine passed on the 
 second and third days after the hemorrhage, the average at any 
 time was considerably below that of the preliminary experiment. 
 For instance, the average of the first nine days was but 467 cc, 
 whereas the average preceding the hemorrhage was 489 cc. This 
 
24 
 
 showed an average retention by the organism of 22 grams of 
 water daily, or 198 grams in the nine days. During the last seven 
 days of the experiment the retained water seemed to have been 
 eliminated and the normal ratio again reached. In the course 
 of these seven days the average urine volume was 518 cc, a daily 
 increase of 29 cc. above that of the preliminary experiment, or a 
 total increase of 203 grams. From the weights as determined we 
 find that during this period of seven days the dog's weight fell 
 from 16.34k. to 16.09k., a total loss of 250 grams. 
 
 3. Discussion of the Income and Outgo of Nitrogen, Sulphur and 
 Phosphorus After the First Hemorrhage. — The study of the first 
 hemorrhage was begun with the subject showing a gain of 0.248 
 gram of nitrogen daily. The effect of the withdrawal of blood 
 was to cause an increase in the nitrogen content of the urine, this 
 increase appearing the first day after the hemorrhage, and reach- 
 ing its maximum at the fifth day. After this date the average 
 elimination decreased and approximate nitrogen equilibrium was 
 reached on the sixteenth day of the experiment. 
 
 By referring to the data for the nitrogen elimination for the five 
 days following this hemorrhage (Table IV), it will be seen that 
 the average daily increase in nitrogen for this period was 1.009 
 grams. The dog was gaining 0.248 gram of nitrogen daily, how- 
 ever, at the time of the hemorrhage, hence the effect was to cause 
 an increased output of 1.257 grams of nitrogen daily. This rep- 
 resents the final effect produced by the anaesthesia, operation and 
 hemorrhage acting in unison. Now we shall see from our con- 
 trol experiments (Table XIX), that the effect of the anaesthesia 
 was to decrease the nitrogen output 0.937 gram daily. Making 
 this correction we have as the effect of operation and hemorrhage 
 an increase of 2.194 grams daily, and further correcting for the 
 effect of the operation we have as the net effect of the hemorrhage 
 an increase in the daily nitrogen output of 0.488 gram (Table 
 XIX). 
 
 The nitrogen balance for the whole sixteen days of the experi- 
 ment (Table III) showed a loss of 0.179 gram of nitrogen daily. 
 The sulphur followed this with a daily loss of 0.023 gram (Tables 
 VI and XI) while the phosphorus showed a daily gain of 0.123 
 grams. 
 
25 
 
 rV. CONTROL EXPERIMENTS. 
 
 In studying- the effect of the withdrawal of blood there 
 were evidently two forms of control experiments necessary 
 before any definite conclusions could be reached. The first 
 of these was the influence of anaesthesia, and the sec- 
 ond the influence of the anaesthesia plus the influence 
 of the operation which accompanied all our withdrawals 
 of blood. If it were practicable to draw blood without the 
 use of any anaesthetic, obviously the first form of control ex- 
 periment could be eliminated. But even were such a method pur- 
 sued other factors, such as the nefvous influence, would be intro- 
 duced and we could not be certain that the effect secured was de- 
 pendent alone upon loss of blood. Obviously, for this reason ex- 
 periments upon the influence of hemorrhage, made withotit the 
 use of anaesthetics, would be extreiiiely difficult to control. Local 
 anaesthetics might be employed, but even here we could not be 
 sure what influence tlie absorption of these bodies w-ould have 
 upon the organism. The experimental plan adopted by us was 
 open to complete control which we feel would not have been possi- 
 ble had we followed either of the other plans mentioned. 
 
 Two control experiments were made, the first, ten days in 
 length, was devoted to the study of the influence of anaesthesia, 
 and in the second, covering a period of thirteen days, an attempt 
 was made to determine the effect of anaesthesia accompanied by 
 the operative manipulation. 
 
 I. Influence of Anaesthesia. — The general procedure in this 
 our first control experiment was practically identical with that of 
 the regular blood-letting experiments. The animal was placed on 
 the operating board, loosely tied to allow freedom of motion in 
 his struggles, and the administration of ether begun. After an in- 
 terval of a few moments a small amount of chloroform was given 
 as in the other experiments. Care was taken to consume the usual 
 length of time in reaching complete anaesthesia. The beast was 
 kept under the influence of the anaesthetic for a period corre- 
 sponding to the normal time of operation and was then returned 
 to his cage. A detailed time schedule follows: — 9.10, anaesthesia 
 begun. 9.18, chloroform administered. 9.40, anaesthesia com- 
 
26 
 
 plete. 1 1. 20, administration of ether discontinued and dog re- 
 turned to cage. 11.30, returning consciousness. 11.50, sits up 
 and staggers about. 12.00, appears normal. The whole period of 
 anaesthesia was without incident except the loss of about 5 cc. 
 of urine at 9.15 by reason of vigorous abdominal movement. This 
 urine was recovered by means of filter paper and added to the 
 washings for the period. The struggling incident to the former 
 anaesthesia was duplicated in detail. 
 
 (a). Observations on the Influence of Anaesthesia. 
 
 Before attempting to study the influence of anaesthesia an ef- 
 fort was made to get the dog as nearly as possible in a condition of 
 nitrogen equilibrium. By referring to the nitrogen balance for 
 the five days immediately preceding the anaesthesia experiment 
 (Table IV, p. 58) it will be seen that the animal was approximate- 
 ly in the desired condition, there being a loss of but 0.159 gram 
 of nitrogen per day. 
 
 Upon an examination of the data for this experiment (Table 
 XII, p. 66) several evident variations from the order ob- 
 taining in the preliminary and first blood-letting experiments 
 are noted. Whereas the average urine volume of the pre- 
 ceeding periods had been 489 cc. in each case, here, upon 
 the same ingestion of water we secured an average urine 
 volume of 522 cc. for the period. The urine volume for 
 the day on which the anaesthetic was administered was 
 particularly worthy of notice. Upon this day, which in 
 the experiment preceeding had shown a urine volume of 377 
 cc. we secured a volume of 654 cc, or nearly double that pre- 
 viously secured. When we compare this volume with the average 
 volume for the whole period preceeding we still have an increase 
 of 165 cc. for the day. This increase in volume is evidently 
 traceable to the diuretic action of the ether. 
 
 Another striking feature of the urine excretion was its high 
 specific gravity accompanied by a relatively low nitrogen content. 
 This was especially true of the first few days following anaes- 
 thesia. As measured by other daily excretions, both before and 
 after the anaesthesia experiment, a urine volume of 654 cc. hav- 
 ing a specific gravity of 1.018 would have given us a nitrogen out- 
 put of 10.94 grams (See data for Nov. 10, Nov. 24, Jan. 12, and 
 
27 
 
 Tan. 13). Tims the effect of the anaesthesia was to diminish the 
 total nitrogen excretion for the day approximately 20%. 
 
 After the excretion of phosphates and sulphates failed to show 
 the cause of the unusual relation between the specific gravity and 
 nitrogen content we turned to the chlorides for a solution of the 
 problem, and beginning Nov. 25 duplicate determinations of the 
 chlorine content of the urine were made for every day up to and 
 including Dec. 3. The following results were obtained : — 
 
 Xov. 25 1.82 grams of chlorine. 
 
 Nov. 26 1. 71 grams of chlorine. 
 
 Nov. 2"] 1.65 grams of chlorine. 
 
 Nov. 28 1.87 grams of chlorine. 
 
 Nov. 29 1.69 grams of chlorine. 
 
 Nov. 50 ^.J7 grams of chlorine. 
 
 Dec. I 2.85 grams of chlorine. 
 
 Dec. 2 2.73 grams of chlorine. 
 
 Dec. 3 2.39 grams of chlorine. 
 
 From this data it will be seen that the chlorine output was fair- 
 Iv constant up to the day the anaesthetic was given, showing an 
 average daily elimination of 1.75 grams, and that on this day an 
 increase of 150% in the chlorine content of the urine occurred. 
 Thus the indications are that the rise in the daily output of chlor- 
 ides through the influence of anaesthesia, caused a higher specific 
 gravity on the days immediately following the administration of 
 the anaesthetic than the determined content of nitrogen would 
 warrant. 
 
 As a further verification we took a volume of water (649 cc.) 
 equal to the volume of urine passed by the dog on Nov. 30, and 
 dissolved in this 7.2 grams of sodium chloride, which, according 
 to our data, was the amount eliminated on that day. This gave 
 us a specific gravity of 1.009. T'le actual specific gravity of the 
 urine of that day being 1.018, we see that a large part of the den- 
 sity of the fluid was due to the presence of sodium chloride. We 
 next added to this sodium chloride solution an amount of urea 
 C18.4 grams) equivalent to the nitrogen content of the urine for 
 that day, and secured a specific gravity of 1.015. This left but 
 three points in density to be met by the other solid ingredients of 
 
28 
 
 the urine. Thus we secured from 7.2 grams of sodium chloride a 
 rise in specific gravity 50% greater than from 18.4 grams of urea. 
 This rough calculation easily explained the condition of high spe- 
 cific gravity and low nitrogen content. 
 
 As has been said elsewhere (p. 23) the drawing of blood, 
 among other well marked effects, caused a very noticeable de- 
 crease in the amount of urine eliminated for an extended period 
 thereafter. Consider, for example, the hemorrhages immediately 
 preceeding and following the anaesthesia experiment. After the 
 first hemorrhage which began at 8.10 A. M. no urine was passed 
 during the next sixteen hours, or up to midnight (Table V). On 
 the following morning at 8.30 the urine volume was 300 cc. As 
 the beast was not observed between midnight and 8.30 A. M. we 
 are unable to conclude at what hour this urine was eliminated. 
 After the second hemorrhage a similar course was followed, i. e., 
 no urine up to midnight, followed by a volume of 590 cc. at 9 
 o'clock the next morning. In the anaesthesia experiment, how- 
 ever, where no blood was drawn, but the individual influence of 
 the anaesthetic was studied, we find very different conditions to 
 prevail. Here, following the administration of the ether at 9.10 
 A. M., we observed a fairly large elimination of urine (283 cc.) 
 in seven hours (4.15 P. M.) or in less than one-half the time that 
 elapsed before the first urine appeared after the hemorrhages 
 mentioned. The diuretic influence of the ether was thus very 
 clearly indicated. 
 
 As was observed in the other periods, the body weight of the 
 animal fell somewhat upon the day of anaesthesia, in this particu- 
 lar casea loss of 0.28k. being noted. 
 
 (b). Discussion of the Income and Outgo of Nitrogen, Sulphur and 
 Phosphorus Before and After Anaesthesia. 
 
 It is very evident that an effect produced by an agency such as 
 anaesthesia or hemorrhage will naturally be more pronounced 
 during the days immediately following the operation. It is also 
 easily seen that in all such instances there will come a point, soon- 
 er or later, at which time the animal will again begin to approach 
 the normal and tend toward nitrogen equilibrium. Such being 
 the situation it is of course essential to know as nearly as possible 
 
29 
 
 when tiitrogen equilibrium is being reached. In order to 
 facihtate comparison and the drawing of conckisions, ni- 
 trogen balances for a short period immediately preceed- 
 ing the commencement of each experiment have been 
 made in order to show the exact state of the organ- 
 ism at the moment the experiment began. In addition, nitro- 
 gen balances for a few days following the commencement of each 
 experiment are given in order to show the immediate effect, if 
 anv. which was secured in each specific instance. No attempt be- 
 ing made after Jan. 19 to get the dog again into nitrogen equili- 
 brium, such balances will not be found for experimental days after 
 that date. As sulphur and phosphorus were not determined in 
 daily samples no such balances will be found for these elements. 
 
 By referring to the nitrogen balance for the short period imme- 
 diately preceeding the administration of the anaesthetic (Table 
 IV } it will be seen that the dog was approximately in nitrogen 
 equilibrium, and by consulting this table further we note that the 
 effect of anaesthesia was to cause a lowering of the nitrogen out- 
 put and a consequent daily gain of 0.937 gram of nitrogen to the 
 body. Data concerning the relation between the nitrogen content 
 and the specific gravity of the urine during this period will be 
 found on page 26. 
 
 The course of the sulphur excretion in a general way followed 
 that of the nitrogen. The period preceeding the anaesthesia ex- 
 periment showed a daily loss of 0.023 gram of sulphur (Table 
 VI), whereas the balance for the period showing the influence 
 of the anaesthetic exhibited a gain of 0.015 gram of sulphur 
 daily. Thus we had as the final effect of the anaesthesia upon the 
 course of the sulphur excretion a daily gain of 0.128 gram. 
 
 The course of the phosphorus excretion seemed to be directly 
 opposite that of nitrogen and sulphur. Showing before the ex- 
 periment a gain of 0.123 gram of phosphorus daily (Table VII), 
 we secured after the anaesthesia a gain of but 0.015 gram daily. 
 In this instance the ])hosphorus showed a loss of 0.108 gram 
 daily, whereas the nitrogen and sulphur each showed a gain. Thus 
 the anae.sthsia caused a fall in the daily excretion of nitrogen and 
 sulphur anrl a coincident rise in the phosphorus excretion. 
 
 2. Influence of Anaesthesia-Operation. — The nitrogen content 
 
30 
 
 of the urines of Dec. 6-9 indicating that the dog was approximate- 
 ly in nitrogen equiHbrium (-|- 0.158 gram of nitrogen per day) 
 it was determined to begin our second control experiment on Dec. 
 10. Apart from the drawing of blood, the procedure in this ex- 
 periment followed the same course as that of the regulation blood- 
 letting experiments. The beast was anaesthetized and the custom- 
 ary operative steps were carefully followed. The regulation incis- 
 ion was made, artery laid bare, (in this case the right femoral-) 
 clamped and the cannula inserted. The wound was then sewed up 
 and the animal returned to his cage. In fact everything was done 
 to make this operation coincide in every detail with the regulation 
 blood-letting operations. Schedule follows: — 8.12 A. M. anaes- 
 thesia begun. ^ 8.20, small amount of chloroform given. 8.45, 
 operation begun. 10.23, anaesthetic discontinued. 10.24, dog 
 placed in cage. 10.28, signs of returning consciousness. 10. 40, 
 sits up. 
 
 (a). Observations on the Influence of Anaesthesia-Operation. 
 
