A clinical method of determining the vasomotor factor in blood-pressure / by Albert Abrams.

  • Albert Abrams
Date:
1904
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Licence: Public Domain Mark

Credit: A clinical method of determining the vasomotor factor in blood-pressure / by Albert Abrams. Source: Wellcome Collection.

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    cavity eosinophile leukocytes disappear almost completely from the peripheral circulation within a few hours. After the inoculation of an organism producing an infection from which the animal is capable of recovering they disappear from the peripheral circulation so that their proportion may fall from 5% or 10% to less than 1%. The number then gradually increases until in four or five days it exceeds the normal pro- portion, and then slowly falls back to normal. When the number of eosinophiles is at the lowest point in the peripheral circulation they are found in great numbers in the vessels of the inflamed mesentery and omentum near the site of inocula- tion. Unlike the polynuclear leukocytes they rarely if ever act as phagocytes. In the region of the bacterial poison they undergo degenerative changes of which nuclear fragmentation is the most characteristic. Under the influence of severe bac- terial infection eosinophile myelocytes together with other elements, usually regarded as characteristic of the bone mar- row, accumulate in the spleen and may be found in the circu- lating blood. The occurrence of this phenomena within two to four hours demonstrates that the elements are derived from the bone marrow and are not formed in the spleen. Bacteria exert a chemotactic influence upon cells with eosinophile granulation, attracting them from the circulating blood to the site of inoculation and from the bone marrow into the blood. EKosinophile leukocytes, like the finely granular polynuclears accumulate in the neighborhood of bacteria injected into the body and though they rarely act as phagocytes, have a part in the series of changes which follow bacterial invasion. A New Case of Chloroma with Leukemia, with a Study of the Cases Reported since 1893.—Gro. Dock and A.S. WarRtTHIN. Dock presented these conclusions: 1. Chlo- roma is a tumor-like hyperplasia of the parent cells of the leukocytes, primary in the red marrow, the periosteum being involved only secondarily. The possibility of a primary chloroma in any part of the body in which white cells are formed must be considered. 2. Asa result of this leukoblastic hyperplasia, atypical leukocytes may appear in the circulating blood in varying number. Chloroma is therefore to be classed with the leukemias. 3. The white cells resulting from the atypical proliferation may in different cases attain different stages of differentiation. In some cases they may be of the large lymphocyte type, in others of the type of neutrophile or eosinophile myelocytes. 4. It is evident, therefore, as in the case of other leukemias, that the blood picture in chloroma may be very varied, and if this be used for a basis of classification it is possible to designate different varieties of chloroma. 5. The essential difference between chloroma and other forms of leukemia is the more marked neoplastic character of the former and the formation of the green infiltrations and metastases. 6. Chloroma is probably to be regarded as a more malignant form of leukemia. This malignancy of chloroma depends chiefly upon the replacement of the red marrow and erythroblastic elements by the proliferating white cells and the consequent diminished red-cell formation. 7. The cause of the green color remains unknown. Types of Splenic Anemia or Splenomegaly.—ALFRED STENGEL reported a series of cases that had been carefully studied clinically and microscopically. The first case was that of a child 3 years old, that had, at the age of 2, shown an increase in the size of the abdomen and marked pallor. Physical examination showed an enlarged spleen and the blood-examination gave 30% of hemoglobin, 2,900,000 red cells and 7,600 white cells. A general dropsical condition appeared and at the same time a leukocytosis of about 20,000. Autopsy revealed a general splenic enlargement with infarcts of the spleen and kidneys, a bronchopneumonia, vegetative endocar- ditis of the mitral valve and miliary tuberculosis of the lungs, liver and spleen. The lymphatic glands showed a marked hyperplasia and necrosis of the endothelial cells. The second case was in an adult showing splenic anemia with cirrhosis of the liver. There was a generally stunted growth, club fingers and pigment changes in the skin. Autopsy examina- tion disclosed hyperplastic changes in the spleen, cirrhosis of the liver and fibroid changes in the lungs and other organs. The third case was in a young woman of 25, whose condition was diagnosed as primitive splenomegaly. The spleen was removed by operation and the patient recovered. Micro- scopic sections of the spleenshowed a very marked hyperplasia with extensive fibroid growth. Discussion.