USA > Ohio > Hancock County > Findlay > Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens > Part 74
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JANUARY, 1911.
similarly indistin the benzol cases. The residue in means of sodium over by steam. " and the ether was Jacquemin's tes As the history o Hospital, I only W & slow, chronic po are quite different the attending phy until, in the prese in the two urines of the patient who The conclusions positive and direct. the aniline which the shape of nitro until sufficient to c Benzol itself has less, and at times h In some of the ca that aniline and nit that nitrobenzol wa it appears probable, have been overlooked employed.
A rough attempt amounts of nitrober intensity of the colo benzol to which kn added. It appeared
1 Allen, Commercial 168
" Wichern: Fabriks Benzinevergiftung, Mü ' Santesson: Arch.
THE V
The study of the v tion of its other physi the idea of discovering to indicate new therap ing the viscosity have is given in a recent ar The work here repo tions:
I. The viscosity of ing a consideration of of the riscosity.
or Toaction in the urine not connected with cases.
due in the still was now made distinctly alkaline by sodium hydroxide, and about 250 cc. were distilled eam. The distillate was then extracted with ether, her was treated as stated before.
lin's test gave a very distinct sky blue color. istory of these cases is on file at the Johns Hopkins [ only wish to point out here, that the symptoms of 'onic poisoning by minute quantities of nitrobenzol, ifferent from those of acute cases,' so much so, that ing physicians at the hospital doubted my results, le presence of one of them, I demonstrated aniline urines which had been submitted, and in the brain ent who died.
clusions to be drawn from these examinations are d direct. The cause of the sickness and deaths was which had been absorbed during long periods in of nitrobenzol and had accumulated in the body ient to cause trouble.
self has been at times declared to be perfectly harm- : times has been denounced as dangerous.'
of the cases on record in the literature ' it is stated e and nitrobenzol were absent. In view of the fact enzol was concerned in the cases under discussion, probable, that its presence in minute quantities may overlooked for want of sensitiveness in the methods
attempt was made to get at the magnitude of the nitrobenzol present in benzol by comparing the the color produced by Jacquemin's test with pure which known quantities of nitrobenzol had been appeared from these tests that the quantities of mmercial Organic Analysis, 3d Ed., Vol. 2, Part 2, p.
Fabriksfeuerwehr, 1909, Vol. 16, pp. 10-11, 13-14. ftung, München. med. Wchnschr., 1909, Vol. 56, p. 11. : Arch. f. Hygiene, Vol. XXI, 1897.
nitrobenzol in the fluids analyzed, fluctuated from 1 to 7 mg. per liter. Assuming 5 mg. as the average, 10 gallons or nearly 38 liters per day of the rubber solution used in the factory would contain 190 mg. of nitrobenzol, a quantity, which, for chronic effects, is certainly not negligible. The quantities of aniline present were much smaller, and in the present con- nection may be neglected.
During the time that the aforementioned analyses were made, samples of various lots of benzol used by the can com- pany during the preceding six months were also examined. The results are tabulated below.
Sample.
Aniline.
Nitrobenzol.
Remarks.
1.
Extremely faint.
None.
Standard by which contract was made.
2.
Extremely faint.
Extremely faint.
59 days later.
Drum
None.
Strong dark blue color.
Drum
Faint light blue
No. 87.
color.
Distinct light blue color.
Drum
Extremely faint trace.
Strong dark blue color.
Drum
None.
Distinct light blue.
Drum
Very faint trace.
Very faint trace, barely visible blue tint.
The gap of about 120 days between sample No. 2 and drum No. 36 is regrettable as it is possible that more definite infor- mation as to the cause of the presence of the nitrobenzol might have been obtained. The tests, however, show that com- mercially C. P. benzol, free from nitrobenzol, can be, and at times was, furnished. That nitrobenzol should have appeared in quantities large enough to cause sickness and death, and should then have disappeared again completely, points to some accidental admixture, possibly by the temporary use of some of the drums for storage of nitrobenzol, followed by insufficient cleaning.
Since " C. P." benzol is used largely in the industries, and consequently a considerable number of people are more or less exposed to its vapors, the can company kindly gave me permis- sion to make public the results of my investigation.
IE VISCOSITY OF THE BLOOD IN HEALTH AND DISEASE.
By CHARLES R. AUSTRIAN, M. D., Medical House Officer, Johns Hopkins Hospital.