 In the main the characteristics of this period were similar to 
 those observed during the anaesthesia experiment. Here with the 
 same uniform water ingestion of 500 cc. we secured an average 
 daily urine volume of 531 cc, thus comparing favorably with the 
 average (522 cc.) of the anaesthesia period, but being in marked 
 contrast to the average elimination (489 cc.) secured during our 
 preliminary experiment. 
 
 The same condition of low nitrogen elimination, when ap- 
 proached from the point of view of specific gravity, maintained 
 here as was seen to prevail during the early part of the anaesthesia 
 experiment. Here as in the former instance we considered that 
 a largely increased output of chlorine caused the peculiar rela- 
 tion. 
 
 In this experiment, as well as in the one devoted exclusively to 
 the study of the influence of ether, we noted a copious flow of 
 urine appearing much earlier than after the blood-letting opera- 
 tions. As in the anaesthesia experiment, this copious flow of 
 urine was doubtless due to diuresis produced by the anaesthetic. 
 
 On Dec. 18 at about i P. M. the dog was observed lapping its 
 
 IThe animal passed a few grams of feces during preliminary anaesthesia. This waS 
 added to the feces for the day. 
 
31 
 
 wound, and upon examination it was found that a slight hemor- 
 rhage had been produced by the animal, probably by means of his 
 foot in the act of scratching. The flow of blood was soon stopped, 
 however, and the wound bandaged with adhesive plaster to pre- 
 vent the animal producing another hemorrhage. Probably not 
 over 25 cc. of blood was lost and practically all of this was eaten 
 by the dog. By an examination of the data it will be seen that the 
 nitrogen elimination of Dec. 18 was the highest of the experiment, 
 while that of Dec. 19 was also relatively high. This increase may 
 have been due partly to the ingested blood, or it may have been the 
 normal excretion since these two days were followed by two days 
 of low elimination which upon the 21st practically restored the 
 ratio as it existed previous to the accidental hemorrhage. 
 
 (b). Discussion of the Income and Outgo of Nitrogen, Sulphur and 
 Phosphorus Before and After Anaesthesia-Operation. 
 
 The nitrogen balance for the four days immediately preceeding 
 the commencement of the anaesthesia-operation experiment (Table 
 IV) showed us that the dog was practically in a condition of ni- 
 trogen equilibrium (-[-0.158 gram daily). The next balance, 
 i. €.. that for the five days immediately following the anaesthesia- 
 operation of Dec. 10, records an average daily loss of 0.61 1 gram 
 of nitrogen. Hence the efifect of the anaesthesia-operation was 
 to cause an increase of 0.769 gram in the daily nitrogen output 
 (Table XIX;. Now we have already seen that the effect of the 
 anaesthesia alone was to decrease the nitrogen elimination 0.937 
 gram daily. Therefore the operation alone caused an increase 
 in the nitrogen output large enough to overcome entirely the de- 
 crease due to the anaesthesia and yet show a daily increase of 
 0.769 gram. Hence the total increase due to the operation was 
 1.706 grams daily (Table XIX). 
 
 As was noted in the anaesthesia experiment the course of the 
 sulphur excretion was very similar to that of the nitrogen. In 
 the case of the phosphorus excretion also a uniformity with the 
 conditions obtaining in the anaesthesia experiment was noted. 
 Tims while the nitrogen and sulphur showed an increased daily 
 elimination as a result of anaesthesia-operation the phosphorus 
 excretion showed a decrease. 
 
32 
 
 V. SECOND HEMORRHAGE. 
 
 This hemorrhage occurred on Dec. 23 at the close of the anaes- 
 thesia-operation experiment. An attempt was again made ta 
 withdraw approximately 3% of the animal's body weight. Apart 
 from minor details the operative procedure was the same as that 
 observed at the first hemorrhage (See p. 21). Two incisions 
 were made as at the first operation. It was attempted to draw 
 the blood from a branch of the left femoral just above the knee, 
 but the vessel being too small at this point a second incision was 
 made higher up and the main trunk of the femoral laid bare. A 
 detailed schedule follows: — 8.14 A. M., anaesthesia begun. 8.20, 
 trace of chloroform. 8.40, first incision made. 9.12, second in- 
 cision made. 9.30, cannula inserted. 9.31, hemorrhage begun. 
 9.40, hemorrhage ended. TO.05, anaesthetic discontinued. 10.10, 
 wounds sewed up. 10.12, animal in cage. 10.24, returning con- 
 sciousness. 11.40, dog appears normal. 
 
 The total amount of blood lost to the organism at this hemor- 
 rhage was 506 grams. 
 
 I. Observations on the Influence of the Second Hemorrhage. — 
 According to Hammarsten^ a hemorrhage amounting to one- 
 fourth of the total blood produces no continued sink- 
 ing of the blood pressure in the arteries ; a loss of 
 one-third reduces the blood pressure considerably and a 
 loss of one-half, in adults, is dangerous to life. Now 
 in our second hemorrhage on Dec. 23 we drew 506 
 grams of blood from the animal weighing at that time 15.72k. 
 Taking the amoimt of blood present as being ^/is.g of his body 
 weight (Hammarsten's figure) or 1164 grams, it is seen that, ac- 
 cording to Hammarsten, a hemorrhage of 582 cc. would be dan- 
 gerous to life. The hemorrhage we produced amounted to 506 
 cc, and, as our data shows, the dog appeared as usual two hours 
 afterward. It seems hardly probable that the animal's condition 
 would have been materially different had we drawn 76 cc. more 
 blood, thus securing Y^ of his entire supply. 
 
 In the main the influence of the second hemorrhage seemed to 
 be closely parallel to that of the first hemorrhage. At this second 
 hemorrhage we noted the low volume of urine (428 cc.) on the 
 
 1 Phj'siological Chemistry, Fourth Edition (English), 1904, p. 209. 
 
33 
 
 day blood was drawn, followed by a period of 16-25 liours (Table 
 \') during which no urine was passed; two points in close agree- 
 ment with those of the first hemorrhage. The urine volume ran 
 much higher after the second hemorrhage than after the first. In 
 the four days following the second hemorrhage the average urine 
 volume was 554 cc. (Table XIl), while the average daily elimina- 
 tion for seven days was 525 cc. and for the whole 21 days of the 
 experiment was 530 cc. When contrasted with the average of 
 451 cc. for the four days following the first hemorrhage and 
 489 cc, the average for the whole experiment, the variations are 
 quite impressive. These vohunes seem to indicate that the second 
 hemorrhage was not so successful in masking the diuretic effect 
 of the anaesthesia as was the first hemorrhage. 
 
 The body weight of the animal fell from 15.72k. to 15.18k. on 
 the first day of the experiment, showing a loss of 0.54k. thus very 
 closely agreeing with the loss of 0.51k. sustained through the 
 agency of the first hemorrhage. The body weight continued to 
 fall until, on the fourth day, a weight of 14.76k was registered. 
 This weight was maintained practically unaltered for six days 
 when another gradual decrease began and continued until the end 
 of the experiment. The total loss of weight in the twenty-one 
 days, exclusive of the loss due to hemorrhage, was 0.76k. The 
 reaction of the urine was as a rule amphoteric during the early 
 days of the experiment, the alkalinity gradually decreasing until, 
 during the closing days of the expepiment the amphoteric charac- 
 ter had disappeared and an acid reaction obtained. 
 
 In agreement with the observations following the first hemor- 
 rhage the second day showed us a large volume of urine having 
 the highest specific gravity of any urine of the experiment, and 
 likewise containing the highest nitrogen content. 
 
 2. Discussion of the Income and Outgo of Nitrogen, Sulphur and 
 Phosphorus After the Second Hemorrhage. — This experiment start- 
 ed with the dog ap];roximately at nitrogen equilibrium, ;'. c, show- 
 ing daily loss of but 0.141 gram of nitrogen. The loss of blood 
 caused this condition to rapidly change into one of largely in- 
 creased nitrogen elimination and at the end of the seventh day a 
 daily increase of 1.799 R^ams of nitrogen was noted. Making the 
 projR-r correction for the influence of the anaesthetic (See p. 75) 
 
34 
 
 we have, for the first seven days a dail}^ increase of 2.736 grams of 
 nitrogen as the combined effect of the operation and hemorrhage, 
 and correcting further for the operation, we obtain a daily in- 
 crease of 1.03 grams as the individual effect of the hemorrhage 
 (Table XIX). It will be recognized that this increase was some- 
 what higher than the increase due to the first hemorrhage. The 
 larger urine volume may have had some influence in this direction. 
 The last five days of the experiment indicate a loss of 0.150 gram 
 of nitrogen daily, comparing very favorably witih the average loss 
 of 0.141 gram at the beginning. 
 
 In agreement with the large increase in the nitrogen excretion 
 following hemorrhage, the excretion of sulphur was also un- 
 usually high. This element showed an increase of 0.180 gram 
 per day for the entire experiment (Table VI). The excretion of 
 phosphorus, as usual, followed a course typically its own and in- 
 stead of showing an increase as did the nitrogen and sulphur, it 
 registered a decreased excretion amounting to 0.163 gram per day 
 (Table VII). 
 
 VI. THIRD HEMORRHAGE. 
 
 The third hemorrhage occurred on the morning of Jan. 13, just 
 21 days after the second hemorrhage. The dog at this time was 
 seemingly in fine condition and was using the leg, operated upon 
 at the second hemorrhage, in a normal manner. It was decided to 
 draw blood on this occasion from the left femoral artery slightly 
 higher up than the site of the second hemorrhage. 
 
 The operation began at 8.20 A. M., the technique being analo- 
 gous to that of former operations. Upon making the incision we 
 were much surprised at the altered position of the femoral artery. 
 Down beneath and around the wound of the second hemorrhage 
 the central end of the artery was surrounded by a peculiar cap- 
 sule formation which pushed upon the artery causing it to lie 
 deeply imbedded among the tissues. After inserting the cannula 
 the hemorrhage was allowed to continue ten minutes at the end of 
 which period it was evident from physical signs that it would not 
 be policy to continue the hemorrhage longer. The tongue of the 
 beast was much more blanched than at previous hemorrhages and 
 the pulse in the right femoral was almost imperceptible. The 
 
35 
 
 animal was so very weak that the sewing up of the wound was 
 hastened and the administration of ether discontinued as soon as 
 possible. Thus the period of anaesthesia was somewhat shorter 
 than at the previous operations. The wound of the second hem- 
 orrhage was drained, a few^ deep lying stitches were removed, and 
 the whole wound cleansed with carbolic acid. A schedule of the 
 operative steps follows : — 8.20 A. M., anaesthesia begun. 8.28, 
 trace of chloroform. 8.41, operation begun. 9.14, cannula insert- 
 ed. 9.15, hemorrhage begun. 9.20, ether discontinued. 9.24, 
 hemorrhage ended. 9.52. wound sewed up. 9.53, animal in cage. 
 10.02. returning consciousness. 10.20, dog sits up. 
 
 There was somewhat less salivation than at previous operations. 
 A short time after the operation the dog used his leg much more 
 handily than after former hemorrhages. The total blood lost to 
 the organism aggregated 505.5 grams. 
 
 I. Observations on the Influence of the Third Hemorrhage. — A 
 larger percentage of the total blood of the animal was drawn at 
 this hemorrhage than upon any other occasion during the course 
 of the experiments. As has been said the blood was allowed to 
 flow until the animal was in an extremely weakened state. When 
 the weights were made it w-as found that the total hemorrhage 
 had been 505.5 grams or 3.51% of the body weight of the animal. 
 According to the theory of Hammarsten (loc. cit.) a hemorrhage 
 of 534 grams would have been fatal. We are inclined to believe 
 that a short continuation of the hemorrhage would have been at- 
 tended by fatal results ; but, in view of the rapid recovery of the 
 dog we do not believe that an increase of 28.5 grams in the 
 amount of blood drawn would have caused the death of the ani- 
 mal. It was very evident, how^ever, that the dog was much more 
 effected by this third hemorrhage than by either of those preceed- 
 ing it. 
 
 In some of the principal points the effects produced by the third 
 hemorrhage corresijonded very closely with those of the first and 
 seconrl hemorrhages. One of the most imjjortant factors, /. e., 
 the nitrogen excretion, showed the same characteristic of increas- 
 ed elimination. We also see upon the first day of the experiment 
 the customary .'^mall volume of urine having a low specific grav- 
 ity ; althfjugh the difference between the urine volume of this day 
 
36 
 
 and the volumes of the days following was not so great as was 
 noted after the first two hemorrhages. The failure of the later 
 days of this experiment to show the usual percentage increase over 
 the volume of the first day is probably to be found in the varia- 
 tion in the time of anaesthesia. At each of the first two hemor- 
 rhages the beast was under the influence of the anaesthetic for 
 approximately 2^ hours ; whereas at the third hemorrhage we 
 were forced to limit the period of anaesthesia to somewhat less 
 than i^ hours.. Bearing in mind the diuretic eftect traceable to 
 the ether it is easily seen that a much larger urine volume might 
 possibly have resulted had the anaesthesia continued the usual 
 length of time. 
 
 The length of the period between the operation and the elimi- 
 nation of the first urine appeared to differ very decidedly from 
 that of the previous hemorrhages. At the first and second hem- 
 orrhages no urine was passed until from 16 to 24 hours after the 
 operation ; whereas after the third hemorrhage the first elimina- 
 tion was in from 5 to 6 hours. By an examination of the data, 
 however, we learn that the last urination preceeded the operation 
 by 8 hours and that therefore ys of the normal daily urine volume 
 was probably in the dog's bladder at the time of the hemorrhage. 
 Hence, under the circumstances, the passing of urine at an earlier 
 hour was to have been expected. A second urination occurred 
 between 16 and 24 hours after the operation and we think, there- 
 fore, that we are justified in considering the first urine passed as 
 having been formed previous to the operation. The volume pass- 
 ed at this first urination was 180 cc. which at the same rate, would 
 have given us a volume of 540 cc. for the entire 24 hours. This 
 value would agree very closely with the average volume (530 cc.) 
 for the experiment immediately preceeding. 
 
 The body weight of the dog. fell from 14.42k. to 13.76k. after 
 the hemorrhage, a loss of 0.66k., the greatest loss noted at any 
 time during the 84 days of the investigation (Table XII). 
 
