268 D. A. K. Black 



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Barbour, A., Bull, G. M., Evans, B. M., Hughes Jones, N. C, and 



LoGOTHETOPOULOS, J. (1953). CHn. Sci., 12, 1. 

 Black, D. A. K., and Stanbury, S. W. (1958). Brit. med. J., 1, 872. 

 CoMROE, J. H., FoRSTER, R. E., DuBOis, A. B., Briscoe, W. A., and 



Carlsen, E. (1955). The Lung. Chicago: Year Book Publishers. 

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Circulation, 6, 874. 

 Nadell, J. (1953). J. din. Invest., 32, 622. 

 Pitts, R. F. (1953). Harvey Lect., 48, 172. 



Platts, M. M., and Greaves, M. S. (1957). Clin. Sci., 16, 695. 

 Sheldon, J. H. (1948). The Social Medicine of Old Age. Oxford 



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DISCUSSION 



Milne : I am not convinced. Dr. Black, that the anuria you mentioned 

 in your two cases is in any way related to the chronic respiratory disease. 

 During the last influenza epidemic in this country some cases of anuria 

 were associated with influenza. I know of one case in Dundee and we 

 ourselves have personally studied three cases. Two of those we saw 

 recovered and one died. The one that died showed typical acute tubular 

 necrosis; the other two showed a clinical course typical of tubular 

 necrosis. None of these patients gave any sign of chronic respiratory 

 disease. They were typical Asiatic influenza cases, as shown by the epi- 

 demiology and serum tests, developing in previously healthy individuals ; 

 one case was uncomplicated and two cases were complicated by a secon- 

 dary staphylococcal pneumonia. A severe respiratory infection of itself 

 in some cases seems to be able to precipitate anuria, and I myself prefer 

 to relate your experience to infection rather than to the biochemical 

 changes of chronic respiratory acidosis. 



My other point is a personal protest : I have a tremendous respect for 

 the work of Dr. Pitts and his colleagues, but I do think we should avoid 

 adopting this term, 'bicarbonate-bound base'. To the chemist bicar- 

 bonate is a hydrogen ion acceptor and therefore is a base itself. Bicar- 

 bonate is the base; bicarbonate-bound base to me is meaningless. 



Black: In quoting from Pitts, I used his terminology, but I do not 

 accept responsibility for it. 



When you say infection, do you mean infection leading to a fall in 

 cardiac output and renal vasoconstriction, or do you mean an infection 

 of the kidney? 



Milne : No, certainly not an infection of the kidney. All I am stress- 

 ing is that these cases occurred in young adults without any evidence 