(From the Medical Clinic of the Johns Hopkins Hospital and University.)
of the viscosity of the blood, like the investiga- ter physical properties, was first undertaken with scovering a further aid to clinical diagnosis and w therapeutic paths. Many methods for measur- ity have been devised, a critical review of which ecent article by Determann.1
ere reported will be dealt with under two cap-
sity of the blood in normal individuals, includ- ition of the factors concerned in the production
II. The viscosity of the blood in disease, a collection of numerous clinical observations in various diseases with an explanation, where possible, of the changes which occur.
In all the determinations made, the Hess ' Viscosimeter was used. The instrument is not well known in this country so a description of it may not be amiss.
On an opaque glass base, H (see drawing), two graduated glass tubes, A and B, are fastened which are connected at one end by a third tube, G, and this in turn is in communication through a branch with the rubber balloon, L. At the other end, the two tubes. C and D, are drawn to capillaries of very
Digitized by
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No. 88.
No. 89.
No. 40.
10
JOHNS HOPKINS HOSPITAL BULLETIN.
[No. 238
fine caliber which widen again to the bore of A and B. The tube, F, placed on H and held there by the support N, is removable, and can be replaced by any of a number of similar ones. By means of the stop-cock Q, it is possible to establish or to interrupt the communication between B and G, and so between B and the balloon L. The tubes A and B are bent to a right angle at their junction with G. Interposed between the rubber tube K, and the balloon L, is a glass tube which com- municates by an opening with the air.
d
H
K
L
HESS VISCOSIMETER.
The entire apparatus is contained in a case 29 x 9 x 6 cm., having compartments for tubes similar to F, for a flask of ammonia, to be used in cleaning the instrument, and a ther- mometer mounted on H.
The method of making determinations is as follows: In the tube B-C-E is a column of distilled water, the left menis- cus of which is at 0 (zero). A tube F is filled by capillary action with blood. It is then placed in position end to end with D, and by means of suction exerted by L the blood column is drawn up to 0 (zero). The cock Q is then opened and under the suction of the bulb, the water and blood flow through the tubes A and B.
As soon as the blood reaches 1 (on the scale) suction is dis- continued and the readings are made. The mass of water which has risen in B, as shown on the scale, gives the relation of the viscosity of the blood in question to that of distilled water.
Water and blood are now expelled by pressure on the bulb L, the cock Q being closed when the water reaches 0 (zero). F is removed, and the tube DA is cleaned with ammonia twice drawn into it.
If the blood is very viscid or coagulates rapidly, it may be drawn to one-half or one-fourth, and the values obtained multiplied by 2 or 4, respectively.
Controls made with fluids of known viscosity show an ac- curacy within 1-2 per cent.
Experiments by Hess showed, that with every rise in tem- perature of 1º C., the viscosity decreases 0.8 per cent. Obser- vations at ordinary room temperatures show an error of about 4 per cent which, in relation to other errors which may arise due to the personal equation, is negligible. A correction is necessary, then, only when there are great variations in the temperature.
The blood for our experiments was obtained from a needle stab in the ear lobule, previously cleaned with alcohol. In those cases in which determinations on the plasma were made, the blood was drawn from the median basilic vein by vene-
puncture, and coagulation was retarded by the addition of dry hirudin * as recommended by Determann.3
In making the determinations, an absolutely fixed tempera- ture was not maintained, the suction force varied, and errors probably arose in drawing the blood. These factors, however, were present in all the experiments, could not be excluded, and therefore do not vitiate the results.
I. THE VISCOSITY OF THE BLOOD IN NORMAL INDIVIDUALS.
The normal viscosity is difficult to determine; first, because it is not always easy to decide just who is normal; and second, because of marked physiological variations in the viscosity of the blood. That various observers do not agree as to the normal, is shown by the table here given :
Man. Woman.
Hess ‘
4.57
Determann 8 Kottmann º 5.11
4.798 4.516
Bence 5
Rotky 6
5.4 5.12 5.1
Robert-Tissot 10 4.79 4.51
We chose for these observations students varying in age from 21 to 28 years-robust young men. The readings showed :
5.0
4.8
4.5
4.4
4.5
4.6
4.6
4.7
4.3
4.5
4.4
4.4
4.4
4.6 4.4
4.7 4.5
4.6
4.5
46
4.5
4.4
4.6
4.7
4.5
The average in these cases gives 4.55 as the viscosity for adult men between the ages of 20 and 30 years.
