What is reported in the following pages is an example of work achieved in a relatively short time by the co-operation of a sufficient number of institutions and individuals. The venue of this research was in the Andes, and the work was carried out in the winter 1921-1922, yet its organisation only commenced definitely in the early summer of 1921, when a group of British and American physiologists secured the support of the various universities or other institutions to which they were attached. This support was given in the most ungrudging way. It included the liberation from immediate duty of the members of the party, often at considerable inconvenience to those who remained at home, the loan of apparatus, the contribution of substantial funds, and a great body of goodwill, which was perpetually translating itself into increased efficiency of the work actually accomplished. The following collaborated in one or more of the ways indicated above:— The Department of Physical Chemistry of Harvard University. The Proctor Fund of Harvard University. The Elizabeth Thompson Fund. The Rockefeller Institute of Medical Research, New York City. Columbia University.—From a fund, to which contributions were made by Dr. Walter B. James, Mr. Cleveland H. Dodge, and a contributor who wishes to withhold his name, but to whom thanks are none the less due. The Royal Society of London. The Research Grant to the Physiological Department of the University of Toronto. The Moray Fund, Edinburgh. The Carnegie Fund, Edinburgh. Sir Robert Hadfield, Bart., F. R. S. Sir Peter Mackie, Bart.
EVER since the work of Haldane and Priestley(l) (1905) on the pressure of C02 in alveolar air, and that of Krogh(2) (1910) on the mechanism of gas exchange in the lung, it has been generally believed that the partial pressure of C02 is the same (to a close approximation) in arterial blood and alveolar air. The relation, however, of the partial pressure of oxygen in alveolar air to that in the arterial blood has not been determined with the same accuracy. This uncertainty is due in part to the dispute concerning the role played by the lungs in oxygen transfer, in part to difference of opinion regarding the mechanics of pulmonary ventilation, and also to lack of precise knowledge of the facts. It is the purpose of this paper to present data with reference to gas exchange in the lung. Our experiments have been performed on normal men while they were breathing air or low oxygen mixtures.Method. The modification of the Haldane-Priestley method used in obtaining samples of alveolar air has been previously reported(3). For the present work we have estimated the partial pressures of both C02 and 02 in the same samples of air. In the above-mentioned communication the method used for the determination of arterial C02 pressure was described. At that time, however, equilibration of the blood was carried out at 37.50 C. In the present series of experiments all equilibrations were done at the oral temperature of the subject. Since the temperatures found under basal conditions for normal subjects are in general at least one degree below the standard temperature, the earlier determinations are about one millimetre higher than the present determinations, owing to the effect of temperature on the C02 dissociation curve. A small error in the earlier work is due to neglect of the effect of acid formation in PH. LXVIII. 18
JN recent years non-traumatic hernia of the * stomach through the esophageal opening hi the diaphragm has attracted the at teuf ion of roentgenologists and of surgeons, but the literature of the subject indicates that internists have Bhown but little interest in this abnormality. Numerous interesting accounts of the condition have been given from a roentgenological point°f view and discussions of surgical technique designed to repair the hernia have been presented from time to time. Very few detailed case histories have been recorded and the authors of this paper have failed to find satisfactory autopsy reports concerning the nature of changes occurring in the stomach except in a few instances in which acute complications have been presentt.We do not propose to discuss the anatomical Possibilities of hernia through the diaphragm, the frequency of the condition, its roentgenological diagnosis or its surgical aspects, but wish to focus attention upon the question of anemia due to sIoav loss of blood resulting from mechanical conditions imposed upon the stomach from the stricture caused by the esophageal ring. The problem of diagnosis is difficult because there may be no symptoms referable to the stomach, and if the possibility of hernia has not been registered in the mind of the physician the condition may be overlooked, or, if found by x-ray examination, surgery for other conditions may be undertaken since the inclination of the clinician is to make a diagnosis of a silent undenionstrable ulcer of the stomach or malignant disease of the colon.Hemorrhage from the stomach is readily explained when ulcer or gastric erosions are present as shown in the papers of Truesdale1 and Harrington-. These conditions, however, are relatively uncommon since Truesdale, in 1932, was able to collect from the literature only seventeen cases of ulcer complicating diaphragmatic hernia. In the series of ten patients having anemia whose histories are incorporated in this paper, no history suggesting ulcer was obtainable and x-ray findings ivere negative for this lesion. To account for the cause of the bleeding, to our great advantage, three patients of this series have had thorough abdominal explorations by able surgeons and two others haA'e come to autopsy. This communication is offered with the hope that it may aid in the recognition of an interesting, disabling syndrome, and to give at least one answer to the cause of bleeding.In 1929, one of us3 presented a brief account of three patients, Cases 1, 2 and 3 of the present series, whose chief complaints Avere due to anemia secondary to blood loss as sIioavii by the presence of occult blood in the stools. Tavo of these patients had a history of passing tarry stools. In addition to anemia the only other major factor common to the three was the presence of hernia of the stomach through the esophageal orifice of the diaphragm, demonstrated by x-ray examination. Cases 1 and 3 underwent abdominal explorations because malignant disease of the colon Avas suspected in the first and a possible b...
This paper describes two allied methods for the determination of the rate of blood flow which have yielded consistently reproducible results in untrained subjects. The data obtained in forty experiments on twenty-one normal resting individuals are presented in tabular form. The first method is suitable for use with subjects having practically any type of pathology but in the resting condition only. The second method is inapplicable when the subject has a pulmonary lesion preventing ventilation of part of the alveoli or a cardiac defect permitting mixture of arterial and venous blood. With these restrictions, however, this method should be useful as it can be carried out in a short time, with a high degree of accuracy and under varying conditions of activity.[ETHOD I Several investigators have studied the circulation rate, determining the gases in the mixed venous blood by some procedure in which the lungs are used as an aerotonometer, and those in the arterial blood indirectly from the alveolar air or directly by analysis of blood obtained by arterial puncture. Burwell and Robinson, in a contemporary publication (1) have reviewed the literature of the subject and a complete bibliography will not be given here.The method of Christianson, Douglas, and Haldane (2) is difficult to apply to patients but, in suitable subjects, should yield results of the correct order of magnitude. It consists in the inhalation of. a mixture of CO2 and air (oxygen was used instead of air in a few ex-*The expenses of this research were defrayed in part by the Proctor Fund and by the Tutorial Fund of Harvard University.
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