Some clinical aspects 287 



heart's action is grossly irregular. Rates 90 100. Auricular fibrillation is present. 

 The liver and spleen are both enormously enlarged, the former reaching the 

 umbilicus, is pulsatile, the latter occupies the greater part of the left flank. 



A few crepitations are heard at the bases and in the interscapular region and 

 axilla ; sputum is still present. 



The urine is dark of high sp. gr. (1026 35), blood was found in it on one 

 occasion ; it contains albumen, but no casts. Quantity reduced. 



June 4th, 1913. (Dr Cotton's report.) 



Chlorides in the blood, 6 - 90 grms. per litre (considerable retention, Normal 5 - 62). 

 Urea in the blood -38 grm. per litre. 

 Bed blood cells : 4,420,000. 

 Haemoglobin content : 92-5. 



June 4th, 1913. (Mr Barcroft's report.) 

 Alveolar air : 



2 C0 2 mm. K.Q. 



14-05 5-5 39 -77 



12-51 6-0 43 -66 



12-84 5-7 41 -67 



Acidosis : Saturation at 17 mm. 71 / = -006 -008% lactic. 



Meionexy : Saturation at 31 mm. 2 and 40 mm. C0 2 49 and 55. ..52 / average. 



Value of K, -000207. 



Slightly meionectic. 



June 4th, 1913. (Dr Wolf's report.) 



Total non-protein nitrogen per 100 c.c. of blood 32-4 mg. 

 Urea ,, ,, ,, ,, 17-2 mg. 



Best ,, ,, ,, 15-2 mg. 



It seems then that these cases of dyspnoea of cardiac or renal 

 origin may be split into two, and that from the obviously cyanotic 

 cases there may be detached a definite type of clinical case in which 

 dyspnoea is a prominent symptom but which differs from the majority 

 of cases of dyspnoea in the absence of what may be regarded as 

 equivalent cyanosis. Clinically and pathologically the cases show 

 cardiac and renal degeneration, though the actual lesions are not 

 destructive. Amongst the common symptoms are those already 

 enumerated, namely, dyspnoea without, or with but a slight grade of, 

 cyanosis, Cheyne-Stokes breathing, restiveness and a relatively high 

 pulse frequency (both of which are more conspicuous in the evening), 

 and also thirst. In its fully developed form it rapidly ends fatally. 

 On the chemical side the symptoms are acidosis (in the sense of an 

 increase of the ratio of acid to basic radicles), absence of abnormal 

 nitrogenous metabolism, and meionexy. 



To Lewis, the clinician of our party, I freely leave what is his due 

 the privilege of providing this particular " asthma " with a suitable 



