Part 54

Treatment consists in combating plethora and constipation by saline purgatives. The subject should be carefully protected from injuries. Locally use styptics such as matico, muriate of iron, tannin, alum with pressure. Internally ergot, lead acetate, iron chloride, tannin, alum, or muriate acids. Transfusion is a dernier resort.

DISEASES OF THE BLOOD.

Obscurity of blood changes. Red globules, biconcave, embryonic. Source. Escape of immature red globules. White globules, eosinophile, neutrophile, uninuclear, multinuclear, lymphocyte, granular amœboid, strap-nucleated. Conditions of increase. Relation to microbes and their products. Blood plates. Destruction of red globules in the liver. Numbers in animals, in different vessels and conditions.

The blood is the common medium through which all nourishment is conveyed to the tissues, all material to the glands for secretion, or transformation, and all effete matter to the various emunctories for elimination. It is beside the carrier of oxygen for the respiration of the tissues, and the seat of changes, as yet little known, effected through the white globules. The activities of the various processes, carried on by the fixed tissue cells and nuclei would suggest, that any disease or derangement of these processes would be at once cognizable in changes shown in the blood. Yet so perfect is the balance of sanguification and elimination on the one hand, and of the remaining vital processes on the other, that it has hitherto been impossible to detect in the blood such changes as would identify the great majority with morbid processes. Some morbid changes are however recognizable and it is important that the significance of these should be known.

The blood is a liquid, consisting of a plasma holding in solution serum albumen, serum globulin, fibrine-forming elements, sugar, urea, salts, and a variety of other soluble bodies, and floating a series of semi-solid organized bodies, the red and white globules.

The red globule is however seen in two distinct forms. 1st. The biconcave disc, non-nucleated, containing a colorless stroma, and the coloring matter—hæmoglobin. 2d. The embryonic red globule, large, nucleated and rarely biconcave. The latter is found in the blood of the fœtal man or animal and persists to a slight extent for some time after birth. These are believed to be formed from the embryonic cell and from the cells of the embryonic liver, spleen, and marrow, whereas after birth they are derived from the marrow cell, and in healthy conditions pass the nucleated stage before they escape into the blood. In pathological anæmia and after severe hæmorrhages they escape more rapidly, probably from both spleen and marrow, and appear in the blood, even of the adult, of the gigantic size and nucleated appearance of the embryonic red globule.

The white blood globules (leucocytes) are spherical, about twice as large as the red globules, and are readily divisible by the acid eosin stain into two kinds: 1st. Cells which are deeply stained by eosin—eosinophile; and 2d. Cells that do not take on the eosin stain—neutrophile (Ehrlich).

Howells further divides these white globules into uninuclear and multinuclear. Of the uninucleated he describes three varieties: a. The lymphocyte which is non-granular and without amœboid movement; b. The granular cell with a protoplasmic envelope and amœboid movement; and c. The granular with strap-shaped, horseshoe or spiral nucleus. Like Lovet he considers the multinucleated as on the way to disintegration.

We cannot as yet speak with confidence of the pathological significance of these respective forms of white globules, but they increase greatly in numbers in connection with certain diseases of lymph plexus, and glands, of the spleen and other blood glands, and in foci of inflammation, and they perform most important functions in connection with the resistance of microbian invasion and in elaborating the antitoxines which confer immunity from second attacks.

The next form of blood solids are the blood plates of Bizzozero, the hæmatoblasts of Hayem. These are nucleated (Semmer) discoid, less than half the diameter of the red globules, and cluster together in granule masses when the blood is drawn. Their true significance is uncertain though it has been surmised that they are intermediate corpuscles (Semmer), that they are the disintegrated nuclei of the leucocytes, and that they furnish paraglobulin to the circulating blood (Schmidt, Howell).

The liver is one centre for the destruction of red blood globules and in the blood of the hepatic vein there may be a reduction of a million to a million and a half of red globules per cubic centimeter, as compared with the portal vein.

Malassez gives 4,500,000 as the number of globules in a cubic millimeter of blood (dog and horse 7,500,000, Nocard). The white globules are to the red in the proportion of about 1 to 300 (domestic animals 1:800, 1:1100, Nocard). The variation in different parts of the vascular system and at different times of the day is striking and suggestive.

In the blood of the splenic vein 1:60; in the hepatic vein 1:170; in the portal vein 1:740; in the morning, fasting 1:716; half an hour after breakfast, 1:347; in boys 1:226; in girls 1:389; in men 1:346; in old men 1:381; in menstruating woman 1:247; in pregnant woman 1:281, (Stricker).

PLETHORA. POLYÆMIA.

Definition. Transitory only. Causes, kidney disease, drinking freely, rich feeding, profuse secretion, polycythemia, hyperalbuminosa, excess of fibrine, sugar or fat. Ratio of blood to body. Variations of globules. Symptoms, general, local. Appearance of blood. Prevention. Treatment.

Definition. An excess of blood, of the blood globules, or of the albuminoids.

Formerly accorded an important place in pathology, plethora has been entirely eliminated from some recent works. The actual amount of blood varies greatly at different times, rising after a free consumption of food or drink, and falling during a period of abstinence. A healthy activity of the secretory and excretory organs secures a fair uniform average in the plenitude of the circulatory system. Moreover, large variations are not in themselves rapidly injurious. Worm-Müller and Cohnheim introduced into dogs ten to twelve per cent. of the body weight (fifty to eighty per cent. of their blood) of canine blood without inducing fatal results. More than this was fatal. In non-fatal cases a reduction to the normal standard is speedily secured.