 2. Discussion of the Income and Outgo of Nitrogen, Sulphur and 
 Phosphorus After the Third Hemorrhage. — The third hemorrhage 
 took place after the animal had apparently entirely recovered from 
 the effect of the second hemorrhage and was again in a condition 
 of approximate nitrogen equilibrium. This condition was repre- 
 
37 
 
 sen'ted by a loss of 0.15 gram of nitrogen daily. Upon the day 
 of the hemorrhage, as was also the case at each of the preceeding 
 hemorrhages, the nitrogen content of the urine was the lowest of 
 any day of the experiment. The second day, however, showed a 
 very decided rise and the maximum was reached on the third day. 
 The average nitrogen elimination was 11.669 grams daily, where- 
 as for the five days preceeding the hemorrhage the dog eliminated 
 an average of 10.421 grams daily. Therefore the hemorrhage 
 and its associated influences caused an increased output of nitro- 
 gen amounting in the aggregate to 1.248 grams daily. It will be 
 recognized that this was almost precisely the same as the com- 
 bined influence of the anaesthesia, operation and hemorrhage at 
 the first withdrawal of blood, the difl:erence being but 0.009 
 gram. The increase in nitrogen after the second hemorrhage was 
 somewhat greater and was probably due, in part, as has already 
 been stated, to the cumulative diuretic effect of the anaesthesia 
 which appreciably raised the urine volume. After the third hem- 
 orrhage, however, as we have seen, the anaesthetic having been 
 administered for a shorter period, this large urine volume was not 
 apparent but the average volume for the period was 53 cc. less 
 than after the second hemorrhage and 12 cc. less than after the 
 first hemorrhage (Table XII). 
 
 After making the proper correction for the influence of the 
 anaesthesia (See p. 75) we secured 2.185 grams (Table XIX) 
 as the increase in the nitrogen output due to the combined influ- 
 ence of the operation and loss of blood ; and correcting further for 
 the operation, we obtained as the net influence of the hemorrhage 
 an increase of 0.479 gram in the daily nitrogen elimination. The 
 balance for the last four days of the experiment (Table IV) show- 
 ed an increase of 0.265 gram in the daily nitrogen elimination, 
 while the data for the entire experiment, owing to the brevity of 
 the period as well as to the greatly increased elimination of the 
 first few days, showed a daily increase of 0.751 gram. 
 
 The excretion of sulphur apparently ran closely parallel with 
 that of nitrogen, the sulphur balance indicating a daily increase 
 of 0.229 gram (Table \T). The excretion of phosphorus on the 
 other hanrl. in close agreement with the ob.servations after the 
 first anrl second hemorrhages, showed a gain of 0.065 gram for 
 each day of the period (Table VTI). 
 
38 
 
 Vn. FOURTH HEMORRHAGE. 
 
 By referring to the proper data it will be seen that the period 
 between the third and fourth hemorrhages was much shorter than 
 that between the first and second, or between the second and third. 
 Furthermore it will be recognized that the fourth hemorrhage was 
 instituted before the dog was as near a condition of nitrogen 
 equilibrium as upon the former occasions. It will be remembered 
 that after the first hemorrhage the dog was brought to nitrogen 
 equilibrium in i6 days, whereas 21 days were necessary to secure 
 a like result after the second hemorrhage. Gathering from these 
 facts that it would probably take three weeks or longer to bring 
 the organism to nitrogen equilibrium after the third hemorrhage, 
 we decided to observe the influence of the hemorrhage over a 
 small number of days, and, when we had secured approximate 
 equilibrium, to follow with another hemorrhage. Then as we al- 
 ready had data for three hemorrhages when the dog was at nitro- 
 gen equilibrium, we decided at this point that an interesting study 
 could be made of hemorrhages at short intervals upon this same 
 animal, no attempt being made to secure nitrogen equilibrium. 
 Therefore the period following the third hemorrhage was termi- 
 nated, and the fourth hemorrhage produced, at a point where the 
 dog was losing 0.265 gram of nitrogen daily. 
 
 At the time of the fourth hemorrhage the dog was able to walk 
 about comfortably, but was not in as normal a condition as upon 
 the occasion of the former hemorrhages. The right femoral 
 artery just above the point at which the saphenous branch left it, 
 was selected as the site of the hemorrhage. After 200 grams of 
 blood had been drawn the arterial pressure was so low that only 
 a slight flow was secured. The blood clotted very rapidly, neces- 
 sitating frequent changes of the rubber tube. The body of the 
 beast was freely massaged above the incision, and the cannula and 
 rubber tube were frequently cleaned by means of a long platinum 
 wire, but even after using the greatest efforts to secure the best 
 conditions for a satisfactory hemorrhage a slow dropping was the 
 maximum rate of flow. Thinking that perhaps the clot might ex- 
 tend back into the artery the platinum wire was frequently insert- 
 ed for some distance into the vessel at the risk of puncture. After 
 securing about 400 grams of blood the first cannula was removed 
 
39 
 
 and a second one inserted a short distance above the first. Here 
 however with fresh cannula and rubber tube the flow was not 
 rapid enough to prevent clotting in both tube and cannula. The 
 tube was discarded and blood collected directly from the cannula 
 but the flow was not accelerated. It being evident that the hem- 
 orrhage had continued to a point where the arterial pressure was 
 insufificient. the attempt to withdraw additional blood was aban- 
 doned. Therefore at 10.19 the administration of ether was dis- 
 continued, the wound sewed up and the animal returned to his 
 cage. The usual schedule follows: — 8.29 A. M., anaesthesia be- 
 gun (ether). 8.37, trace of chloroform. 8.55, operation begun. 
 9.16. cannula inserted. 9.18, hemorrhage begun. 9.57, second can- 
 nula inserted to facilitate flow. 10.18, hemorrhage ended, making 
 a total collection of 444.5 grams of blood. 10.19, second cannula 
 out and ether stopped. Tongue extremely w^hite. 10.31, wound 
 sewed up. 10.36. in cage. 10.43, returning consciousness. 10.56, 
 sits up. The period of anaesthesia of this experiment was two 
 hours and fourteen minutes, being somewhat longer than that of 
 the third hemorrhage and essentially the same as those of the first 
 and second hemorrhages. There was practically no salivation at 
 this operation.^ The total blood lost to the organism was 449.3 
 grams. 
 
 I. Observations on the Influence of the Fourth Hemorrhage, 
 with a Discussion of the Income and Outgo of Nitrogen, Sulphur 
 and Phosphorus. — An interesting condition was noted after this 
 hemorrhage for the first time during our experiments. 
 This was a loss of api)etite on the part of the dog. 
 At the usual meal hour the animal was given his food, 
 but contrary to custom, he ate very little of the mix- 
 ture, and a large part of that eaten was water. About 
 five minutes later he was again offered the food while he was 
 lying clown. This time he ate the entire amount, but did not 
 evince his accustomed eagerness. The same lack of appetite was 
 noted upon the next day also. 
 
 There was no excretion of urine for 12 hours after the hemor- 
 rhage (Table V). The urine volume on the day of the hemor- 
 
 1 Preliminary to the operation the wound from the tliird lit-niorrhage was flushed and 
 the collateral circulation noted. 
 
40 
 
 rhage was 463 cc. (Table XII) and this was followed by a grad- 
 ual rise until the maximum excretion of 770 cc. was reached on 
 the third day. This volume was also the largest output of any 
 day during the investigation. The usual decrease in body weight 
 was noticed after this hemorrhage. 
 
 An examination of the data showed a greatly increased nitrogen 
 excretion. This increase, after correcting for anaesthesia-opera- 
 tion, was 2.506 grams (Table XIX) and was about 5 times as 
 great as that observed after the first and third hemorrhages and 
 about 2y2 times as great as that after the second hemorrhage. 
 This evidently showed quite forcibly the cumulative efifect of suc- 
 cessive hemorrhages upon proteid catabolism. 
 
 The days following the hemorrhages gave an average increase 
 of 0.348 gram in the sulphur elimination. In agreement with the 
 nitrogen increase this increased excretion of sulphur was the 
 largest of any period during the investigation. 
 
 For the first time the post hemorrhagic efifect upon the phos- 
 phorus output was an increased elimination. There was an aver- 
 age daily increase of 0.180 gram (Tables VII and XIX). 
 
 VIII. FIFTH HEMORRHAGE. 
 
 No efforts were made to get the dog into nitrogen equilibrium 
 after the fourth hemorrhage, it being thought best to determine 
 the effect of another very severe hemorrhage before the organ- 
 ism had been given time to recover, in any great degree, from the 
 loss of blood occasioned by the fourth hemorrhage. 
 
 The same procedure was followed as at the other hemorrhages, 
 the blood being drawn from the right femoral artery above the 
 point of the fourth hemorrhage. 
 
 X'o pulse could be felt at the point determined upon for the in- 
 cision, but thinking the artery had changed position and become 
 more deeply imbedded in the tissues the incision was made. After 
 locating the artery it was found to be completely closed by a blood 
 clot which extended some distance above the incision of the fourth 
 hemorrhage. This necessitated another incision farther up. 
 
 It was determined to be guided entirely by the condition of the 
 subject as to the amount of the hemorrhage, as the loss of blood 
 was to be carried to the extreme limit. 
 
41 
 
 After a hemorrhage of 317.5 grams or 2.46% of the body 
 weight had been produced, it was very apparent, from the condi- 
 tion of the animal, that approaching death was indicated, and the 
 flow of blood was suspended. The number of red corpuscles in 
 the blood at this point was found to be 1,800,000 per cubic milli- 
 meter, thus indicating a very anaemic state. 
 
 In spite of very vigorous stirring in the presence of 25% NaCl 
 solution, the blood, while possessing a very thin watery appear- 
 ance as it flowed from the artery, soon coagulated. The whole 
 mass was filled with light colored flakes due to the greatly in- 
 creased number of leucocytes. 
 
 After being placed in his cage, and having recovered from the 
 eflfect of the ether, the animal failed to show his habitual desire 
 to sit up, but lay in a collapsed condition on the bottom of the 
 cage. At 12 o'clock, two hours after the hemorrhage, his respira- 
 tion was 9 and his pulse 152 per minute. At i P. M. 152 cc. of 
 urine was passed having a specific gravity of 1.0255, rr.uch high- 
 er than any former urine had shown on the day of hemorrhage. 
 At 4 P. M. his extremities were cold, axillary temperature was 
 subnormal, and in spite of the greatest efforts to preserve his life 
 the animal died 3 hours later. 
 
 I. Post-mortem Examination. — The bladder was removed and 
 14 cc. of urine with a specific gravity of 1.036 (the highest of any 
 sample during the entire investigation) was secured. From our 
 records it was learned that the dog urinated last at i P. M. and 
 therefore this 14 cc. of urine represented the total urine formation 
 for f} hours. Ordinarily the animal would have passed over 100 
 cc. during a period of that length. 
 
 All of the animal's organs were extremely pale, and showed 
 practically no tendency to bleed when cut. Even the heart was 
 blanched and upon laying it open, a very small clot in the left 
 ventricle was the only blood to be found. 
 
 In general the i)Ost-mortem examination showed conclusively 
 that a very great portion of the animal's blood had been removed. 
 As only about 300 cc. of blood was taken at the fifth hemorrhage, 
 it was evident that the regeneration of the volume during the 
 period since the fourth hemorrhage had been exceedingly slow. 
 
42 
 
 C— SECOND SERIES OF EXPERIMENTS. 
 
 This second series of experiments was much shorter than the 
 first series and was made principally for the purpose of check- 
 ing, upon another organism., the results from our first series. In 
 this second series the experiments were made upon a dog weigh- 
 ing 11.85kg. 
 
 In our first series the influence of anaesthesia-operation was not 
 determined until after the animal had been subjected to a prelim- 
 inary hemorrhage. In the present series, however, after getting 
 the organism into a condition of approximate nitrogen equilibrium 
 by means of a preliminary period, the influence, of anaesthesia- 
 operation was studied before any blood was drawn. Following 
 this, after returning to equilibrium, the efifect of hemorrhage was 
 studied. 
 
 The diet as shown by Table XV, was qualitatively the same as 
 that of the first series of experiments. 
 
 I. Preliminary Experiment. 
 
 In a preliminary period of nine days, during which the dog was 
 fed a constant diet, the organism was brought to approximate 
 nitrogen equilibrium. For this period, as may be seen from an 
 examination of Table XVI, there was an average daily loss of 
 but o.io gram of nitrogen to the body. The organism was there- 
 fore in an exceptionally good condition for the study of the influ- 
 ence of anaesthesia-operation. 
 
 II. Influence of Anaesthesia-Operation. 
 
 As has been said, the influence of anaesthesia-operation in the 
 first series of experiments was not determined until after the or- 
 ganism had been subjected to an initial hemorrhage. In order to 
 secure additional data the influence of anaesthesia-operation was 
 determined in the second series before the first hemorrhage. 
 
 As usual, the femoral artery was laid bare just above the point 
 at which the saphenous branch is given off. The incision was 
 longer and deeper than at any previous operation, in order to 
 demonstrate to the full any influence exerted by this operative 
 
43 
 
 procedure. The schedule of operations was as follows : — 8.22 A. 
 M.. anaesthesia begun. 8.26, trace of chloroform given. 8.55, 
 incision made. 9.20, wound sewed up. 9.45, returning conscious- 
 ness. 10.00. dog sat up. This animal was evidently more suc- 
 ceptible to the influence of the ether than the former beast as was 
 evidenced by the ease with which the preliminary anaesthesia was 
 conducted as well as by the weakness of the animal after con- 
 sciousness had returned. 
 
 The influence of anaesthesia-operation was studied through a 
 period of nine days. Here as in the case of the first series of ex- 
 periments, the anaesthesia-operation was followed by an imme- 
 diate rise in the excretion of nitrogen by the urine. The average 
 daily output of nitrogen by the urine, during the preliminary 
 period was 'j.'/'ii grams (Table XVII). On the first day of the 
 anaesthesia-operation period the nitrogen elimination was increas- 
 ed to 8.56 grams (Table X\TI) and the average daily output for 
 the first three days of the period was 9.12 grams. Taking the 
 whole nine days into consideration the average daily output of 
 nitrogen by the urine was 8.79 grams. The balance for the period 
 showed a daily loss of 1.09 grams of nitrogen to the organism 
 (Table X\'I). At the beginning of the period the organism was 
 losing o.io gram of nitrogen daily, and correcting for this we see 
 that the net effect of the anaesthesia-operation upon the excretion 
 of nitrogen has been to increase the output on an average 0.99 
 gram per day. 
 
