EDEMA 



173 



REACTION OF THE BLOOD IN HEART FAILURE. The dyspnea in heart 

 failure is attributed by Peters and others to an increase in the hydrogen 

 ion concentration of the blood, due to increased carbon dioxid content. 

 Accurate determinations of the actual hydrogen ion concentration of the 

 blood as it exists in the body in heart failure are not available, but such 

 evidence as is at hand indicates that the change .in actual hydrogen ion 

 concentration is very slight, though it may be sufficient to account for 

 severe dyspnea. 



It now appears ( Henderson (/), 1920, and McLean, Murray, and Hen- 

 derson (6)) that the regulation of the hydrogen ion concentration of the 

 blood, and of the total electrolyte concentration of the plasma involves a 

 more complex mechanism, including the transfer of various substances be- 

 tween the tissues and the blood plasma, and between the plasma and the red 

 cells, than had previously been believed. In this mechanism hemoglobin 

 (which appears to possess the property of varying its acidity according to 

 the degree of its oxygenation), oxygen, carbon dioxid, bicarbonates, 

 chlorids, and other electrolytes each play a role. Not until all the factors 

 in heart failure have been studied can the mechanism of the changes which 

 occur be completely understood. 



Sodium Chlorid Content of the Plasma, in Heart Failure. : The sodium 

 chlorid content of the plasma in heart failure has been studied by the 

 author (1915). In general, it may be said that the chlorids of the plasma 

 are usually within normal limits or are only slightly increased. A de- 

 crease has usually been noted during the diuresis following the administra- 

 tion of digitalis (Table X). 



Number and Volume of the Red Cells in Heart Failure. Koranyi 

 and others have noted an increase in the number and volume of the red 



G.M., male, aged 50. Cardiac hypertrophy, auricular fibrillation, edema. 



