HÆMORRHAGE.
Arterial, venous and capillary hæmorrhage belong almost exclusively to the domain of surgery. Internal hæmorrhages will be considered in connection with the organs in which they take place.
HÆMOPHILIA.
Definition. Causes, lack of plasticity of the blood, thin walls, blood tension, cardiac erethism, hypertrophy and neurosis. Sex. Heredity through the female. Treatment, depletive, styptic, astringent. Transfusion.
This is a constitutional infirmity, usually hereditary and characterized by the occurrence of profuse and continuous bleeding as the result of otherwise insignificant injuries or even apart from any recognizable lesion. It has been attributed to a slow coagulation of the blood, but at the start of a hæmorrhage the blood is rich in corpuscles and coagulates firmly. It has also been ascribed to extreme tenuity of the vascular walls, but this has only been met with in a certain proportion of the cases. Another potent factor is a permanent over-filling of the bloodvessels (Immermann, Delafield, Prudden). The same writers attach importance to cardiac erethism, cardiac hypertrophy, and certain neurotic influences which temporarily increase the habitually congestive diathesis. In man the majority of victims have been males, perhaps because most subject to traumatisms. On the contrary the hereditary transmission is mainly through the female members of the family. The families are very prolific, a condition counterbalanced by the death of the majority of the victims at an early age. Among the lower animals it has been observed in horses consequent on castration (Siedamgrotzky, Kohne, Friedberger and Fröhner), setoning (Kohne, Dieckerhoff), and an ulcer of the leg (Kohne).
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.