 The general tendency of the sulphur excretion to follow a 
 course similar to that of the nitrogen excretion was noted here. 
 By means of the preliminary period of nine days the organism 
 was placed in a condition of almost exact sulphur equilibrium, the 
 average daily loss being 0.00 1 gram (Table XVIII). The in- 
 fluence of the anaesthesia-operation was shown in the form of an 
 increased sulphur excretion. During this period the organism 
 showed an average daily loss of 0.053 gram, thus signifying that 
 the sulphur excretion was increased 0.052 gram daily as the ef- 
 fect of the anaesthesia-operation, or a total increase of 0.496 gram 
 for the nine days. 
 
 As usual the phosphorus excretion showed a slight decrease as 
 the effect of the anaesthesia-operation. The animal at the open- 
 
44 
 
 ing of the period was losing 0.03 gram of phosphorus daily 
 (Table XVIII). Under the intiuence of the anaesthesia-operation 
 the phosphorus excretion decreased a trifle, making the average 
 daily loss for the period 0.025 gram. 
 
 III. Influence of Hemorrhage. 
 
 Upon June 20 a hemorrhage was induced in the left femoral 
 artery. The blood was withdrawn rapidly in this case, the total 
 amount of blood taken aggregating 342.5 grams or 3.11% of the 
 body weight of the animal. Due to the rapidity of the hemor- 
 rhage there were profound disturbances of pulse and respiration, 
 but these were of short duration. The schedule of operations was 
 as follows: — 8.15 A. M., anaesthesia begun. 8.20, chloroform 
 given. 8.35, operation begun. 8.50, cannula inserted. 8.53, 
 hemorrhage begun. 9.00, hemorrhage ended. 9.02, cannula re- 
 moved. 9.15, wound sewed up. 9.20, anaesthesia discontinued 
 and dog returned to cage. 9.50, dog stood up. 
 
 In complete agreement with the data for the combined effect of 
 hemorrhage and anaesthesia-operation in the first series of exper- 
 iments, we also find here in the second series that a considerable 
 increase in the excretion of nitrogen by the urine resulted. The 
 average daily excretion of nitrogen was 9.47 grams for the period 
 of five days following the hemorrhage (Table XVII). The 
 nitrogen balance for this period showed an average daily loss of 
 1.88 grams (Table XVI). Correcting this for the normal daily 
 loss of o.io gram, determined in the preliminary period, we find 
 that the combined effect of hemorrhage and anaesthesia-operation 
 has been to cause an average daily increase of 1.78 grams in the 
 excretion of nitrogen. And correcting further for the influence 
 of anaesthesia-operation (0.99 gram), we find that the withdrawal 
 of 342.5 grams of blood^ was instrumental in causing an average 
 daily increase of 0.79 gram in the nitrogen excretion throughout 
 a period of five days. 
 
 As usual the course of the sulphur excretion was similar to 
 that of nitrogen, while the phosphorus excretion instead of being 
 increased by the hemorrhage was slightly decreased (Table 
 XVIII). 
 
 IThe analysis of this blood was as follows : Nitrogen, 3.17 per cent.; sulphur, 0.156 per 
 cent.; phosphorus, 0.48 per cent. 
 
45 
 
 D.— ALTERATIONS IN THE SPECIFIC GRAV- 
 ITY, AND IN THE NITROGEN, SULPHUR 
 AND PHOSPHORUS CONTENT OF THE 
 BLOOD FOLLOWING HEMORRHAGE. 
 
 The first and second hemorrhages being separated from each 
 other by a period of nearly six weeks may be considered initial 
 hemorrhages. That is, the composition of the blood drawn on 
 Dec. 23 cannot be considered as the composition of the blood as 
 effected by the hemorrhage of Nov. 14, for it is well known that 
 the influence of a very severe hemorrhage would, so far as the 
 composition of the blood is concerned, have disappeared long be- 
 fore the second hemorrhage. Hence the blood drawn on Dec. 23 
 may be considered normal blood. 
 
 Of the elements under consideration the nitrogen appeared to 
 be the only one effected in any uniform manner by the successive 
 hemorrhages. With this element beginning Dec. 23, which may 
 be considered the commencement of the series of hemorrhages, 
 we note, by referring to Table II, the normal nitrogen content of 
 the blood to be 2.85%. Three weeks later the third hemorrhage 
 showed a nitrogen content of 2.38^, while following this, after 
 an interval of one week, the fourth hemorrhage gave us a nitrogen 
 value of 1.848%, and after a short interval of four days at the 
 fifth and final hemorrhage the minimum point v/as reached and 
 the surprisingly low nitrogen value of 1.421% was recorded. Thus 
 the effect of four successive hemorrhages in a period of one 
 month on the nitrogen content of the blood had been to decrease 
 the amount from 2.85% to 1.421%, a decrease of more than 50%. 
 There was an actual decrease of 16%; in the nitrogen content of 
 the blood at the third hemorrhage, of 22% at the fourth hemor- 
 rhage and of 23% at the fifth hemorrhage. The time between the 
 hemorrhages decreasing as it did from three weeks to only four 
 days at the final hemorrhage, there seems to have been a very pro- 
 nounced cumulative effect of some kind which produced in four 
 days time a greater percentage decrease in the content of nitrogen 
 than was previously secured after a lapse of three weeks. 
 
46 
 
 The sulphur did not exhibit the same regularity as the nitrogen. 
 It coincided, however, in showing the minimum output following 
 the last hemorrhage. The content of phosphorus also was not 
 governed by any uniformity, but differed radically from the nitro- 
 gen and sulphur in showing the maximum percentage at the last 
 hemorrhage. Hence the maximum phosphorus occurred coin-, 
 cidently with the minimum sulphur, and the minimum phosphorus 
 with the maximum sulphur (See analyses for fourth hemor- 
 rhage). 
 
 The specific gravity was lowered at each successive hemor- 
 rhage, falling from 1.0625 ^^ ^^^ ^^^^ hemorrhage to 1.047 ^^ the 
 fourth. The blood from the fifth hemorrhage showed a greatly 
 increased specific gravity. This was due to the fact that the blood 
 immediately after withdrawal, even in the presence of the 25% 
 NaCl solution, showed a tendency to coagulate. This of course 
 prevented the accurate determination of its specific gravity, and 
 made the specific gravity as determined much too high. We are 
 satisfied that the blood as drawn from the animal had a very low 
 specific gravity as it was extremely thin and watery. Without 
 doubt it was lower than that of any of the samples previously ex- 
 amined. 
 
 E.— RELATION BETWEEN TOTAL NITROGEN 
 AND VOLUME OF URINR 
 
 The ratio between the nitrogen content of the urine and the 
 urine volume showed quite decided fluctuations under different 
 experimental conditions. Starting with a ratio of i :55-9 for the 
 preliminary experiment (Table XIII), the first hemorrhage pro- 
 duced a very decided lowering of the ratio, the relation at this 
 time being i 145 .8. During the latter part of the first hemor- 
 rhage experiment the ratio gradually rose and at the time nitro- 
 gen equilibrium had been reached it was i :54.5. 
 
 The anaesthetic through its diuretic action now forced the ratio 
 still higher, the maximum point being reached during the last days 
 of the anaesthesia experiment. This was evidently due to the 
 cumulative diuretic effect of the ether. From the result obtained 
 
47 
 
 during the first days of the anaesthesia experiment we would natu- 
 rally expect a rise in the ratio during the first days of the anaes- 
 thesia-operation experiment. Here, however, although the anaes- 
 thesia was of the same duration as before, instead of a rise we ob- 
 tained a fall. This evidently indicated that the individual influ- 
 ence of the operation had been partly to overcome the rise due to 
 anaesthesia. The ratio rose slightly higher during the following 
 days of the experiment, but was at no time higher than the normal 
 ratio of the preliminary experiment. 
 
 The second hemorrhage produced a corresponding fall to that 
 observed after the first hemorrhage with a similar rise dtiring the 
 later days of the experiment. The third, fourth and fifth hemor- 
 rhages, while not strictly comparable with the first and second 
 hemorrhages, each showed a low ratio, those of the fourth and 
 fifth (I 143.0 and i 140.3) being the lowest of the whole investiga- 
 tion. This rapid fall in the ratio after the fourth and fifth hemor- 
 rhages was evidently due to the fact that while the regenerative 
 activities caused a large increase in proteid decomposition a cor- 
 responding increase in water output was impossible since the 
 water content of the body had been so greatly decreased by the 
 excessive blood-letting. 
 
 R— DISCUSSION OF RESULTS. 
 
 The data from our experiments indicate that the loss of blood 
 by an organism is followed immediately by an increased proteid 
 catabolism. And furthermore, it was plainly demonstrated, by a 
 series of hemorrhages on the same organism brought to a condi- 
 tion of nitrogen equilibrium before each loss of blood, that there 
 is a tendency under such conditions for the catabolism of proteid 
 to become more and more pronounced as the series progresses. 
 This was shown by a daily increase of 1.257 grams in the nitrogen 
 elimination as the result of a hemorrhage of 2.93% of the body 
 weight of the animal, followed some weeks later by a daily in- 
 crease of 3.275 grams in the nitrogen elimination after a hemor- 
 rhage of 3.26% of the body weight. 
 
48 
 
 The influence of the anaesthesia to which the animal was sub- 
 jected was to cause a daily decrease of 0.937 gram in the nitrogen 
 output.^ Another influencing factor was the operation which was 
 shown of itself to cause an increased proteid catabolism, the aver- 
 age daily nitrogen elimination being increased 1.706 grams. Now 
 taking the values named in the above paragraph as representing 
 the gross influence of the hemorrhage, and correcting them for 
 the influence of the anaesthesia and of the operation, we see that 
 the net efl^ect of the hemorrhage alone (Table XIX) was to cause 
 a daily increase in the nitrogen elimination varying from 0.488 
 gram after a loss of blood amounting to 2.93% of the body weight, 
 to 2.506 grams after a hemorrhage of 3.26% of the body weight. 
 
 The influence of the hemorrhage and its accompanying factors 
 upon the excretion of sulphur was similar to that noted in the case 
 of nitrogen. The daily increase in the sulphur excretion follow- 
 ing hemorrhage varied from 0.023 gram to 0.348 gram, and the 
 increase due to the anaesthesia-operation was 0.119 gram daily. 
 The anaesthesia of itself caused a daily decrease of 0.128 gram 
 in the sulphur excretion. 
 
 The phosphorus excretion, with a single exception, was influ- 
 enced by hemorrhage and its associated factors in a manner di- 
 rectly opposite to that in which the nitrogen and sulphur excre- 
 tions were influenced. In the case of the phosphorus the net in- 
 fluence of the hemorrhage alone was to cause a decrease in the 
 elimination, the daily decrease varying from 0.163 gram to 0.065 
 gram. The anaesthesia-operation caused a daily decrease of 0.148 
 gram and the anaesthesia alone caused a daily increase of 0.108 
 gram. The decrease in the elimination of phosphorus after hem- 
 orrhage we believe to be due primarily to the unusual demands 
 made upon nuclear material for the construction of leucocytes and 
 nucleated erythrocytes. 
 
 Upon the day of the hemorrhage the urine volume was invar- 
 iably sub-normal, but following this came a greatly increased out- 
 put of urine which generally reached its maximum on the third 
 or fourth day after the hemorrhage. This increase in the urine 
 volume was partly due no doubt to the diuretic influence of the 
 anaesthetic. Furthermore, the animal received a uniform supply 
 
 IHawk : Proceedings of the American Physiological Society, 1903. 
 
49 
 
 of water daily and this supply was sufficient for the dog under 
 normal conditions as was witnessed by the promptness with which 
 nitrogen equilibrium was reached. Upon withdrawing a large 
 amount of blood, however, this normal water supply was more 
 than sufficient for the needs of the altered metabolism, and there- 
 fore a portion of the excess was excreted. As was to have been 
 expected this large urine volume was accompanied by an increased 
 elimination of nitrogen, this increase being due in part to a flush- 
 ing-out of the tissues as well as to a direct stimulation of proteid 
 catabolism.^ 
 
 The body weight of the animal decreased very materially on the 
 day of the hemorrhage, the decrease being due apparently as much 
 to the influence of the anaesthesia- as to the effect of the loss of 
 blood. 
 
 The well konwn leucocytosis followed the hemorrhages and a 
 decrease in the number of erythrocytes was also noted. As has 
 already been stated on page 41, a most remarkable leucocytosis 
 was observed at the time of the fifth hemorrhage. 
 
 The appetite of the subjects, with the single exception noted, 
 (page 39). continued uniformly good throughout the experi- 
 ments, even when the body weight of the animal had decreased 
 very considerably. The regular normal diet which was just suffi- 
 cient to bring the organism weighing about 17kg. to nitrogen 
 equilibrium was very probably in excess of the needs of the body 
 when the weight had been reduced to about 13kg. at the time of 
 the fourth hemorrhage. Therefore this excessive amount of pro- 
 teid material may have tended to stimulate proteid catabolism and 
 thus assisted in the production of the maximum increase in the 
 nitrogen elimination which was observed at that time. 
 
 G.— CONCLUSIONS. 
 
 I. Hemorrhages of 2.9% to 3.5% of the body weight u])on 
 dc^s fed a constant diet and in a condition of nitrogen equilib- 
 rium, caused an increased urinary elimination of nitrogen and sul- 
 phur and a decreased elimination of phosphorus. 
 
 ' Hawk : fniversity of Pennsylvania Medical Bulletin, igo.s.XVIII., 7. 
 2 Hawk : Proceedings of the American Pliysiological Society, 1903. 
 
50 
 
 2. Ether anaesthesia incident to ordinary surgical procedure 
 was followed by a decreased elimination of nitrogen and sulphur 
 and an increased elimination of phosphorus and chlorine. 
 
 3. The combined effect of the ether anaesthesia and the opera- 
 tive procedure was to cause an increased elimination of nitrogen, 
 sulphur and chlorine and a decreased elimination of phosphorus. 
 
 4. After hemorrhages of 2.9% to 3.5% of the body weight there 
 was an immediate decrease in the volume of urine. This decrease 
 was followed after the first day by an increase and the maximum 
 urine volume generally occurred on the third or fourth day after 
 the hemorrhage. 
 
 5. Ether anaesthesia unaccompanied by loss of blood, produced 
 an immediate diuresis which caused the maximum urine volume 
 to appear vipon the day of the anaesthesia. 
 
 6. Successive hemorrhages on the same organism caused a 
 gradual decrease in the nitrogen and sulphur content of the blood, 
 and a less regular decrease in the phosphorus content. 
 
