as the tissues are usually well nourished to start with, and the metabolism 

 is even higher than normal owing to the pyrexia." Strinsover found that 

 the amount of formic acid in the urine did not exceed normal values in 

 compensated heart disease, but that it was increased in conditions associ- 

 ated with asphyxia and in cardiac failure. 



There are few facts available with regard to the metabolism of inorganic 

 salts in the diseases of the. circulation and respiration. The retention of 

 sodium, calcium and chlorin in pneumonia is the result of the febrile con- 

 dition and is not associated with the disturbance of the function of res- 

 piration. In the two cases of asthma studied by Zugsmith and Kahn there 

 was a positive mineral balance. According to Magnus-Levy (&) there may 

 be a retention of sodium chlorid in the tissues in certain cases of cardiac 

 insufficiency, arteriosclerosis, bronchitis, and emphysema, without definite 

 evidence of renal involvement. In general, however, in circulatory dis- 

 eases the retention of inorganic salts either depends on renal insufficiency 

 or is associated with water retention. Allen (d) found the blood plasma 

 chlorids to be increased in cases of vascular hypertension without impair- 

 ment of renal function, and he believes that this rise is intimately related 

 to the rise in blood pressure. In a study of certain physical constants of 

 the blood serum, Gettler and Oppenheimer found that in cardiac disease 

 with edema the freezing point and ash content were normal, while the spe- 

 cific gravity, solids, and refraction were decreased. In arteriosclerosis no 

 important abnormalities were discovered, while in cases with arterial hy- 

 pertension the solids and freezing point were high. The problem of water 

 retention in heart disease remains one about which little is known, because 

 there is as yet no satisfactory method of studying the fluid lost from the 

 body by way of the skin and lungs. Richter(/) states, however, that reten- 

 tion of water and retention of solids do not necessarily move parallel to 

 one another. 



The results derived from studies of the blood and urine on the metab- 

 olism of the diseases of the respiration and circulation are thus as in- 

 complete and conflicting as are those on the gaseous metabolism. Devia- 

 tions from the normal, when they are found, are slight. In cases of mild 

 or moderate severity the various compensatory mechanisms are such 

 that the metabolism is not aifected. In cases with serious disturbances of 

 the functions of the respiration and circulation the metabolism may be 

 increased and there may be evidences of interference with oxidative proc- 

 esses. The latter probably occurs only in the more advanced cases, and 

 the increases in metabolism when present would seem to be usually due 

 largely to the muscular efforts which take part in the compensations, 

 rather than to the production of asphyxia. 



