The Association of Renal and Gastric Disorders with Constancy of the Urinary Reaction.

It has been said that determinations of the alkaline tide in urine are of value in the study of two entirely distinct clinical conditions. One of these is associated with diseases of the stomach. Bence-Jones (1, 2) who seems to have been the first to describe diurnal variations in the acidity of urine, believed that they were associated with the secretion of acid into the stomach. Many physiologists have held similar views, (3, 4) and a number of different workers have suggested that an absence of changes in the reaction of urine means that the stomach does nbt secrete hydrochloric acid, (5, 6, 7). Leathes, (8, 9) McCorvie, (10) and others have taken an entirely different view of the problem. They believe that disease of the kidneys is usually, if not always, responsible for an absence of the alkaline tide. According to them relative over-ventilation through the lungs is the cause of the rhythmical changes in the reaction of the urine. When the kidneys are diseased the urine fails to reflect the changes in the blood induced by hyperpnoea, and its reaction is relatively constant. There seems to be no extensive series of cases in the literature in which the relationships of urinary reaction to both gastric and kidney abnormalities are considered in the same patients. Such a study is presented in this article. Alkaline tide determinations have been made in this institution upon 296 subjects by the foliowing technique. At seven o'clock the patient was aroused, and the night urine voided and, in most instances, discarded. Specimens were collected at hourly intervals thereafter until one o'clock. The reaction of these was determined by a colorimetric method. A meal, usually consisting of a glass of milk, a glass of water, two slices of toast with butter, and an egg, was fed between