Peter Fleming

The lung in shock

Abstract Alveolar gas exchange studies in 8 patients with shock revealed marked reduction in PaO 2 and increase in the alveolar-arterial oxygen difference while they were breathing room air. Failure to adequately increase PaO 2 while breathing 100 percent oxygen indicated significant increases in venoarterial shunting and demonstrated persistent perfusion of nonventilated lung units. An increase in the alveolar-arterial carbon dioxide difference indicated increased alveolar dead space, suggesting that some alveolar units were underperfused. Continuous pressure breathing improved PaO 2 in 6 of 7 patients but tended to increase venous pressure and reduce aortic pressure. These observations suggest that alterations in lung function are part of the generalized metabolic decompensation characteristic of the shock state. Decreased pulmonary nutrition secondary to decreased blood flow, increased left atrial pressure and pulmonary venoconstriction have all been implicated. Progressive pulmonary changes may preclude reversibility of the shock state.

Peripheral vascular volumes and whole body hematocrit during human heart lung bypass.

Indicator-dilution curves were obtained across the peripheral vascular bed in 15 patients soon after the beginning of heart lung bypass, and in eight of these persons they were repeated just prior to the conclusion of bypass. A bolus containing labelled red cells and albumin was injected into the arterial inflow line just proximal to the aorta. Serial blood samples were obtained at intervals of 1 second from the venous return line, just distal to the right atrium, and the radioactivity was measured. The interposed volume of blood in the pump oxygenator delayed recirculation, allowing extrapolation of the exponential downslope and calculation of flow rates and indicator distribution volumes by the Hamilton-Stewart equations.The distribution volume of albumin (average, 56.3 ml/kg) was always greater than that of red cells (average, 44.8 ml/kg). The average ratio of whole body hematocrit to perfusate hematocrit was 0.873. The absence of significant differences between data obtained at the beginning and just prior to the end of bypass suggests that there were no alterations in venous tone or the volume relationships of large vessels to the microcirculation.

News from Tartary : a journey from Peking to Kashmir

For most travellers, and all merchants, the road from China to India lies as it has lain for centuries, through Singkiang along that ancient Silk Road which is the most romantic and culturally the most important trade route in the history of the world. In 1935 Peter Fleming set out to travel that route, from Peking to Kashmir. It was a journey which swept him and his companion 3500 miles across the roof of the world. It took them seven months to complete the journey. They travelled across deserts and mountains, through ice and sand and into some of the most beautiful, mysterious and dangerous areas in the world. His account of that journey is filled with endurance and adventure, with strange encounters in the wilderness, with tales of Chinese, Mongol tribesmem and Indians, and with a spirited sense of humour and courage.