48 Paul Fourman and Patricia M. Leeson 



blood pressure was 180/80. His fits were rapidly controlled, but he then 

 had a bilateral spastic paralysis with extensor plantar responses, and 

 never regained consciousness. On the second day he stopped breathing 

 and respiration had to be maintained with a Beaver respirator for 12 

 hours. Subsequently he had a purulent bronchopneumonia and on the 

 fourth day a tracheotomy was done to enable a clear airway to be 

 maintained by suction. The bladder was kept drained by a Foley 

 catheter but the urine was not infected until the last days of his iMness. 

 He died on 11th August of bronchopneumonia. 



At post-mortem there was a large area of softening in the left temporal 

 lobe. The vessels of the circle of Willis were very atheromatous. There 

 was evidence of an earlier hypertension ; the left ventricle was hyper- 

 trophied to a thickness of 22 mm. compared to 8 mm. in the right 

 ventricle, and the kidneys showed hypertensive changes. There was 

 remarkably little evidence of infection in them although there was a 

 purulent cystitis. 



Albert was certainly water- deficient in the early days of his illness. 

 His extrarenal losses of water were large, and for the first three days his 

 total intake was only two litres. On 29th May his plasma [Na] was 137 

 m-equiv./l. but at the same time the volume of the packed cells in his 

 blood was 55 per cent. He was then given six litres of water in two days ; 

 the packed cell volume fell to 41 per cent and the plasma [Na] fell to 

 128 m-equiv./l. Subsequently his plasma [Na] fluctuated between 130 

 and 110 m-equiv./l. The blood urea was 34 mg. per 100 ml. and the 

 creatinine clearance 70 ml./min. 



Ivor, aged 54, was admitted on 11th June 1957 having been ill for 18 

 days with acute peripheral neuropathy affecting mainly the motor 

 nerves and accompanied by an enlargement of the liver. The plasma 

 albumin (2nd July) was 2-9, and the total protein 6 g. per 100 ml. 

 The cause of his illness was not discovered. In the next five days he 

 developed a partial respiratory paralysis with bronchopneumonia. His 

 blood pressure, which had been normal, fell to 90/60. Subsequently 

 he was fed by tube ; and his purulent bronchial secretion was aspirated 

 through a tracheostomy. At the end of June he began slowly to recover 

 and was taking some food by mouth on 4th July, but almost immedi- 

 ately had a severe relapse. Tube feeding continued until the end of 

 July, by which time he was able to move his limbs, though they were 

 still very weak. He subsequently had three relapses and died in Decem- 

 ber. We have not the details of the latter stages of his illness. 



Before he was fed by tube his intake of water was inadequate to cover 

 his losses, which were augmented by copious sweating associated with 

 his chest infection, and he must have sustained a considerable deficit of 

 water and probably of salt. The water deficiency was corrected on 17th 

 and 18th June by the administration of a total of 8 -9 litres of water, of 

 which he excreted only 3-5 litres during those two days. Consistent 

 with a "dehydration reaction", on 17th June his urine contained only 

 2 m-equiv. sodium in 24 hours. With the correction of his water deficit 

 his plasma [Na] fell from 133 to 120 m-equiv./l. in 24 hours. In spite 



