Part 2

Some of the simpler problems have already been flooded with light by those who following in Ehrlich's footsteps have studied the blood in disease. But many of even greater importance might be cited from the work before us. With the abundant information, the well argued deductions and the carefully drawn up statement here placed before us it may be claimed that we are now in a position to make diagnoses that not long ago were quite beyond our reach, whilst a thorough training of our younger medical men in the methods of blood examination must result in the accumulation of new facts of prime importance both to the pathologist and to the physician.

Both teacher and investigator cannot but feel that they have now at command not only accurate results obtained by careful observation, but the foundation on which the superstructure has been built up--exquisite but simple methods of research. Ehrlich's methods may be (and have already been) somewhat modified as occasion requires, but the principles of fixation and staining here set forth must for long remain the methods to be utilised in future work. His differential staining, in which he utilised the special affinities that certain cells and parts of cells have for basic, acid and neutral stains, was simply a foreshadowing of his work on the affinity that certain cells and tissues have for specific drugs and toxins; the study of these special elective affinities now forms a very wide field of investigation in which numerous workers are already engaged in determining the position and nature of these seats of election for special proteid and other poisons.

The researches of Metschnikoff, of Kanthack and Hardy, of Muir, of Buchanan, and others, are supplementary and complementary to those carried on in the German School, but we may safely say that this work must be looked upon as influencing the study of blood more than any that has yet been published. It is only after a careful study of this book that any idea of the enormous amount of work that has been contributed to hæmatology by Ehrlich and his pupils, and the relatively important part that such a work must play in guiding and encouraging those who are interested in this fascinating subject, can be formed.

The translation appears to have been very carefully made, and the opportunity has been seized to add notes on certain points that have a special bearing on Ehrlich's work, or that have been brought into prominence since the time that the original work was produced. This renders the English edition in certain respects superior even to the original.

G. SIMS WOODHEAD.

NOTE BY THE TRANSLATOR.

This translation of the first part of Die Anæmie, Nothnagel's Specielle Pathologie und Therapie, vol. VIII. was carried out under the personal guidance of Professor Ehrlich. Several alterations and additions have been made in the present edition. To my friend Dr Cobbett I owe a debt of gratitude for his kind help in the revision of the proof-sheets.

W. M.

CONTENTS.

PAGE

INTRODUCTION 1

DEFINITION. CLINICAL METHODS OF INVESTIGATION OF THE BLOOD 1

The quantity of the blood 2 Number of red corpuscles 4 Size of red corpuscles 12 Amount of hæmoglobin in the blood 13 Specific gravity of the blood 17 Hygrometry 21 Total volume of the red corpuscles 21 Alkalinity of the blood 23 Coagulability of the blood 24 Separation of the serum 24 Resistance of the red corpuscles 25

THE MORPHOLOGY OF THE BLOOD 27

A. METHODS OF INVESTIGATION 29

B. NORMAL AND PATHOLOGICAL HISTOLOGY OF THE BLOOD 48

The red blood corpuscles 48 Diminution of hæmoglobin equivalent 49 Anæmic or polychromatophil degeneration 49 Poikilocytosis 52 Nucleated red blood corpuscles 54 Normoblasts and megaloblasts 56 The fate of the nuclei of the erythroblasts 57 The clinical differences in the erythroblasts 61

THE WHITE BLOOD CORPUSCLES 67

I. NORMAL HISTOLOGY AND CLASSIFICATION OF THE WHITE BLOOD CORPUSCLES 71

The lymphocytes 71 The large mononuclear leucocytes 73 The transitional forms 74 The polynuclear leucocytes 75 The eosinophil cells 76 The mast cells 76 Pathological forms of white blood corpuscles 77 The neutrophil myelocytes 77 The eosinophil myelocytes 78 The neutrophil pseudolymphocytes 78 Stimulation forms 79

II. ON THE PLACES OF ORIGIN OF THE WHITE BLOOD CORPUSCLES 81

III. ON THE DEMONSTRATION OF THE CELL-GRANULES, AND THEIR SIGNIFICANCE 121

History of the investigation of the granules 121 Since Ehrlich. 123 Methods of demonstration 124 Vital staining of granules 124 The Bioblast theory (Altmann) 128 The granules as metabolic products of the cells (Ehrlich) 130 Secretory processes in granulated cells 134

IV. LEUCOCYTOSIS 138

Biological importance of leucocytosis 138 Morphology of leucocytosis 142 [alpha]. 1. Polynuclear neutrophil leucocytosis 143 Definition 143 Clinical occurrence 144 Origin 144 [alpha]. 2. Polynuclear eosinophil leucocytosis, including the mast cells 148 Definition 149 Clinical occurrence 150 Origin 154 . Leukæmia ("mixed leucocytosis") 167 Lymphatic leukæmia 170 Myelogenous leukæmia 171 Morphological character 187 Origin 187

V. LEUKOPENIA 188

The blood platelets. The hæmoconiæ 190

INDEX TO LITERATURE 195