 7. In a series of hemorrhages the specific gravity of the blood 
 gradually decreased to the end of the series. 
 
 8. Repeated hemorrhages at intervals of from one to five weeks 
 caused the coagulation rate of the blood to shorten very percepti- 
 bly, particularly at the end of the series. 
 
 9. A decrease in body weight followed hemorrhage. 
 
 10. There was a pronounced leucocytosis and a decrease in the 
 number of erythrocytes after hemorrhage. 
 
 11. Hemorrhage caused no disturbance of the digestive func- 
 tions and had no effect upon intestinal putrefaction. 
 
 The author wishes to express his sincere thanks to Prof. W. J. 
 Gies under whose direction this investigation was conducted. 
 
 H.— BIBLIOGRAPHY, 
 
 1. Bauer : Zeitschrift fiir Biologie, 1872, VIII., p. 567. 
 
 Miinchener Medicinische Wochenschrift, 1892, 39, p. 537 
 
 2. Jiirgensen : v. Ziemssen's Handbuch d. Allgenieine Therapie, 1880. 
 
 3. Maltschewsky : Thesis (Russian), 1892. 
 
 4. Ascoli and Draghi : Berliner Klinische "Wochenschrift, 1900, 37, p. 
 1055- 
 
51 
 
 5- Frankel : Virchow's Archiv, 1876, LXVII. 
 
 6. V. Noorden : Lehrbuchder Pathologic desStofFwechsels, Berlin, 1893. 
 
 7. Lukjanow : Zeitschrift fiir Phys. Chem. 1883, VIII., p. 336. 
 
 8. Giirber : Miinchener ]Medicinische Wochenschrift, 1892, 39, pp. 416 
 and 605. 
 
 9. Autokonenko : Archives des sciences biologiques, 1893, II., p. 516. 
 
 10. Baumann : Journal of Physiology, 1903, 29, p. 18. 
 
 11. Luzet : Archives de physiologic nortnale et pathologiquc, 1891, 3, 
 P- 455- 
 
 12. Vulpain : Comptes rendus des sceances de I'acadcmic des sciences, 
 1877, 84, p. 1279. 
 
 13. Hiinerfauth : Virchow's Archiv, 1879, 76, p. 310. 
 
 14. Buntzen : Copenhagen, 1879, p. 56. Quoted by Jiirgensen. 
 
 15. V. Lesser: Archiv fiir Anatomic und Physiologic ( Physiologische 
 Abtheilung), 1S78, p. 74, 
 
 16. Lyon : Virchow's Archiv, 84. Quoted by Autokonenko. 
 
 17. Bizzozcro and Salvioli : Arch, per lescienze mediche, IV., 12, p. 273. 
 
 18. Monassein : Tiibingen, 1872, p. 41. 
 
 19. Tschoudnowsky : Thesis (Russian), 1869. Quoted by Autokonenko. 
 
 20. Riedcr : Bcitriige zur Kenntniss der Lencocytosis und verwandter 
 zustande des Blutes, 1892, p. 90. 
 
 21. Haycm : Lecons sur les modifications du sang, Paris, 1882. 
 
 22. Himmelstjerna : Dissertation, 1882, p. 25. Quoted by Autokonenko. 
 
 23. Virchow : Die Cellularpathologie, Berlin, 1862. 
 
 24. Limbeck : Grundriss einen clinischcn pathologic des Blutes, 1892, 
 p. 49- 
 
 25. Molassez : Gazette Medicale de Paris, 1880, II., p. 465. 
 
 26. Henle : Quoted by Jiirgensen and Autokonenko. 
 
 27. Rcmak : Quoted by Jiirgensen and Autokonenko. 
 
 28. Woltersom : Quoted by Donders, Phys. des Menschen, I., p. 166. 
 Quoted by Bauer. 
 
 29. Conheim : ] 
 
 30. Massart and Bordet : I 
 
 31. Gabritschewsky : j 
 
 32. Afanasiew : I 
 
 33. Leber : j- Quoted by Autokonenko. 
 
 34. Roemer : I 
 
 35. Buchner : 
 
 36. Escherich : 
 
 37. Foster : J . ' 
 
 38. Leichtenstcrn : Zeitschrift fiir Biologic, 1868, VII., p. 215. 
 
 39. Kussniau! and Tenner : Frankfort, 1857. Quoted by Bauer and 
 Jiirgen.sen. 
 
 40. Naunyn and Quinke : Du Bois Reymond's Archiv, 1869, Heft 2. 
 
 41. Gies : American Journal of Physiology, 1903, IX., p. 13. 
 
52 
 
 42. Worm-MuUer : Berichte der Sachsischen Gesellschaft der Wissen- 
 schaften, 1873, p. 642. 
 
 43. Volkmann : Die Hamodynamik, p. 197. 
 
 44 
 45 
 46 
 
 47 
 48 
 
 49 
 50 
 51 
 52 
 53 
 54 
 55 
 56 
 57 
 58 
 
 59 
 60 
 61 
 62 
 
 63 
 64 
 
 65 
 
 66 
 
 67 
 von 
 68 
 69 
 70 
 71 
 72 
 73 
 74 
 
 Nawrotzky : 
 
 Magendie : [Quoted by Bauer. 
 
 Nawlichen : 
 
 Hayem : Loc. cit. 
 
 Hall : Quoted by Liebernieister in v. Ziemmsen's Handbuch, 1880, 1. 
 
 Traube : Quoted by Bauer. 
 
 Spielnian : 1 
 
 Frese and Charaszewski : > Quoted by Jiirgensen. 
 
 Wunderlich : J 
 
 Briicke : Virchow's Archiv, 1857, XII., p. 179. 
 
 Nasse : Das Blut, Bonn, 1836, p. 156. 
 
 Jiirgensen : Loc. cit. 
 
 Mayer : Quoted by Jiirgensen. 
 
 Vierordt : Archiv der Heilkunde, XIX., p. 193. 
 
 Briicke : Loc. cit. 
 
 Nasse : Loc. cit. 
 
 Baumann : Loc. cit. 
 
 Sherrington and Copenian : Journal of Physiology, 1893, XIV , p. 52. 
 
 [■Quoted by Sherrington and Copeman. 
 
 Jones : 
 
 Bizzozero and Salvioli : Loc. cit. 
 Woltersoni : Loc. cit. Quoted by Vierordt. 
 Baumann : Loc. cit. 
 
 Tolmatscheff : Medicinische Chem. Untersuchungen herausgegeben 
 Hoppe-Seyler, Tiibingen, III., p. 400. 
 Bauer : Loc. cit. 
 Jiirgensen : Loc. cit. 
 Lister : Quoted by Jiirgensen. 
 Hiinerfauth : Loc. cit. 
 
 Goll : Zeitschrift fiir Rationelle Medicin, Neue Folge, 1854, IV., p. 78. 
 Schramm : Medic. Jahrbiicher, Wien, 1885, p. 492. 
 V. KireefF: Archiv fiir Anatomic und Physiologic (Physiologische 
 Abtheilung), 1884, p. 156. 
 
 75. Hayem : Loc. cit. 
 
 76. Noll : Quoted by Kronecker. 
 
 77. Kronecker : Correspondenzblatt fiir Schweizer Aerzte, 1886, 16. 
 
 78. Ott : Thesis (Russian), 1884, p. 32. 
 
 79. Maydl : Medic. Jahrbiicher, Wien, 1884, p. 77. 
 
 80. Schramm : Loc. cit. 
 
 81. Prevost and Dumas : Quoted by Maydl. 
 
 82. Skvortsov : Inaugural Dissertation, St. Petersburg, 1890. Quoted 
 in Bulletin 45, Office of Experiment Stations, Department of Agriculture* 
 U. S. A. 
 
53 
 
 S3. Debierre and Linossier: Bulletin General de Therapeutique, 1885, 
 CVIII, p. 167. 
 
 84. Emminghaus : Bar. uber d. Verhandl. d. Kouig. 
 
 Sachs ; Gesellsch. d. Wiss. Z. Leipzig, 1S73, XXV. 
 
 85. Fleischer and Penzoldt : Deutsches Archiv fiir Klinische Medicin, 
 1880, XXVI., p. 400. 
 
 86. Lipmann-Wulf : v. Noorden's Beitrage zur Lehre vom Stoffwechsel, 
 1892, I., 24. 
 
 87. Ketcher : Vrach, 11, p. 1042. Quoted in Bulletin 45 (loc. cit). 
 
 88. Moraczewski : Zeitschrift fiir Klinische Medicin, 1897, 33. 
 
 89. Eichorst : Die progress, pernic. Anamie, Leipzig, 1S78, p. 205. 
 Quoted by v. Noordeu. 
 
 90. Burzhinski : Vrach, 10, p. 994. Quoted in Bulletin 45, (loc. cit). 
 
 91. Sticker : Zeitschrift fiir Klinische Medicin, 1888, 14. 
 
 92. Albrecht : Jahrbuch fiir Kinderheilkunde, 1882, 18, p. i. 
 
 93. Hayem : Loc. cit. 
 
 94. Rieder : Loc. cit. 
 
 95. Hayem : Loc. cit. 
 
 96. Samuel : Manuel de pathologic general, 1S79, p. 254. 
 
 97. King : American Journal of the Medical Sciences, 1902, CXXIV., 
 p. 450. 
 
 98. Mosler : Leukamie. Quoted by Bauer. 
 
 99. Lowit : Virchow's Archiv, 117, p. 569. 
 
 100. Miiller : Deutches Archiv fiir Klinische Medicin, 1901, 48. 
 loi. Osier: Osier's Practice of Medicine, p. 789. 
 
 102. V. Noorden : Loc. cit. 
 
 103. Neusser : Wiener Klinische Wochenschrift, 1897, 10, p. 629. 
 Quoted by Kolisch. 
 
 104. Kolisch : Wiener Klinische Wochenschrift, 1897, 26, p. 628. 
 
 I.— BIOGRAPHICAL. 
 
 Philip Bovier Hawk graduated from Wesleyan University in 
 1898 with the degree of Bachelor of Science. During the next 
 two years (1898-1900) he was assistant to Prof. W. O. Atwater 
 of We.sleyan University. During this time he also did graduate 
 work in the University and received the degree of Master of 
 Science in 1900. As a university scholar, in 1900- 1901, he pur- 
 sued graduate studies in physiological cheniistr}^ and physiology 
 in Yale University and in 1902 received the degree of Master of 
 Science from that institution. He served as assistant in physi- 
 
54 
 
 ological chemistry in Columbia University (College of Physicians 
 and Surgeons) during 1901-1903, at the same time pursuing 
 graduate work in physiological chemistry. In 1903 the degree 
 of Doctor of Philosophy was conferred upon him by Columbia 
 University. 
 
 He is a member of Delta Kappa Epsilon, Sigma Xi, the Ameri- 
 can Physiological Society and the Society for Experimental 
 Biology and Medicine. 
 
 J.— PUBLICATIONS. 
 
 1. On the elimination of nitrogen, sulphates and phosphates after the 
 ingestion of proteid food (with H. C. Sherman); American Journal of Physi- 
 ology, 1900, IV., p. 25. 
 
 2. Chemical studies of osseomucoid, with determinations of the heat of 
 combustion of some connective tissue glucoproteids (with W. J. Gies); 
 American Journal of Physiology, 1901, V., p. 387. 
 
 3. On the composition and chemical properties of osseoalbumoid, with a 
 comparative study of the albumoid of cartilage (with W. J. Gies); American 
 Journal of Physiology, 1902, VII., p. 340. 
 
 4. On the quantitative determination of acid albumin in digestive mix- 
 tures (with W. J. Gies); American Journal of Physiology, 1902, VII., p. 460. 
 
 5. On the influence of rennin upon the digestion of the proteid constitu- 
 ents of milk ; American Journal of Physiology, 1903, X., p. 37. 
 
 6. On the time relations of proteid metabolism ; American Journal of 
 Physiology, 1903, X., p. 115. 
 
 7. A study in the course of the nitrogen, sulphate and phosphate excre- 
 tion, as observed in short periods following a small increase in the proteid 
 ingested (with Joseph S. Chamberlain); American Journal of Physiology, 
 1904, X., p. 269. 
 
 8. On the morphological changes in the blood after muscular exercise ; 
 American Journal of Physiology, 1904, X., p. 384. 
 
 9. On the influence of external hemorrhage on chemical changes in the 
 organism, with particular reference to proteid catabolism (with W. J. Gies); 
 American Journal of Physiology, 1904, XI., p. 171. 
 
 10. On the influence of copious water drinking ; University of Pennsyl- 
 vania Medical Bulletin, 1905, XVIII., p^ 7. 
 
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59 
 
 TABLE v.— ELIMINATION OF URINE 
 As Influenced by Anaesthesia and Hemorrhage 
 
 
 
 
 
 1/ 
 
 II 
 
 
 Experiment. 
 
 Date. 
 
 Time 
 Begun. 
 
 First urine 
 passed. 
 
 Hour s 
 operatioi 
 u r i ti e 
 passed. 
 
 Remarks- 
 
 1902 
 
 a. m. 
 
 p. m. 
 
 
 
 
 First hemor- 
 rhage Inov. 14 
 
 (2.93 percent.) 
 
 8.10 
 
 Between Mid- 
 night and S.30 
 a. m. 
 
 (Nov. 15th) 
 
 16 — 24 
 
 300 
 
 
 Anaesthesia . . . Nov. 30 
 
 9 10 
 
 4- 15 
 
 7 
 
 283 
 
 
 Anaesthesia — 
 operation . . . Dec. 10 
 
 8.12 
 
 4.20 
 
 8 
 
 294 
 
 
 Second hemor- 
 rhage 
 
 (3.22 per cent.) 
 
 Third hemor- 
 rhage 
 
 (351 per cent.) 
 
 Dec. 23 
 
 1903 
 Jan. 13 
 
 8.14 
 8.20 
 
 Between Mid- 
 night and 9 
 
 a. m. 
 (Dec. 24) 
 
 1-2 
 
 16 — 25 
 5-6 
 
 590 
 180 
 
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 the operation. Hence 
 1 the major portion of the 
 ■ 180 cc. passed between 
 I p. m. and 2. p. m. was 
 evidently in the bladder 
 at the time of operation. 
 
