Some clinical aspects 289 



The following changes in the value of K sh,ow the degree of 

 meionexy which obtained in each case : 



K 



Normal limits of A' ......... -00024 '00034 



-00018 



1. J. P. 7 March, a week after admission 



"00018 



2. ,, 13 March, shortly before discharge ... (1) '00023 



3. ,, 7 April, a few hours before death .... ! ' | -00011 " 



Another case which showed variations was that of a female 

 patient, M. P. 



She was a mild case on May 23rd when first tested, by June 24th 

 the dyspnoea had disappeared and the case was discharged. 



K 



1. 23 May, dyspnoeic ......... (1) -00020 



2. 24 June, breathing normal ...... (2) -000274 



Not only had the value of K become normal but the alveolar C0 2 

 rose from 33 mm. to the normal value of 39 mm. and the blood in the 

 absence of C0 2 on May 23rd was 61 % saturated with oxygen at 

 17 mm. oxygen pressure, whilst on June 24th the percentage satu- 

 ration at 17 mm. had risen to the normal figure of 74 / ; the former 

 corresponded to normal blood with '01 % f lactic acid added. 



One more point : in the account of the case of J. P., given above, 

 when tested just before death the values of K given do not appear 

 to be very concordant. The interpretation of this irregularity, which 

 appears in very meionectic curves, e.g. Figs. 30 and 134, where the 

 points observed are below the curve at low pressures and above 

 it at high ones is, in the light of more recent* work, that blood has 

 gained sufficient in acidity to cause a measurable change in the value 

 of n, the average number of molecules of haemoglobin clumped 

 together. The effect is of course in the direction of increased clumping 

 of haemoglobin and, as in other cases of the same phenomenon, its 

 significance lies in the fact that a similar clumping of other protein 

 molecules probably takes place and alters the properties of every cell 

 in the body by a reduction of the velocity of its molecular vibrations. 



REFERENCES. 



(1) Lewis, Ryffel, Wolf, Cotton and Barcroft, Heart, v, p. 45, 1913; Journal of 



Physiol. XLVI, p. liii. 



(2) Poulton and Ryffel, Physiol. Proc. ; Journal of Physiol. XLVI, p. xlviii. 



* See Appendix II. 

 B. R. P. 19 