—OsLER thought that these cases illustrate the extreme complexity of the subject and said that while the third case belonged to a very definite group it was doubtful if they could often be recognized clinically. He had seen such a case operated upon by Mikulicz some years ago and the patient was afterward exhibited before the German Surgical Congress. Since Osler’s last report on this subject he has seen 9 cases of great enlargement of the spleen associated with anemia. One was a case of socalled primitive splenomegaly ; 4 were cases of chronic splenic enlargement with pigmentation of the skin; 2 belonged to that group which resembles Hanneaux disease, and 2 were cases of splenic anemia subsequently becoming pernicious anemia. Sippy related a case which he had seen since the report he published in 1899. The patient was a woman with a movable spleen that came down below the umbilicus and readily moved about in the abdominal cavity. She presented the picture of a gradually developing anemia. The spleen was removed by operation and she made a complete and satisfactory recovery. He raised the question whether the splenic anemia in these cases might be due to poisonous substances secreted by the enlarged spleen or whether it be due to malnutrition. CaBpor replied to this point that there is no evidence, clinical 3 experimental, that splenic anemia is ever due to malnutri- ion. The Agglutination and Filtration of Trypanosomes, —The main features presented in this work by F. G. Novy and his associates, MCNEAL and HAR#, may be briefly sammed up as follows: 1. The trypanosome present in the Philippine surra can be cultivated artificially. 2. Attenuated cultures of this organism can be obtained, as in the case of Trypanosoma brucei. *3. This trypanosome is differentiated by its cultural characteristics from Trypanosoma brucei and Trypanosoma lewist, 4. The Philippine surra is therefore a distinct disease, different from nagana, and this observation confirms the work of Laveran and Mesnil on the nonidentity of nagana and the surra of Mauritius. 5. The morphologic differences between the Mauritian and Philippine trypanosomes suggests the probability that these organisms are distinct species, and hence that the term surra covers a group of closely allied diseases. Zonal Necrosis of the Liver.—E. L. OPrE reviewed the vascular and other anatomic features peculiar to the liver structure to show the varying facility with which necrosis occurs in different zones of that organ. He referred at length to the experimental work which has heretofore been done on this subject, and then considered in sections the conditions associated with zonal necrosis of the liver in various diseases, dividing the subject into central necrosis, peripheral necrosis, and midzonal necrosis, and followed that with a special consid- eration of the relation of midzonal necrosis to acute yellow atrophy of theliver. He related the clinical and anatomic his- tories of cases in each class. The paper is an extremely inter- esting one, not susceptible of satisfactory abstraction, and can be profitably read in full by those who are interested in the subject. Experimental Arthritis and Endocarditis Produced by a Streptococcus Isolated from the Blood of a Case of Rheumatism, Endocarditis, and Chorea.—M. J. Lewis and W.P.LonGcoorr. Ina fatal ease of rheumatism, endocarditis, and chorea a streptococcus was isolated from the blood before death. This organism did not differ materially from the com- mon varieties of Streptococcus pyogenes in cultural properties, but produced very characteristic lesions in rabbits when injected intravenously. Such inoculations were always fol- lowed after a few days’ incubation period by a multiple arthritis, which usually started in the ankles. In one rabbit extensive vegetations were found on the mitral valve, while typical infarctions were seen in the spleen and kidneys. This organ- ism was believed to be the same as that described by Wasser- mann, Meyer, Poynton and Paine, and Ainley Walker, and considered by them to be the specific cause of rheumatic fever. Serum Treatment for Hay-fever.— Harper’s Weekly states that in a list of 285 patients to which serum treatment had been given under different circumstances and in different countries, recently compiled in Germany, 60% are reported as completely relieved, 29% partly cured, and 11% failures. ‘‘ Hay- fever,” says the Weekly, *“‘is supposed to result from the pollen of various plants, and the serum was prepared by inoculating horses with this pollen. It may be used in liquid or powdered form, and is applied locally, no attempts having been made as yet at subcutaneous injection. There is strong evidence to believe in the efficacy of the serum, and in the majority of cases it was found possible to relieve the patient and to shorten mate- rially the seizure. Although it does not, however, prevent a recurrence of the attack, it has great value as a prophylactic.” Ceylon’s Battle with the Plague.—A correspondent to an exchange states that the last governor of Ceylon, fearful that the bubonic plague might gain a footing in this island as in the ad- jacent mainland, left no means of prevention and no precaution untried. The railway stations are posted over with regulations and instructions in case of plague patients being apprehended on a train, and no one with arash, a high temperature, a glassy eye, or a swelling near the glands of the throat need present himself at a ticket office and expect togoon. Despite the hordes of coolies traveling back and forth between southern India and the Ceylon tea estates, the plague has never been established on the island. There is strict quarantine against Madras, and tourists coming down by Tanjore and the temple towns of southern India are obliged to keep themselves under inspection and record for 10 days. A permit is given them and they are free to travel in Ceylon if they report themselves daily to the government med- ical officer, who stamps the paper day by day. This mysterious black death is almost as far from being understood as in the A Japanese bacteriologist discovered the bacillus 10 years ago, and since then all means of battling with it have been experimental. It rages in Madras, Calcutta, and Bombay, in all of which ports the most elaborate sanitary regulations have been in force for years; and it only exists at times, in- stances in which it has been directly brought from other places, in Colombo and Singapore. If the high temperature of Colombo cooler hill country should invite the black plague of Yunnan to whatever temperature it prefers.
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