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 8.29 
 
 8.30 
 
 12 
 
 200 
 
 f No more urine until after 
 (I p. m. Jan. 2i.st. - 
 
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 i/) 
 
 00 
 
 uS 
 
 ■4 
 
 rO 
 
 ^ 
 
 
 
 
 
 
 
 
 
 -55 
 
 
 
 
 
 
 
 
 
 u 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ^ 
 
 re* 
 
 lO 
 
 :^ 
 
 t^ 
 
 lo 
 
 lO 
 
 o 
 
 Tf 
 
 ^ 
 
 «E5 
 
 T 
 
 r^ 
 
 ^ 
 
 LO 
 
 (N 
 
 o> 
 
 ON 
 
 •:; 
 
 1m 
 
 "S- 
 
 LO 
 
 lO 
 
 >£! 
 
 t^ 
 
 \o 
 
 t~» 
 
 w 
 
 S 
 
 d 
 
 d 
 
 d 
 
 d 
 
 d 
 
 d 
 
 d 
 
 ii 
 
 
 
 
 
 
 
 
 c 
 
 
 
 
 
 
 
 
 K « 
 
 
 
 
 
 
 
 
 «-^ 
 
 
 
 
 
 
 
 
 
 0^ 
 
 CTn 
 
 (N 
 
 »-i 
 
 o 
 
 j^ 
 
 ■* 
 
 CO 
 
 CO 
 
 ts 
 
 •^ 
 
 rO 
 
 t^ 
 
 lO 
 
 '^ 
 
 '3- 
 
 lO 
 
 ID 
 
 lO 
 
 ■^ 
 
 lO 
 
 <:c 
 
 
 
 
 
 
 
 
 x 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 o w 
 
 
 
 
 
 
 
 
 (N 
 
 vO 
 
 o 
 
 <r> 
 
 » 
 
 t^ 
 
 ^ 
 
 d n 
 
 
 
 
 
 (S 
 
 
 
 ^•= 
 
 
 
 
 
 
 
 
 
 
 
 c^ 
 
 
 M 
 
 
 
 
 r^ 
 
 ON 
 
 1 
 
 
 
 ^ 
 
 o 
 
 
 V 
 
 T M 
 
 T 
 
 1 
 
 1 
 
 o 
 
 V 
 
 1 
 
 i 
 
 « 
 
 . CT> 
 
 
 o 
 
 
 
 
 
 Q 
 
 > - 
 
 O 
 
 > 
 
 O 
 
 r<5 
 > 
 
 o 
 
 Q 
 
 re 
 >— > 
 
 C 
 a; 
 >— 1 
 
 
 
 
 Z 
 
 
 Q 
 
 
 
 
 
 
 
 
 
 n 
 
 
 
 
 
 
 
 
 
 
 _o 
 
 
 
 
 
 
 
 1 ^ 
 
 
 
 
 
 ' ^ 
 
 ^ --^ 
 
 
 
 
 
 
 
 CS 
 
 V . 
 
 &C . 
 
 
 
 
 i) ^ 
 
 
 
 u 
 
 W w 
 
 M*' 
 
 « -^ 
 
 ^ 
 
 
 
 M = 
 
 
 
 ^ 
 
 J c 
 
 « C 
 
 ji a 
 
 c 
 
 
 
 CB 1* 
 
 
 
 a 
 
 u m 
 
 J 1» 
 
 u 4) 
 
 g 
 
 
 
 J3 W 
 
 
 
 o 
 
 2" 
 
 t: u 
 
 te w 
 
 
 IR 
 
 .2 
 
 1 
 .2 
 
 2S 
 
 2 u 
 
 Cu 
 
 w 
 
 
 |S 
 
 
 Hi 
 
 
 01 ^ 
 — lO 
 
 
 
 .^ 
 
 ^ (N 
 
 '■fi 
 
 1^ 
 
 
 •rr -^ 
 
 1 -!? 
 
 
 "^ 
 
 ■yj — • 
 
 n 
 
 2 
 
 .C^ ^"^ 
 
 o 
 
 
 k> 
 
 
 
 
 u 
 
 
 
 
 C- 
 
 
 '•^ 
 
 < 
 
 
 < 
 
 t/5 
 
 H 
 
 fc 
 
66 
 
 TABLE XII. 
 
 Daily Data of the First Series of Experiments. 
 
 /. Preliminary Experiment, Nov. 2-1 j, igo2 
 
 
 Body- 
 weight. 
 
 Urine. 
 
 Feces. 
 
 Day 
 
 No. 
 
 Volume. 
 
 Specific 
 gravity. 
 
 Nitrogen. 
 
 Period average to date. 
 
 Weight. 
 
 
 
 
 
 
 
 
 
 
 
 Volume. 
 
 Nitrogen. 
 
 Fresh. 
 
 Dry. 
 
 
 kilos 
 
 cc. 
 
 
 grams 
 
 cc. 
 
 grams 
 
 grams 
 
 grams 
 
 I 
 
 16.96 
 
 499 
 
 1017 
 
 8.30 
 
 499 
 
 8.30 
 
 46.5 
 
 24.4 
 
 2 
 
 16.96 
 
 581 
 
 1019 
 
 10.23 
 
 540 
 
 9.26 
 
 
 
 3 
 
 16.96 
 
 394 
 
 I02I 
 
 7.82 
 
 491 
 
 8.78 
 
 43-1 
 
 22.1 
 
 4 
 
 16.95 
 
 499 
 
 1020 
 
 9.84 
 
 493 
 
 9-05 
 
 .^5-8 
 
 19.7 
 
 5 
 
 16.92 
 
 461 
 
 1020 
 
 8.56 
 
 487 
 
 8.95 
 
 27.8 
 
 15-6 
 
 6 
 
 16.89 
 
 445 
 
 1020 
 
 8.10 
 
 480 
 
 8.81 
 
 71. 1 
 
 36.4 
 
 7 
 
 17.01 
 
 400 
 
 IO18 
 
 6.51 
 
 468 
 
 8.48 
 
 
 
 8 
 
 16.78 
 
 662 
 
 IOI8 
 
 11.27 
 
 493 
 
 8.83 
 
 54.1 
 
 .38.1 
 
 9 
 
 16.91 
 
 436 
 
 IOI8 
 
 7-33 
 
 486 
 
 8.66 
 
 32.4 
 
 18.2 
 
 10 
 
 16.83 
 
 443 
 
 IOI9 
 
 7.71 
 
 482 
 
 8.57 
 
 30.6 
 
 17.7 
 
 II 
 
 16.85 
 
 486 
 
 IOI9 
 
 8.57 
 
 482 
 
 8.57 
 
 32.3 
 
 17.8 
 
 12 
 
 16.80 
 
 560 
 
 IOI9 
 
 10.60 
 
 489 
 
 8.74 
 
 27.2 
 
 14.4 
 
 //. First Hemorrhage, (2.93 per cent.) Nov. f4-2g, igo2 
 
 13 
 
 16.29 
 
 377 
 
 1017 
 
 6.33 
 
 377 
 
 6.33 
 
 34-3 
 
 20.2 
 
 14 
 
 16.20 
 
 556 
 
 1027 
 
 13-34 
 
 467 
 
 9.84 
 
 
 
 15 
 
 ]6.20 
 
 501 
 
 1022 
 
 10.87 
 
 478 
 
 10.18 
 
 36-1 
 
 20.5 
 
 16 
 
 16.25 
 
 370 
 
 1022 
 
 763 
 
 451 
 
 9-54 
 
 69.1 
 
 34-1 
 
 17 
 
 16.20 
 
 570 
 
 1025 
 
 13-67 
 
 475 
 
 10.37 
 
 
 
 18 
 
 16.32 
 
 • 307 
 
 1017 
 
 5-25 
 
 447 
 
 9-51 
 
 45-3 
 
 23-1 
 
 19 
 
 16.37 
 
 475 
 
 1022 
 
 9.84 
 
 451 
 
 9-56 
 
 33-6 
 
 20.0 
 
 20 
 
 16.33 
 
 586 
 
 1021 
 
 11.40 
 
 468 
 
 9-79 
 
 38.2 
 
 19.0 
 
 21 
 
 16.34 
 
 462 
 
 1020 
 
 9.69 
 
 467 
 
 9.78 
 
 41.8 
 
 27-5 
 
 22 
 
 16.33 
 
 512 
 
 1019 
 
 8.84 
 
 472 
 
 9.69 
 
 
 
 23 
 
 16.32 
 
 520 
 
 1018 
 
 8.20 
 
 476 
 
 9-55 
 
 37-5 
 
 19-5 
 
 24 
 
 16.28 
 
 498 
 
 1019 
 
 9.41 
 
 478 
 
 9-54 
 
 37-1 
 
 20.7 
 
 25 
 
 16.29 
 
 463 
 
 102 1 
 
 9.28 
 
 477 
 
 9-52 
 
 35-8 
 
 17.4 
 
 26 
 
 16.27 
 
 444 
 
 1019 
 
 7-56 
 
 474 
 
 9-38 
 
 42.5 
 
 21.6 
 
 27 
 
 16.18 
 
 576 
 
 1019 
 
 IO-33 
 
 481 
 
 9-44 
 
 40.3 
 
 20.0 
 
 28 
 
 16.09 
 
 615 
 
 1020 
 
 11.04 
 
 489 
 
 9-54 
 
 32-8 
 
 16.9 
 
 ^ 
 
 
 ///. Anaesthesia, Nov. 
 
 SO- Dec. 9 
 
 igo2 
 
 
 
 29 
 
 i5-8i 
 
 654 
 
 1018 
 
 8.59 
 
 654 
 
 8.59 
 
 64.0 
 
 35-9 
 
 30 
 
 15-85 
 
 495 
 
 1021 
 
 8.56 
 
 575 
 
 8.58 
 
 
 
 31 
 
 15.88 
 
 467 
 
 1019 
 
 8.80 
 
 539 
 
 8.65 
 
 36.2 
 
 20.1 
 
 32 
 
 16.02 
 
 388 
 
 1021 
 
 8.22 
 
 501 
 
 8.54 
 
 31.3 
 
 16.7 
 
 33 
 
 16.03 
 
 512 
 
 1020 
 
 10.70 
 
 503 
 
 8.97 
 
 59-3 
 
 32.6 
 
 34 
 
 16.09 
 
 458 
 
 loiq 
 
 8.06 
 
 496 
 
 S.82 
 
 
 
 35 
 
 16.00 
 
 570 
 
 1018 
 
 9.01 
 
 506 
 
 8.85 
 
 64.0 
 
 36.4 
 
 36 
 
 16.00 
 
 555 
 
 1018 
 
 8.78 
 
 512 
 
 8.84 
 
 32.6 
 
 17-3 
 
 37 
 
 15-98 
 
 593 
 
 1017 
 
 9.20 
 
 521 
 
 8.88 
 
 
 
 38 
 
 15-94 
 
 532 
 
 1020 
 
 9-65 
 
 522 
 
 8.96 
 
 71.9 
 
 35-3 
 
^7 
 
 TABLE XII {Co7iti7iued) 
 /K Anaesthesia^Operation, Dec. 10-22, igo2 
 
 
 Body- 
 weight. 
 
 Urine. 
 
 Feces. 
 
 Day 
 
 No. 
 
 Vohime. 
 
 Specific 
 gravity. 
 
 Nitrogen. 
 
 Period average to date. 
 
 Weight. 
 
 
 
 
 
 
 
 
 
 
 
 Volume. 
 
 Nitrogen. 
 
 Fresh. 
 
 Dry. 
 
 
 kilos 
 
 cc. 
 
 
 grams 
 
 cc. 
 
 grams 
 
 grams 
 
 grams 
 
 39 
 
 15-44 
 
 754 
 
 I018 
 
 9-98 
 
 754 
 
 9-98 
 
 40.0 
 
 20.5 
 
 40 
 
 15-42 
 
 572 
 
 1020 
 
 10.72 
 
 663 
 
 10.35 
 
 
 
 41 
 
 15.64 
 
 330 
 
 I019 
 
 6-73 
 
 552 
 
 9-15 
 
 35-2 
 
 19.0 
 
 42 
 
 15-67 
 
 520 
 
 1024 
 
 12.28 
 
 544 
 
 9-93 
 
 28.1 
 
 15-5 
 
 43 
 
 15-68 
 
 530 
 
 1020 
 
 10.07 
 
 541 
 
 9.96 
 
 63-4 
 
 35-4 
 
 44 
 
 15-68 
 
 596 
 
 IOI8 
 
 9.27 
 
 550 
 
 9.84 
 
 
 
 45 
 
 15-72 
 
 400 
 
 IOI9 
 
 7-77 
 
 529 
 
 9-55 
 
 41.9 
 
 21.7 
 
 46 
 
 15-69 
 
 558 
 
 1020 
 
 II. 12 
 
 533 
 
 9-75 
 
 I18.8 
 
 51-4 
 
 47 
 
 15-68 
 
 526 
 
 1023 
 
 12.81 
 
 532 
 
 10.09 
 
 
 
 48 
 
 15-66 
 
 556 
 
 I02I 
 
 10.87 
 
 534 
 
 10.16 
 
 21-3 
 
 15-7 
 
 49 
 
 15-74 
 
 405 
 
 IO18 
 
 7-41 
 
 522 
 
 9.91 
 
 32.5 
 
 15-7 
 
 50 
 
 15-70 
 
 575 
 
 IOI8 
 
 9.68 
 
 527 
 
 9.89 
 
 51-0 
 
 29-3 
 
 51 
 
 15-72 
 
 5S0 
 
 IO18 
 
 10.00 
 
 53r 
 
 9.90 
 
 23.2 
 
 13-3 
 
 l^. Second Hemorrhage {j. 22 per cent.) Dec. 2j, igo2-Jan. 12, /goj 
 
 52 
 
 15-18 
 
 428 
 
 1014 
 
 5.58 
 
 428 
 
 5-58 
 
 30.3 
 
 19.1 
 
 53 
 
 15-09 
 
 590 
 
 1027 
 
 13-51 
 
 509 
 
 9-55 
 
 
 
