Critical review : polycythaemia, erythrocytosis and erythraemia.

  • Frederick Parkes Weber
Date:
1908
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Licence: In copyright

Credit: Critical review : polycythaemia, erythrocytosis and erythraemia. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    blood was estimated in the same way by Haldane himself, and was found to be greatly in excess of the normal. In fact, with a blood-count of between eight and nine million red cells to the cubic millimetre, and with a haemoglobin- value of about 150 per cent, of the normal standard, there was likewise a great excess of the total blood-volume, that is to say, a condition of true plethora was also present. This is exactly what one would suppose from the plethoric look of such patients and from the engorged state of their visceral blood-vessels as revealed at the few post-mortem examinations which have as yet been recorded. I have Dr. T. D. Aeland’s permission to state that in an as yet unpublished case of splenomegalic polycythaemia under his care at St. Thomas’s Hospital, Dr. Haldane made a clinical estimation of the total blood-volume by the carbon-monoxide method, and showed that it was about two and a half times the normal. Dr. R. Hutchison also kindly informs me that in two typical cases of splenomegalic polycythaemia (accounts of which have not yet been published) at the London Hospital Dr. A. E. Boycott determined the total blood-volume by Haldane and Lorrain Smith’s method and found it in both cases very much increased; in one of the two cases, indeed, it appeared to reach the extraordinary figure of 10,750 cubic centimetres, that is to say, probably more than three times the volume normally corresponding to the patient’s body-weight. Quite recently, in another patient, Boycott and Douglas determined the total blood-volume by the same method and again found it greatly increased, as it w7as in all the other cases. In regard to the polycythaemia of high altitudes there is less evidence of associated polyaemia (true plethora) in human beings, but Jaquet and Suter found that in rabbits kept at high altitudes (Davos) a very striking increase occurred, not only in the number of red corpuscles and richness in haemoglobin per cubic millimetre of blood, but likewise in the total quantity of blood (and haemoglobin) which could be extracted from the body. Guillemard and Moog, from their observations on rabbits at the summit of Mont Blanc, also conclude that the total blood-volume is increased at high altitudes. The relation of increased total blood-volume (polyaemia, plethora vera) to absolute polycythaemia. Not many years ago the possibility of the persistence of a condition of plethora was denied by most authorities. R. von Limbeck, in the second edition (published in Germany in 1896, English translation, 1901) of his Clinical Pathology of the Blood, wrote: 4 The doctrine of plethora, formerly a dogma, has received its death-blow, owing to the growth of experimental investigation. It was especially due to the works of von Lesser, Worm-Muller, and Cohnheim that the possibility of the persistence of a condition of plethora came to be denied.’ In 1900, J. Lorrain Smith, by the 4 carbon-monoxide method ’ previously referred to, proved that in the so-called anaemia of chlorosis the total volume of the blood was in reality greatly increased (in proportion to the severity of the disease), and now, as we have already pointed out, it appears that true (absolute and persistent) polycythaemia is always, or almost always, accompanied by a condition of true plethora (polyaemia). [Q. J. M., Oct., 1908.] H