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Knowledge of the changes in blood volume taking place in the course of congestive heart failure is necessary for an understanding of alterations in the dynamics of circulation in that disease. Changes in blood volume in cardiac decompensa-tion reported in the literature are of a confficting nature. Bock (1), Brown and Rowntree (2), Thompson (3), Schiirmeyer (4), Mies (5), using modifications of the original dye method of determining the blood volume; Plesch (6), using the carbon monoxide method, and Ewig and Hins-berg (7); using a combination of the two methods , have reported the blood volume as variably increased during cardiac decompensation. The most extensive studies have been made by Woll-heim (8, 9, 10, 11), using a modification (12) of the original Keith-Rowntree technique, Levin (13), and Goldbloom and Libin (14). On the basis of their studies these authors have described two types of congestive failure; the so-called " plus " and " minus " types. In the former type, in which failure is characterized by cya-nosis, distension of cervical veins, engorgement of the liver, edema and other symptoms and signs of congestion, the volume is said to be above normal during failure and to decrease with compensation. In the latter type, characterized by pallor, poor venous filling, marked respiratory distress and weakness, but no marked edema, the volume is said to be below normal during failure and to increase during compensation. In this communication we will report the results of our studies in patients in congestive heart failure, selected from the Cardiac Clinic and Medical Wards of the Peter Bent Brigham Hospital. We have employed the method developed by Gregersen, Gibson and Stead (15), as modified for clinical use by us (16). This method measures the plasma volume by means of an azo dye, Evans Blue, and employs the spectrophotometer for colorimetric estimation of dye concentration in serial samples of blood serum. The total blood volume and red cell volume are calculated from hematocrit values of venous blood and the plasma volume. In addition, many observations on ve-nous pressure and circulation time were made by methods previously described (16). Changes occurring during the transition from the compensated to decompensated state were studied by means of statistical analysis of a large number of single determinations in patients in varying stages of heart disease. Cases were placed in groups according to the severity of symptoms and clinical signs of congestive failure. …

CLINICAL STUDIES OF THE BLOOD VOLUME. III. CHANGES IN BLOOD VOLUME, VENOUS PRESSURE AND BLOOD VELOCITY RATE IN CHRONIC CONGESTIVE HEART FAILURE