 54 
 
 14.92 
 
 579 
 
 1024 
 
 13.06 
 
 532 
 
 10.72 
 
 30.6 
 
 16.8 
 
 55 
 
 14.76 
 
 620 
 
 1020 
 
 11.62 
 
 554 
 
 10.94 
 
 57-8 
 
 37-7 
 
 56 
 
 14.76 
 
 478 
 
 1026 
 
 II. 89 
 
 539 
 
 II. 13 
 
 26.5 
 
 18.3 
 
 57 
 
 14.76 
 
 447 
 
 1024 
 
 10.27 
 
 524 
 
 10.99 
 
 18.4 
 
 II. I 
 
 5« 
 
 14-77 
 
 534 
 
 1024 
 
 13-19 
 
 525 
 
 11.30 
 
 27.8 
 
 14-7 
 
 59 
 
 14.77 
 
 482 
 
 1022 
 
 10.93 
 
 520 
 
 ir.26 
 
 41-5 
 
 20.7 
 
 60 
 
 14.78 
 
 415 
 
 lorS 
 
 7.02 
 
 508 
 
 10.78 
 
 48.7 
 
 24-5 
 
 61 
 
 14-75 
 
 566 
 
 1023 
 
 11.77 
 
 514 
 
 10.88 
 
 24.3 
 
 16.7 
 
 62 
 
 14.70 
 
 598 
 
 1019 
 
 10.29 
 
 52r 
 
 10.83 
 
 33-5 
 
 16.9 
 
 63 
 
 14.64 
 
 600 
 
 1020 
 
 11.47 
 
 528 
 
 10.88 
 
 31.8 
 
 16.8 
 
 64 
 
 14.56 
 
 534 
 
 1020 
 
 10.33 
 
 529 
 
 10.84 
 
 69.0 
 
 37-7 
 
 65 
 
 14.44 
 
 620 
 
 1019 
 
 10.97 
 
 535 
 
 10.85 
 
 
 
 66 
 
 14-46 
 
 468 
 
 1020 
 
 9-48 
 
 531 
 
 10.76 
 
 35-5 
 
 17-5 
 
 67 
 
 14-45 
 
 546 
 
 1021 
 
 10.97 
 
 532 
 
 10.77 
 
 69.1 
 
 35-9 
 
 68 
 
 14-43 
 
 522 
 
 1019 
 
 9.61 
 
 5.^t 
 
 10.70 
 
 
 
 69 
 
 14-45 
 
 510 
 
 1020 
 
 9-84 
 
 530 
 
 10.65 
 
 48.9 
 
 26.3 
 
 70 
 
 14-38 
 
 542 
 
 1019 
 
 972 
 
 531 
 
 10.61 
 
 33-5 
 
 21.0 
 
 71 
 
 14.40 
 
 518 
 
 io;8 
 
 9 22 
 
 530 
 
 10.54 
 
 37-8 
 
 19.8 
 
 72 
 
 14.42 
 
 534 
 
 1018 
 
 9.17 
 
 530 
 
 10.47 
 
 103.8 
 
 46.1 
 
68 
 
 85 
 
 TABLE XII {^Continued^ 
 VI. Third Hemorrhage {3.51 per cent. ) Jan. 13-19, 1903 
 
 
 Body- 
 weight. 
 
 Urine. 
 
 Feces. 
 
 Day 
 
 No. 
 
 Volume. 
 
 Specific 
 gravity. 
 
 Nitrogen. 
 
 Period average to date. 
 
 Weight. 
 
 
 
 
 
 
 
 
 
 
 
 Volume. 
 
 Nitrogen. 
 
 Fresh. 
 
 Dry. 
 
 
 kilos 
 
 cc. 
 
 
 grams 
 
 cc. 
 
 grams 
 
 grams 
 
 grams 
 
 73 
 
 13.76 
 
 460 
 
 IOI8 
 
 7.91 
 
 460 
 
 7.91 
 
 
 
 74 
 
 13.80 
 
 475 
 
 1026 
 
 11-55 
 
 468 
 
 9-73 
 
 
 ... 
 
 75 
 
 13-70 
 
 624 
 
 I02I 
 
 13.01 
 
 520 
 
 10.82 
 
 47-5 
 
 23.0 
 
 76 
 
 13.76 
 
 394 
 
 1023 
 
 9-03 
 
 488 
 
 10.38 
 
 42.3 
 
 21.7 
 
 77 
 
 13.82 
 
 412 
 
 1024 
 
 10.44 
 
 473 
 
 10.39 
 
 57-8 
 
 28.0 
 
 78 
 
 13.80 
 
 484 
 
 1024 
 
 10.96 
 
 475 
 
 10.48 
 
 103.9 
 
 38-5 
 
 79 
 
 13-77 
 
 488 
 
 IOI8 
 
 8-33 
 
 477 
 
 10.18 
 
 56.5 
 
 19.7 
 
 VII. Fourth Hemorrhage {3.26 per cent.) Jan. 20-23, 1903 
 
 80 
 
 13-35 
 
 463 
 
 IOI8 
 
 8.88 
 
 463 
 
 8.88 
 
 
 
 81 
 
 13.36 
 
 518 
 
 1033 
 
 13-92 
 
 490 
 
 11.40 
 
 
 
 82 
 
 13-04 
 
 770 
 
 1022 
 
 17-14 
 
 584 
 
 13-31 
 
 29-5 
 
 15-9 
 
 83 
 
 12.90 
 
 464 
 
 1024 
 
 11-75 
 
 554 
 
 12.92 
 
 134-5 
 
 59-6 
 
 VIII. Fifth Hemorrhage {2.46 per cent.) Jan. 24-23, 1903 
 
 11.28 I ..-. I .... I ..•• I •■•• 
 
 Death occurred at the end of the .<^econd hour. 
 
 I I II 
 
69 
 
 TABLE XIII 
 Relation Between Total Nitrogen and Volume of Urine. 
 
 Preliminary experiment- ■ • • 
 
 After first hemorrhage 
 
 (2.93 per cent. ) 
 
 Preliminary to Anaesthesia 
 Experiment 
 
 (Dog in nitrogen equil. ) 
 
 First four days of Anaesthe- 
 sia experiment 
 
 (Control experim't No. i ) 
 
 Last four days of Anaesthe- 
 sia experiment 
 
 (Dog in nitrogen equili- 
 brium) 
 
 1 irst five days of Anaesthe- 
 sia-operation experiment- 
 (Control experim't No. 2) 
 
 Preliminary to .second hem- 
 orrhage 
 
 (Dog in nitrogen equil.) 
 
 After second hemorrhage- - • 
 (3.22 per cent. ) 
 
 Preliminary to third hem- 
 orrhage 
 
 (Dog in nitrogen equil.) 
 
 After third hemorrhage • ■ - • 
 (3.51 per cent.) 
 
 After fourth hemorrhage - . ■ 
 (3.26 per cent. ) 
 
 After fifth hemorrhage 
 
 ( 2.46 per cent.) 
 
 Nov. 2-13 
 1902 
 
 Nov. 14-18 
 
 Nov. 25-29 
 
 Nov. 30-Dec. 3 
 
 Dec. 6-9 
 
 Dec. 10-14 
 
 Dec. 19-22 
 Dec. 23-29 
 
 Jan. S-12 
 1903 
 
 Jan. 13-15 
 
 Jan. 20-21 
 
 Jan. 24 
 
 No. of 
 days. 
 
 Average 
 Nitrogen 
 (grams) 
 
 Average 
 
 volume. 
 
 cc. 
 
 8.74 
 
 489 
 
 10.37 
 
 475 
 
 9-52 
 
 519 
 
 8.54 
 
 501 
 
 9.16 
 
 563 
 
 9.96 
 
 541 
 
 9-49 
 
 529 
 
 11.30 
 
 525 
 
 9-51 
 
 525 
 
 10.82 
 
 520 
 
 11.40 
 
 490 
 
 11.28 
 
 455 
 
 Ratio. 
 (N:V) 
 
 1:55-9 
 1:45-8 
 
 1:54-5 
 
 1:58.7 
 1:61.5 
 
 1:54-3 
 
 1:55-7 
 1:46.5 
 
 1:55-2 
 
 1 :48. 1 
 1:43.0 
 1:40.3 
 
JO 
 
 TABLE XIV 
 
 Nitrogen Content of Composite Urine Samples. 
 
 
 Experiment. 
 
 No. of 
 days. 
 
 Nitrogen (grams). 
 
 tn-r; 
 
 Si s 
 
 Content of 
 
 composite 
 
 urine sample. 
 
 Total content 
 of daily 
 samples. 
 
 Daily 
 variation. 
 
 
 
 12 
 16 
 ID 
 
 13 
 21 
 
 7 
 4 
 
 104.30 
 
 ^52-31 
 89.48 
 
 130.32 
 220.48 
 
 70.54 
 51. r6 
 
 104.84 
 152.68 
 
 89-57 
 128.70 
 219.91 
 
 71-23 
 51-69 
 
 0.045 
 0.023 
 0.009 
 0.125 
 0.027 
 0.098 
 0.142 
 
 
 First hemorrhage 
 
 CO 
 
 .M 
 
 a; 
 cn 
 
 s 
 
 Anaesthesia-operation 
 Second hemorrhage • • 
 
 Third hemorrhage 
 
 Fourth hemorrhage- . . 
 
 
 'j*otal 
 
 83 
 
 818.59 
 
 818.62 
 
 003^ 
 
 
 
 
 tn 
 
 
 9 
 9 
 
 5 
 
 69.92 
 78.82 
 46.82 
 
 69-57 
 79.11 
 
 47-34 
 
 0.039 
 0.032 
 0.104 
 
 ■73 
 O 
 
 Anaesthesia-operation 
 Hemorrhage 
 
 
 Total 23 
 
 195-56 
 
 196.02 
 
 0.46 
 
 1 This variation of but 0.03 gram of nitrogen for a period of 83 days is very striking. 
 
7T 
 
 TABLE XV 
 
 Daily Diet (Second Series). 
 
 Constituent of 
 the diet. 
 
 Beef 
 
 Cracker dust 
 
 Lard 
 
 Bone ash . . • 
 Water 
 
 Total 
 
 < be 
 
 200 
 
 52 
 15 
 
 8 
 375 
 
 650 
 
 Nitrogen. 
 
 Per 
 cent. 
 
 3-759 
 1-55 
 0.028 
 0.026 
 
 Grams. 
 
 7-5'8 
 0.806 
 0.004 
 0.002 
 
 8.33 
 
 Sulphur. 
 
 Per 
 cent. 
 
 0.288 
 O.1318 
 0.03 
 0.06 
 
 0.576 
 0.069 
 0.004 
 0.005 
 
 0.654 
 
 Phosphorus. 
 
 Per 
 cent. 
 
 0.220 
 
 0.1345 
 0.085 
 
 17-79 
 
 Grains. 
 
 0.440 
 0.070 
 0.013 
 1-423 
 
 1.946 
 
m 
 o 
 
 < 
 < 
 
 pq 
 
 w 
 c 
 o 
 
 ^ 2^ 
 
 to ^ 
 O 7 
 
 < 
 
 m 
 
 > 
 
 n 
 < 
 
 
 
 T3 
 
 <M 
 
 
 ■^ 
 
 
 
 ^ 
 
 m 
 
 T 
 
 
 O 
 
 00 
 
 "-" 
 
 >o 
 
 00 
 
 
 Tf 
 
 u 
 
 
 'H 
 
 d 
 
 d 
 
 o6 
 
 CJN 
 
 >-< 
 
 CT\ 
 
 
 
 
 V 
 
 
 
 
 
 
 
 hT 1 
 
 fc 
 
 1 
 
 1 
 
 1 
 
 1 
 
 i 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 c 
 
 
 
 o 
 
 TT 
 
 ^cj- 
 
 ON 
 
 00 
 
 00 
 
 
 
 >l 
 
 •-; 
 
 O 
 
 ■^ 
 
 o 
 
 rO 
 
 00 
 
 'c 
 
 
 rt 
 
 d 
 
 d 
 
 ,_4 
 
 t_' 
 
 d 
 
 >h' 
 
 c 
 
 
 Q 
 
 1 
 
 1 
 
 1 
 
 1 
 
 1 
 
 1 
 
 
 
 ■6 
 _o 
 
 in 
 
 r^ 
 
 ^ 
 
 oo 
 
 n 
 
 OO 
 
 
 
 OG 
 
 00 
 
 NO_ 
 
 fi. 
 
 M 
 
 q 
 
 
 a 
 
 'u 
 
 lO 
 
 ■«r 
 
 CO 
 
 
 NO 
 
 
 
 aj 
 
 V 
 
 r^ 
 
 pi 
 
 
 
 
 lO 
 
 
 ^ 
 
 cu 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 u 
 
 
 
 
 
 
 
 
 
 ."ti 
 
 
 ro 
 
 ON 
 
 t^ 
 
 N 
 
 1-4 
 
 M 
 
 
 ^ 
 
 'S- 
 
 <N 
 
 r^ 
 
 ■^ 
 
 r-- 
 
 01 
 
 
 Q 
 
 cd 
 
 CO 
 
 dv 
 
 6\ 
 
 co 
 
 d 
 
 •l^iox 1 
 
 
 T3 
 
 
 
 
 
 
 
 
 
 
 
 00 
 
 o 
 
 
 
 
 r-- 
 
 
 ^ 
 
 
 CO 
 
 
 TT 
 
 r^ 
 
 CN 
 
 c« 
 
 
 <u 
 
 6 
 
 d 
 
 d 
 
 d 
 
 d 
 
 d 
 
 
 o 
 
 Ph 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ."ti 
 
 >> 
 
 o 
 
 o 
 
 CO 
 
 CO 
 
 CO 
 
 r^ 
 
 
 z 
 
 03 
 
 '-'^ 
 
 
 o 
 
 O 
 
 o 
 
 ^-i 
 
 
 « 
 
 G 
 
 d 
 
 d 
 
 d 
 
 d 
 
 d 
 
 •sSntqsBAi | 
 
 
 ■B 
 
 
 
 
 
 
 
 
 
 
 
 00 
 
 r^ 
 
 
 CO 
 
 NO 
 
 m 
 
 S 
 
 a; 
 
 
 ON 
 
 d 
 
 d 
 
 r-^ 
 
 q 
 
 d 
 
 d 
 
 2 
 
 1 
 
 CL( 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ' 
 
 
 >, 
 
 „ 
 
 « 
 
 N 
 
 0) 
 
 CN 
 
 « 
 
 o 
 
 2 
 
 CO 
 
 Q 
 
 
 
 
 
 
 
 i? 
 
 d 
 
 d 
 
 d 
 
 d 
 
 d 
 
 d 
 
 3 
 O 
 
 
 
 
 
 
 
 
 
 •JPH 1 
 
 
 ■d 
 
 
 
 
 
 
 
 
 
 
 
 
 I-- 00 
 
 r^ o\ 
 
 
 
 
 
 
 ^ in 
 
 CO 
 
 
 ro 
 
 
 lU 
 
 'u 
 
 ■«■ 
 
 
 cs 
 
 rh M 
 
 
 
 
 
 CIh 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 u 
 
 
 
 
 
 
 
 
 
 *^ 
 
 ca 
 
 ON 
 
 ON « 
 
 ro n 
 
 NO 
 
 
 ^ 
 
 ■a- 
 
 ■«- ^ 
 
 ■tr -a- 
 
 
 
 
 
 d 
 
 o 
 
 o 
 
 d 
 
 o 
 
 d 
 
 •saoaa 1 
 
 
 -d 
 
 >- 
 
 r^ -^ 
 
 „ 
 
 Tf 
 
 ^ 
 
 
 
 U-) 
 
 t^ oo 
 
 t-" 
 
 
 ^ 
 
 
 n 
 
 'H 
 
 & 
 
 r 
 
 •^ 
 
 cr> rr 
 
 r^ 
 
 
 dj 
 
 V 
 
 \o 
 
 
 
 r^ 01 
 
 ^ 
 
 
 i» 
 
 Pi 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 u 
 
 
 
 
 
 
 
 
 
 -^ 
 
 >> 
 rt 
 
 rr> 
 
 C^ ^ 
 
 ON . cc 
 
 r^ 
 
 
 k 
 
 r^ 
 
 
 t^ o 
 
 Tl- 
 
 
 Q 
 
 f^ 
 
 r^ ON 
 
 CO 
 
 00 
 
 dv 
 
 ■3uun 1 
 
 ? 
 