But we cannot count on absolute immunity in all circumstances. Disease of the kidneys, or drinking water to excess, determines a surplus of water and urinary salts (serous plethora, polyæmia aquosa). In cases of rapid gain in condition from rich feeding, and above all after profuse watery secretion (diarrhœa, diuresis, perspiration), the red globules are relatively increased (plethora polycythæmica). After hearty feeding there is a large increase of albumins (plethora hyperalbuminosa). Fibrine-forming elements are apparently in excess during rheumatism, pneumonia and other acute inflammations. Sugar is in excess after a saccharine or farinaceous meal, fat in obese individuals, after consumption of fat, after injuries to the bone marrow, and after severe diseases with much destruction of albumen.

The ratio of blood to the body weight is: In birds 1: 12; in Guinea pig 1: 19; in rabbit 1: 20; in cat 1: 21; in dog 1: 17; in horse 1: 18; in sheep 1: 24; in pig 1: 26; in ox 1: 29 (Colin). As showing the variation under even different normal conditions of the system Bollinger found the blood but 2.2 per cent. of the body weight in a fat pig, whilst it was 13.5 per cent. in a draft horse. Colin found it 2.4 per cent. in the fat ox instead of the usual 3.4 per cent.

The excess of red globules and usually also of albumins is seen as a temporary condition, in lean but vigorous animals put suddenly on an abundant diet, rich in assimilable albuminoids, in working animals, put in confinement to feed, and above all in high conditioned cows after an easy parturition, when the uterine blood has been suddenly thrown on the general circulation and the emunctories have failed to establish a balance. Also in the lymphangitis occurring after a day or two of rest, in a horse that has been hard worked and heavily fed.

It should be borne in mind that the number of red globules varies considerably in the different animals. In the dog it was by weight 148.3 grammes per 1000; in the pig 105.7; in the horse 102.9; in the ox 99.71, and in the sheep 98.2 (Andral, Gavarret, Delafond). By count the horse has 5,500,000 per cubic millimeter (7,500,000, Nocard); and the dog 5,000,000.

Symptoms. Under a sudden dangerous increase of the volume or the organic elements of the blood, there are usually dulness, lassitude, dropping of the head, strong, full, hard pulse, extra force in the heart beats, thirst, elevated temperature, and redness of the visible mucous membranes. At first there is no indication of local disease, but unless relief comes by free secretion some local complication is likely to ensue. This may be epistaxis, congestion or apoplexy of the brain, parturition fever, lymphangitis, or congestion of some internal organ, etc. A drop of blood colors deeply the finger or other object, it clots firmly in three to five minutes, and shows more than usual of a buffy coat.

Treatment. As dangerous plethora is usually a very transient condition the main attention should be given to prevention, in keeping the diet low and the emunctories active in high conditioned parturient cows; in lowering the diet and securing free secretion, or in giving exercise to high fed, hard worked horses that have been laid off work; in changing only by slow gradations thin, vigorous animals to a rich diet, etc. When the danger is imminent prompt relief can be secured by the liberal abstraction of blood. Purgatives, diuretics, and restricted diet may be applied to less urgent cases.

HYDROÆMIA. ANÆMIA OLIGÆMIA.

Definition. Causes: bleeding, watery repair, hydroæmia, repair of globules, changes in red globules, in bone marrow. Cause of chronicity; profuse secretions; moplasms; parasites; chronic exhausting diseases; defective diet or hygiene; diseases of jaws or throat; overwork; toxic substances. Symptoms: pallid mucosæ, weakness, perspiration, soft tissues, small pulse, palpitation, anæmic heart—arterial and venous murmurs, depilation, indigestion, costiveness, urine clear, abundant, emaciation. Lesions: blood poor in globules, embryonic, and other abnormal red globules, fatty degeneration, blood clot. Treatment: remove causes, diet, hygiene, sunshine.

Definition. Bloodlessness; Deficiency of blood; Lack of red blood globules. The last named is the condition to which the term is habitually applied.

Causes. Anæmia is not so much a disease, as a result of a great many debilitating and exhausting conditions. =Hæmorrhage= the most direct cause of anæmia determines at first an actual lack of blood (oligæmia) and of blood pressure, which may be sufficient to cause fainting and death. In case of survival the amount of blood is rapidly made up by absorption from all available sources of liquid in the economy, but the blood so restored is essentially hydroæmic having an excess of water and a lack of globules and dissolved solids. If however the loss has been moderate the quality may be restored in a few days. Buntzen found that after moderate bleeding the volume is restored in a few hours; after a profuse hæmorrhage in 24 to 48 hours. After bleeding to 1.1 to 4.4 per cent. of the body weight the increase of the red globules may be noticed after 24 hours, and is completed in 7 to 34 days. It is noteworthy that during this repair the bone marrow becomes much redder and more cellular, and that new red cells found in the blood are nucleated (Neumann) and contain less hæmoglobin (Ott). The absence of hæmoglobin is nearly in proportion to the amount of the hæmorrhage (Bizzozero, Salvioli). If the hæmorrhage is slow and continuous this repair is counterbalanced and the anæmia is much more persistent.

=Profuse secretion= as of milk (cows, goats, ewes, bitches, on poor feeding), of liquid fæces, urine, or pus often determine a marked and even dangerous anæmia.