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HISTOLOGY OF THE BLOOD

NORMAL AND PATHOLOGICAL.


London: C. J. CLAY AND SONS,
CAMBRIDGE UNIVERSITY PRESS WAREHOUSE,
AVE MARIA LANE,

AND

H. K. LEWIS,
136, GOWER STREET, W.C.

Glasgow: 50, WELLINGTON STREET.
Leipzig: F. A. BROCKHAUS.
New York: THE MACMILLAN COMPANY.
Bombay: E. SEYMOUR HALE.

Transcriber's note:

For Text: Words surrounded by a cedilla such as ~this~ signifies that
the words are bolded in the text. Words surrounded by underscores like
_this_ signifies the words are in italics in the text. Words surrounded
by equal signs (=like this=) means the letters in the words are spaced
out (gesperrt). For numbers and equations, carats before bracketed
numbers denote a superscript.

Minor typos have been corrected.


HISTOLOGY OF THE BLOOD

NORMAL AND PATHOLOGICAL

BY

P. EHRLICH AND A. LAZARUS.


EDITED AND TRANSLATED

BY

W. MYERS, M.A., M.B., B.Sc.

JOHN LUCAS WALKER STUDENT OF PATHOLOGY.


WITH A PREFACE

BY

G. SIMS WOODHEAD, M.D.

PROFESSOR OF PATHOLOGY IN THE UNIVERSITY OF CAMBRIDGE.

CAMBRIDGE:
AT THE UNIVERSITY PRESS.
1900

[_All Rights reserved._]

Cambridge:
PRINTED BY J. AND C. F. CLAY,
AT THE UNIVERSITY PRESS.




PREFACE.


In no department of Pathology has advance been so fitful and interrupted
as in that dealing with blood changes in various forms of disease,
though none now offers a field that promises such an abundant return for
an equal expenditure of time and labour.

Observations of great importance were early made by Wharton Jones,
Waller, and Hughes Bennett in this country, and by Virchow and Max
Schultze in Germany. Not, however, until the decade ending in 1890 was
it realised what a large amount of new work on the corpuscular elements
of the blood had been done by Hayem, and by Ehrlich and his pupils. As
successive papers were published, especially from German laboratories,
it became evident that the systematic study of the blood by various new
methods was resulting in the acquisition of a large number of facts
bearing on the pathology of the blood; though it was still difficult to
localise many of the normal hæmatogenetic processes. The production of
the various cells under pathological conditions, where so many new
factors are introduced, must necessarily be enshrouded in even greater
obscurity and could only be accurately determined by patient
investigation, a careful arrangement and study of facts, and cautious
deduction from accumulated and classified observations.

The pathology of the blood, especially of the corpuscular elements,
though one of the most interesting, is certainly one of the most
confusing, of all departments of pathology, and to those who have not
given almost undivided attention to this subject it is extremely
difficult to obtain a comprehensive and accurate view of the blood in
disease. It is for this reason that we welcome the present work in its
English garb. Professor Ehrlich by his careful and extended observations
on the blood has qualified himself to give a bird's-eye view of the
subject, such as few if any are capable of offering; and his book now so
well translated by Mr. Myers must remain one of the classical works on
blood in disease and on blood diseases, and in introducing it to English
readers Mr. Myers makes an important contribution to the accurate study
of hæmal pathology in this country.

Comparatively few amongst us are able to make a cytological examination
of the blood, whilst fewer still are competent to interpret the results
of such an examination. How many of our physicians are in a position to
distinguish between a myelogenic leukocythæmia and a lymphatic leukæmia?
How many of us could draw correct inferences from the fact that in
typhoid fever there may not only be no increase in the number of certain
of the white cells of the blood, but an actual leukopenia? How many
appreciated the diagnostic value of the difference in the cellular
elements in the blood in cases of scarlet fever and of measles, and how
many have anything more than a general idea as to the significance of a
hypoleucocytosis or a hyperleucocytosis in a case of acute pneumonia, or
as to the relations of cells of different forms and the percentage
quantity of hæmoglobin found in the various types of anæmia?

One of the most important points indicated in the following pages is
that the cellular elements of the blood must be studied as a whole and
not as isolated factors, as "it has always been shown that the character
of a leukæmic condition is only settled by a concurrence of a large
number of single symptoms of which each one is indispensable for the
diagnosis, and which taken together are absolutely conclusive."
Conditions of experiment can of course be carefully determined, so far,
at any rate, as the introduction of substances from outside is
concerned, but we must always bear in mind that it is impossible, except
in very special cases of disease, to separate the action of the
bone-marrow from the action of the lymphatic glands; still, by careful
observation and in special cases, especially when the various organs and
parts may be examined after death, information may be gained even on
this point. By means of experiment the production of leucocytosis by
peptones, the action of micro-organisms on the bone-marrow, the
influence of the products of decaying or degenerating epithelial or
endothelioid cells, may all be studied in a more or less perfect form;
but, withal, it is only by a study of the numerous conditions under
which alterations in the cellular elements take place in the blood that
any accurate information can be obtained.

Hence for further knowledge of the "structure" and certain functions of
the blood we must to a great extent rely upon clinical observation.

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

[alpha]. Preparation of the dry specimen 32
[beta].



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Keywords: already, ehrlich's, though, observations, carefully, action, information, observation, professor, studied
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