1. The pulmonary artery reflex test, that is, the cessation of breathing after the deepest possible inhalation results reflectively in bradycardia and the fall of blood pressure. According to our investigation these changes are due to high blood pressure in the pulmonary artery caused by the resistance of alveolar capillaries, strengthened by the expansion of the alveolar wall, and by the increase of the alveolar pressure that follows the deepest possible inhalation.2. This test, however, stimulates not only the pulmonary artery wall, but also the bronchus, the bronchia and visceral-and parietal pleura at the same time. However, we made clear that the bradycardia and the fall of blood pressure caused by this test is practically unaffected when the above said tissues other than the pulmonary artery, are stimualted.3. The degree of the said changes of pulse rate and blood pressure caused by this test differs among persons. Generally the bradycardia and the fall of blood pressure caused thereby appear more strongly in the persons with vagotonia (parasympathicotonia) than in those with sympathicotonia. In the same persons they vary with the day, their mental state and so on.4. This test is very useful not only for judging the condition of the autonomic nervous system of human beings, but also for the explanation of the various symptoms which occur in the pulmonary circulation, for instance pulmonary embolism, breath holding spells of children and so on.5. The comparison of the pulmonary artery reflex test with Valsalva's test and their clinical applications have been discussed in this article.6. The parietal pleura has many sensory endings of various types, although they are generally different from those in the pulmonary artery, the carotid sinus and the aortic arc.Although relativey infrequent, asthmatic attacks do occur while treating patients suffering from tubercular disease, with pneumothorax. This phenomenon is due to the stimulation of the parietal pleura by pneumothorax and the resultant parietal pleura reflex, but perhaps it only occurs in patients with a easily excitable lung-vagus.Furthermore, the shock and syncope rarely occur during the therapeutical manipulation of this pleura, for instance washing the pleura of the patients suffering from the empyema of chest, with the physiological saline solution. But when shock and syncope do occur in such situations, this phenomenon is also due to the parietal pleura reflex being caused by the stimulation of the said pleura by the manipulation, but perhaps only in persons with easily excitable heartvagus.

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In the previous study on autopsy material, I concluded that although the heart which had failed showed various myocardial, valvular or vascular abnormalities, these cardiac lesions alone could not explain a development of heart failure, and that the passive venous congestion was localized in the organs proximal to the heart.In an attempted analysis of the complicated conditions found in congestive heart failure, experimental laboratory study of animals is of recognized value. The present study was designed to produce with experimental aortic or pulmonic stenosis chronic congestive heart failure in a rabbit. One hundred and twenty-eight male adult rabbits were used. Fifty-eight of them died during or just after the operation. Among the remaining seventy rabbits which survived the operation, some were given physical exercise or sodium solution everyday, or sensitized to produce allergic myocarditis. As the signs of chronic congestive heart failure, subcutaneous edema in scrotum and limbs, and increase in body weight were taken up clinically, and the presence of ascites or pleural effusion, and cirrhosis of the liver, at autopsy. Duration of the experiment was 495 days at the longest. Two rabbits showed congestive heart failure clinically and the other two revealed it at autopsy. A brief description of them is as follows : NO. 41. 364 days after the operation of pulmonic stenosis, it was given isotonic sodium solution subcutaneously or orally. 438 days after the operation subcutaneous edema in scrotum appeared and later in the limbs. It died 449 days after the operation. At autopsy pleural effusion of 89 cc. (L., 29cc.; R. 60 cc.), ascites of 125 cc. and cirrhosis of the liver were found.No. 11. 470 days after the operation of pulmonic stenosis, physical exercise was given for one hour a day. Four days after then subcutaneous edema in scrotum appeared. It died 477 days after the operation. At autopsy pleural effusion of 60cc. (L., 20 cc.; R., 40 cc.), ascites of 40 cc. and cirrhosis of the liver were found.No. 100. 168 days after the operation of aortic stenosis, physical exercise and isotonic sodium solution were given. It died 198 days after the operation. At autopsy pleural effusion of 40 cc., ascites of 20 cc., conspicuous venous congestion of the lungs and partial cirrhosis of the liver were found.No. 108. 72 days and 130 days after the operation of aortic stenosis respectively, it was sensitized to produce allergic myocarditis. 163 days after the operation, physical exercise and isotonic sodium solution were given. It died 170 days after the operation. At autopsy ascites of 10 cc. was found.Being fixed for 24-48 hr. in 10% formaldehyde solution, the thickness of the ventricular wall was measured at the anterior middle part of the heat. The left ventricle in aortic stenosis and the right in pulmonic stenosis showed conspicuous hypertrophy. This indicates that cardiac hypertrophy occurs at the chamber which is under the strain retrograde from the site of stenosis.In the case of rabbits with cardiac hydrothorax, the larger effusion was also localized in the right pleural cavity, as in the case of man.

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