Some clinical aspects 285 



The liver is enlarged, the edge is hard and feels nodular, and there is tenderness 

 to pressure over it ; there is a suspicion of some ascites. 



The urine flow is not free ; sp. gr. 1017, dark, acid with faint smell of (?) acetone. 

 Albumen and granular casts are present. She has leucorrhoea. 



May 5th, 1913. (Dr Cotton's report.) 



11-97 x N /36-06 



T (duration of observation, minutes) 65 mm. 



v (vol. of urine in time T) 15 



V (calculated vol. of urine in 24 hours) 332 c.c. 



C (concen. of urea in grs. per litre) 36-06 (grs ' per htre) ' 33 



D (urea in 24 hours) 11-97 



D 2 5 -nr- - = 14-36 



K pTg-087*. 



May 5th, 1913. (Dr Gloyn's report.) 



Red blood cells 3,300,000 



Haemoglobin 82 / 



Colour Index -9 (nearly) 



Eed cells showed marked poikelocytosis. 



May 5th, 1913. (Dr Ryffel's report.) 



Blood : 0'030 grm. lactic acid per 100 c.c. 



Excess about O'Olo grm. per 100 c.c. 

 Urine: day's volume 385 c.c., sp. gr. 1022. 

 No acetone. Marked excess urobilin. Alb. 0-7 %. 

 Total N. 1-432 per cent., 5'51 grms. per diem. 

 Ammonia N. - 27 grm. per diem. 

 Amm. N 



Total N " /0 ' 



N 

 Total acidity. 279 c.c. y^ per diem. 



Lactic acid 0-0062 per cent., 0-024 grm. per diem. 

 Large deposit of urates and some uric acid crystals. 



May 5th, 1913. (Mr Barcroft's report.) 

 Alveolar CG-2 ... ... ... 31mm. 31 mm. (abnormally low) 



Respiratory quotient (corrected) -63 -53, '61 (abnormally low) 



Blood acidosis ... ... ... Saturation at 17 mm. 44 / , abnormally low. Evidence 



of considerable acidosis. 

 Meionexy ... ... ... Gas in tonometer, 2 pressure 30 mm. 



,, ,, C0 2 ,, 29 mm. 



Saturation of blood exposed to this gas 38-5 % . 

 Normal limits of saturation at 30 mm. 51 64. 

 K= -000127. 

 Very meionectic attributable to considerable acidosis. 



May 23rd, 1913. (Dr Lewis' report.) 



More specimens taken. In much the same condition as regards breathing. Getting 

 weaker. Cyanosis, as before, very slight. 



June llth, 1913. Progressively weaker ; evidently dying, but very slowly. C. S. 

 breathing continues as before. 



* See Appendix IV. 



