III. ON THE DEMONSTRATION OF THE CELL-GRANULES, AND THEIR SIGNIFICANCE 121
History of the investigation of the granules 121 Since Ehrlich. 123 Methods of demonstration 124 Vital staining of granules 124 The Bioblast theory (Altmann) 128 The granules as metabolic products of the cells (Ehrlich) 130 Secretory processes in granulated cells 134
Biological importance of leucocytosis 138 Morphology of leucocytosis 142 [alpha]. 1. Polynuclear neutrophil leucocytosis 143 Definition 143 Clinical occurrence 144 Origin 144 [alpha]. 2. Polynuclear eosinophil leucocytosis, including the mast cells 148 Definition 149 Clinical occurrence 150 Origin 154 [beta]. Leukæmia ("mixed leucocytosis") 167 Lymphatic leukæmia 170 Myelogenous leukæmia 171 Morphological character 187 Origin 187
DEFINITION OF ANÆMIA. CLINICAL METHODS OF INVESTIGATION OF THE BLOOD.
In practical medicine the term "anæmia" has not quite the restricted sense that scientific investigation gives it. The former regards certain striking symptoms as characteristic of the anæmic condition; pallor of the skin, a diminution of the normal redness of the mucous membranes of the eyes, lips, mouth, and pharynx. From the presence of these phenomena anæmia is diagnosed, and according to their greater or less intensity, conclusions are also drawn as to the degree of the poverty of the blood.
It is evident from the first that a definition based on such a frequent and elementary chain of symptoms will bring into line much that is unconnected, and will perhaps omit what it should logically include. Indeed a number of obscurities and contradictions is to be ascribed to this circumstance.
The first task therefore of a scientific treatment of the anæmic condition is carefully to define its extent. For this purpose the symptoms above mentioned are little suited, however great, in their proper place, their practical importance may be.
Etymologically the word "=anæmia=" signifies a want of the normal =quantity of blood=. This may be "general" and affect the whole organism; or "local" and limited to a particular region or a single organ. The local anæmias we can at once exclude from our consideration.
_À priori_, the amount of blood may be subnormal in two senses, quantitative and qualitative. We may have a diminution of the amount of blood--"=Oligæmia=." Deterioration of the quality of the blood may be quite independent of the amount of blood, and must primarily express itself in a diminution of the physiologically important constituents. Hence we distinguish the following chief types of alteration of the blood; (1) diminution of the amount of Hæmoglobin (=Oligochromæmia=), and (2) diminution of the number of red blood corpuscles (=Oligocythæmia=).