286 Chapter XIX 



May 23rd, 1913. (Mr Barcroft's report.) 



Alveolar air : 2 C0. 2 mm. E. Q. correct 



14-24 4-05 28-6 -56 



Blood acidosis : Saturation at 17 mm. 43 / = -04 lactic. 

 Meionexy : Saturation at 29'5 mm. 2 and 27 mm. C0 2 47'5 48 / . 

 K= '00019. 

 Meionectic. 



May 23rd, 1913. (Dr Cotton's report.) 



Urea in blood -78 grm. per litre. 



Chlorides in blood 6'10 grms. per litre (normal quantity of chloride per litre is 5'62). 



May 23rd, 1913. (Dr Gloyn's report.) 

 Haemoglobin =90%. 



With the case of H. L. may be compared that of another patient 

 E. M. with distressed breathing which is of quite a different type. 

 Here also there is meionexy to a slight extent but there is no 

 acidosis, no fall in the C0 2 pressure in the alveoli, but rather a rise, 

 and deep cyanosis. The meionexy is due to the rise in C0 2 which in 

 turn is due to deficient circulation. 



CARDIAC CONTROL 



B. M. xiv/18. Age 29. (Dr Lewis' report.) 



A married woman of 29 years, admitted to hospital for shortness of breath and 

 swelling of the legs and stomach. 



There is a history of St Vitus dance at the age of 6 years. 



Her illness commenced 11 years ago when she began to get short of breath on 

 exertion, about the same time the legs and abdomen began to swell ; she has suffered 

 from these symptoms off and on ever since, having been admitted on several occasions 

 to hospital for exacerbations of the symptoms. On the present occasion the breath- 

 lessness has been considerable for 14 days and the swellings have been present for 

 the same period. She has a cough with fairly copious, sometimes haemorrhagic 

 sputum for several months. For two weeks occasional vomiting has been ex- 

 perienced. 



Condition June 4th, 1913. A thin subject who sits propped up in bed. Cyanosis is 

 deep, the lips being plum coloured and cheeks dusky and the ears tinged with blue. 

 The conjunctivae and skin generally are tinged with urobilin. The respirations are 

 hurried and irregular. The veins of the neck are very distended and pulsate freely. 

 Slight oedema of the skin is present. Temperature is normal. 



The cardiac impulse is very diffuse in the 5th, 6th and 7th spaces. The shock of 

 the heart-beat is seen and felt over a wide area and there is epigastric thrust. An 

 early diastolic or full diastolic thrill is palpable at the apex. R. L. C. D., 7 inches, 

 L. L. C. D., 2 inches, U. L. C. D., 2nd rib. Early diastolic or full diastolic, and systolic 

 murmurs are heard at the apex. The aortic and pulmonary sounds are normal. The 