 
 •6 
 _o 
 
 r^ 
 
 On 00 
 
 t^ ON 
 
 in 
 
 
 q- 
 
 °> °> 
 
 as cs 
 
 NO 
 
 
 
 'u 
 
 
 TT C7\ 
 
 
 
 ca 
 
 <u 
 
 It 
 
 r^ 
 
 CV 
 
 
 r^ 0) 
 
 ■* 
 
 bb 
 
 g 
 
 Pi 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 V 
 
 ■ji 
 
 
 ro 
 
 ^ 
 
 5 M 
 
 ro f^ 
 
 ro 
 
 
 iz; 
 
 
 m fo 
 
 r' 
 
 ■> m 
 
 ro 
 
 8 
 
 cc' 
 
 oc 
 
 00 
 
 OC 
 
 cc 
 
 CO 
 
 
 
 
 
 
 
 
 
 
 HH 
 
 
 
 
 
 •;3ia 
 
 
 
 
 •s^Ba 
 
 On 
 
 fO NO 
 
 ON « 
 
 in 
 
 
 
 
 o 
 
 2 ^ 
 
 On on 
 
 1 
 
 
 ol 
 
 
 ' 
 
 1 ' 
 ro CO 
 
 )- 
 
 r^ 
 
 o 
 
 
 
 
 
 o „ 
 
 
 
 
 
 
 "S 
 
 
 CJ 
 
 « i! OJ 
 
 D <u 
 
 jj 
 
 
 P 
 
 
 3 
 
 ^ t 
 
 1— 1 1— N 
 
 3 
 
 
 
 
 
 
 
 
 
 
 
 ^ 
 
 
 
 J) ;: 
 
 01 t- 
 
 U) 
 
 b. 
 
 O • 
 
 ;^ 1 ■1-' 
 
 
 0; 
 
 
 >> 
 
 ca a 
 
 ca P- 
 
 11 
 
 s 
 
 0; 
 
 
 . s 
 
 !3 . <U 
 
 
 _s 
 
 
 ca 
 
 s o 
 ca 1 
 
 S 
 ca 1 
 
 s 
 
 
 
 
 S:" 
 
 
 *c 
 
 
 
 ca 
 
 i_.2 " 
 
 C3 , 
 
 V 
 
 •"^ <u u 
 
 
 OJ 
 
 
 p 
 
 
 w iJ o u 
 
 rn •" 
 
 V bt> 
 
 MP, 
 
 
 P< 
 
 
 
 S.'= 
 
 fe =" 
 
 I- cfl ^ 
 
 
 M 
 
 
 "5 
 
 £^'-= 
 
 ■^J='*i ■" 
 
 JS-^ 
 
 °-5 
 
 i^X « 
 
 
 w 
 
 
 (U *J ct 
 
 ■<-.53 ca i*- 
 
 -w cc 
 
 OJ t- 
 
 
 
 
 
 Ps 
 
 pq 
 
 < 
 
 < 
 
 
 P5 
 
73 
 
 TABLE XVII 
 
 Dailv Data of the Second Series of Experiments. 
 
 /. Ptelifninary Experiment, June 2-10, igoj 
 
 
 Body- 
 weight. 
 
 
 
 Urine. 
 
 
 
 Feces. 
 
 Day 
 No. 
 
 Volume. 
 
 Specific 
 gravity. 
 
 Nitrogen. 
 
 Period average to date. 
 
 Weight. 
 
 
 
 
 
 
 
 
 
 
 
 Volume. 
 
 Nitrogen. 
 
 Fresh. 
 
 Dry. 
 
 
 kilos 
 
 cc. 
 
 
 gram.s 
 
 cc. 
 
 gram.s 
 
 grams 
 
 grams 
 
 I 1 
 
 1 1. 85 
 
 390 
 
 I016 
 
 7.63 
 
 390 
 
 7-63 
 
 .22.8 
 
 15.8 
 
 ^ i 
 
 11.80 
 
 415 
 
 IO18 
 
 6.99 
 
 40,^ 
 
 7 
 
 31 
 
 ... 
 
 
 3 1 
 
 11.82 
 
 388 
 
 1020 
 
 7.58 
 
 398 
 
 7 
 
 40 
 
 50.2 
 
 293 
 
 4 
 
 11.70 
 
 485 
 
 1020 
 
 965 
 
 419 
 
 7 
 
 96 
 
 
 
 5 
 
 11.76 
 
 344 
 
 I017 
 
 5-31 
 
 404 
 
 7 
 
 43 
 
 
 
 6 
 
 11.60 
 
 515 
 
 I018 
 
 963 
 
 423 
 
 7 
 
 80 
 
 40.3 
 
 30.8 
 
 7 
 
 11-57 
 
 402 
 
 IOI9 
 
 8.14 
 
 420 
 
 7 
 
 85 
 
 34.2 
 
 21.4 
 
 8 
 
 11.63 
 
 298 
 
 IOI8 
 
 5-52 
 
 405 
 
 7 
 
 56 
 
 40.0 
 
 235 
 
 9 
 
 11.68 
 
 452 
 
 1020 
 
 9.12 
 
 410 
 
 7 
 
 73 
 
 41.5 
 
 24-3 
 
 //. Anaesthesia — operation, June ii-ig, /goj 
 
 10 
 
 11.40 
 
 450 
 
 1019 
 
 8.56 
 
 450 
 
 8.56 
 
 54-8 
 
 31.8 
 
 II 
 
 11.30 
 
 560 
 
 1019 
 
 9.46 
 
 505 
 
 9.01 
 
 
 
 
 12 
 
 11.28 
 
 484 
 
 1018 
 
 9-33 
 
 498 
 
 9.12 
 
 22 
 
 .5 
 
 17.9 
 
 13 
 
 11.24 
 
 432 
 
 1019 
 
 8.66 
 
 482 
 
 9.00 
 
 
 
 
 14 
 
 11.26 
 
 422 
 
 1016 
 
 6.3t 
 
 470 
 
 8.46 
 
 57 
 
 5 
 
 28.5 
 
 15 
 
 II. 10 
 
 544 
 
 1023 
 
 •2.55 
 
 482 
 
 9.14 
 
 
 
 
 16 
 
 11.06 
 
 383 
 
 1018 
 
 7. II 
 
 468 
 
 8.85 
 
 46 
 
 2 
 
 28.8 
 
 17 
 
 11.03 
 
 404 
 
 1020 
 
 8.00 
 
 460 
 
 8.75 
 
 29 
 
 I 
 
 19. 1 
 
 18 
 
 11.00 
 
 480 
 
 1018 
 
 9-13 
 
 462 
 
 8.79 
 
 
 . 
 
 
 ///. Hemorrhage {3. 11 percent.) June 20-24, igos 
 
 19 
 
 10.47 
 
 442 
 
 1020 
 
 8.96 
 
 442 
 
 8.96 
 
 37-6 
 
 26.5 
 
 20 
 
 10.63 
 
 323 
 
 1028 
 
 9-59 
 
 383 
 
 9.28 
 
 
 
 21 
 
 10.60 
 
 418 
 
 1019 
 
 8.51 
 
 394 
 
 9.02 
 
 37-5 
 
 28.3 
 
 22 
 
 10.58 
 
 445 
 
 1023 
 
 9-94 
 
 407 
 
 925 
 
 
 
 23 
 
 10.48 
 
 503 
 
 1021 
 
 10.34 
 
 426 
 
 9-47 
 
 41.0 
 
 19.8 
 
W 
 o 
 
 < 
 
 < 
 
 PQ 
 
 o 
 
 w 
 
 en 
 O 
 W 
 
 Ph 
 Q 
 
 rO 
 
 
 P ^ tC 
 
 o 
 
 >^ 
 p^ 
 <^ 
 
 > 
 
 
 
 
 
 „ 
 
 
 
 
 
 
 
 
 o 
 
 O TT 
 
 
 
 •c 
 
 o o 
 
 o 
 
 o 
 
 
 
 
 i-r 
 
 fi< 
 
 1 1 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 p 
 
 
 
 
 
 1 
 
 >> 
 
 
 t-l 
 
 
 nj 
 
 
 
 o 
 
 Q 
 
 1 1 
 
 1 
 
 
 
 T3 
 O 
 
 
 s 
 
 
 
 ^ 
 
 
 
 
 
 
 lO VO 
 
 ro 
 
 
 p. 
 
 "3 
 
 
 
 
 >, 
 
 rO f^ 
 
 
 
 
 M 
 
 
 
 
 
 
 
 O O 
 
 O 
 
 ■I^iox 1 
 
 
 -0 
 
 o 
 
 
 (N 
 
 
 
 
 
 
 
 u 
 
 
 O 
 
 
 
 
 O O 
 
 O 
 
 
 ft 
 
 PM 
 
 
 
 
 
 
 
 ;^ 
 
 
 8 8 
 
 I 
 
 
 
 
 
 o o 
 
 o 
 
 •sSuinsBAV 1 
 
 
 •a 
 
 .0 
 
 o r^ 
 
 CO 
 
 
 
 
 
 S 
 
 tl 
 
 
 
 
 
 ^ 
 
 
 
 t 
 
 bo 
 
 -•a 
 
 PL, 
 
 
 
 
 
 
 o 
 
 tB 
 
 >> 
 
 o o 
 
 o 
 
 
 
 P 
 
 o o 
 
 o 
 
 
 
 
 
 
 O 
 
 
 
 
 
 •JIBH 1 
 
 
 o 
 
 -a- lO 
 
 ro 
 
 
 
 'C 
 
 
 
 
 3 
 
 <u 
 
 M M 
 
 
 
 A 
 
 P-( 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 tfi 
 
 
 -^ -^ 
 
 
 
 
 Q 
 
 o o 
 
 O 
 
 •S3D3iI 1 
 
 
 O 
 
 
 00 
 
 
 
 
 
 
 
 Vh 
 
 
 
 
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 ^^ 
 
 M- ^ 
 
 CN 
 
 
 
 P-I 
 
 
 
 
 
 
 
 
 >. 
 
 •* o 
 
 SO 
 
 
 
 t!j 
 
 -* lO 
 
 in 
 
 
 
 
 
 o o 
 
 o 
 
 •anpn 1 
 
 ^ 
 
 
 
 
 
 
 
 
 
 
 
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 ^ 
 
 
 (N 
 
 s 
 
 3 
 
 u 
 
 
 
 bJ3 
 
 t 
 
 PU 
 
 
 
 
 
 
 
 
 
 
 
 
 
 p>1 
 
 
 
 fi 
 
 fli 
 
 so ^ 
 
 \Cl 
 
 8 
 
 c 
 
 
 fi 
 
 o o 
 
 o 
 
 
 
 
 
 
 
 
 
 hH 
 
 
 
 ■;3ia 
 
 
 •sAbq 
 
 ON OS 
 
 >o 
 
 
 
 
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 ^ 
 
 
 
 
 
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 ft 
 
 
 
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 w^ 
 
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 •c 
 
 
 
 
 
 
 
 
 
 
 
 
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 r^ 
 
 r^ 
 
 OS 
 
 " 
 
 ■"^ 
 
 
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 " 
 
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 •sSuillSBTtt. 
 
 ■S^BQ 
 
 saoaj 
 
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 .2 c 
 £.2 
 
 £^ 
 "^ ir! 
 
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 c o 
 
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 erg 
 
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 5^ imum urine 
 
 
 OJ 
 
 OJ 
 
 ■p^ 
 
 l-H 
 
 ►I 
 
 
 
 
 
 
 
 1 volume. 
 
 
 
 
 
 
 
 1 >^ 
 
 
 
 
 
 
 
 
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 c^ 
 
 ~ 
 
 •-I 
 
 
 
 1-1 ^ - w 
 
 
 
 Ni 
 
 fO 
 
 -^ 
 
 
 
 to - C ?;: 
 
 
 
 ^J 
 
 ^ 
 
 ■vD 
 
 
 
 Cn S .; ' 
 
 
 
 Ol 
 
 CO 
 
 vC 
 
 
 
 ^ 
 
 £>o 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ^ 
 
 10 
 
 10 
 
 
 
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 !M so 
 
 <<* 
 
 
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 *-« 
 
 •^ 
 
 
 
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 2"^^ 
 
 ^' 
 
 
 
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 w 
 
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 0^ 
 
 
 
 -t^ 
 
 _^.-o 
 
 
 
 
 
 
 
 
 
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 p 
 
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 i^ 
 
 b 
 
 
 
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 4i 
 
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 K) 1 H 03 — ' 
 
 •a 
 
 
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 3" 
 
 
 
 ^ 
 
 
 
 
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 3 m _• 
 
 •0 
 
 
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 2 
 
 
 
 
 
 
 
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 5 
 
 
 
 
 
 
 
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 p 
 
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 p 
 
 
 p »5;?o 
 
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 1^ 
 
 tm^ 
 
 
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 CTn 
 
 ■u 
 
 
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 ii-r 
 
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 w 
 
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 l-C 
 
 w 
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 l-H 
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,,,§PUTH PROPERTY,^, 
 
 Hawk 
 
 The influence of hemorrhage upon 
 metabolism 
 
 MAY 12,1943 J^c^^-Slj^iJ^ 
 
 DM PERSONAL RLSh:KVii: SHELF