Similar determinations made on healthy women, in the same decade of life, showed :
4.5
5.0
4.6
4.3
4.5
4.7
4.5
4.3
4.5 4.3
4.9
4.3
4.8
4.6
4.4
4.6
4.5
4.5
4.4
4.8
4.3
4.3
4.7
4.2 4.3
Thus the normal for women-4.51-is very little different from that in men.
Hess ' and others have shown that the viscosity of the blood varies with age. Low values as 3.89 (male) and 3.80 (female) present in the first decade, are supplanted by rising values as life advances.
Variations with the time of day, digestion, rest in bed, muscular activity, body weight, body temperature, menstrua- tion, pregnancy, etc., have been previously noted.
The relative importance of the other physical and chemical properties of the blood in determining its viscosity, is much mooted. Viscosity does not vary directly with the specific gravity-" low viscosity values occur with high specific gravity
* Hirudin is a scaly solid, soluble in water, obtained from an extract of the buccal glands of the leech-Hirudo medicinalis. It has the power of retarding coagulation of the blood even when used in minute quantities, and has no influence on viscosity.
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JANUARY, 1911.
and conversely, elements of the b gravity, only som For the blood is bound in the erytl That hæmoglol proportion is shov
Hæmoglobin. 50 79 58 95 80 95 As to the consta the red corpuscles cu-sion has arisen. fairly close parallel are found, that on safe inference as Opitz,“ on the othe are the principal blood."
In our earlier ob between these two indeed did this rela red-cell count from Subsequent series though the viscosi erythrocytes frequer instances no close p
Vis
B. B. C. 4840000 3650000 3900000 4130000 4480000 2200000 4320000 4000000 4100000 3700000 4300000 4700000 5600000 6400000 4200000 5800000 6800000 4200000 3200000 3850000
3 4
In order to estim portance the red cor of the blood, the follo Twenty cubic centi conditions from the tining 2 mgm. of d blood determined. until sedimentation "The supernatant plas it measured. The co Vozicał saline solution
C
N
Hirsch & Beck ™
rowy, was probably to the fact that, whereas all the of the blood enter into the production of the specific ily some of them influence the viscosity " (Adam "). lood is not iso-viscous, the more viscid substances he erythrocytes losing some of their potency. emoglobin and viscosity do not always vary in direct is shown below :
obin.
Viscosity.
Hæmoglobin.
Viscosity.
3.2
30
3.0
4.5
100
5.0
4.5
60
3.8
4.5
42
2.6
4.3
75
4.2
4.0
73
3.4
le constancy of the relation between the number of rpuscles and the viscosity of the blood, no little dis- s arisen. Determann (l. c.8) notes that " though a : parallel exists between the two, so many exceptions that on the determination of the red-cell count no ence as to the viscosity can be drawn." Burton- the other hand, maintains that " the red corpuscles incipal factor in determining the viscosity of the
earlier observations, it seemed that a direct relation lese two factors could be demonstrated. So close this relation seem, that we felt able to estimate the int from the readings obtained on the viscosimeter. t series of observations, however, have shown that e viscosity of the blood and the number of the 's frequently do vary in direct proportion, in many 10 close parallelism can be proved.
Viscosity.
R. B. C.
Viscosity.
0
2.9
3120000
3.1
0
3.6
4000000
4.3
)
3.2
2080000
2.6
)
2.6
2100000
2.0
)
4.4
4220000
4.1
)
2.6
4900000
4.1
1
4.4
3700000
4.0
1
4.3
3900000
4.0
3.9
4000000
5.0
3.9
4000000
4.3
4.6
3800000
4.2
4.6
4400000
4.2
4.7
2760000
3.0
5.5
3300000
3.0
4.7
5120000
5.1
4.9
4700000
5.0
5.2
5000000
4.5
4.2
4320000
4.6
3.4
2975000
3.1
4.6
4100000
3.3
to estimate, if possible, of just how much im- red corpuscles are in determining the viscosity the following experiments were performed :
bic centimeters of blood were drawn under aseptic pm the median basilic vein, into a syringe con- m. of dry hirudin and the viscosity of the whole ined. A part of this blood was centrifugalized Itation of the formed elements was complete. ant plasma was pipetted off and the viscosity of The corpuscles were then washed with physio- solution, and suspensions made, until the cell
count was the same as that of the blood used. The viscosity of this suspension was then determined, and making allowance for that of the saline solution, we had the coefficient for the red corpuscles.
Blood.
Plasma.
R. B. C. 2.4
1
4.6
1.7
2.2
4.5
1.8
2.0
. .
4.7
2.0
2.3
. .
4.3
1.8
1.9
. .
5.0
1.7
2.2
..
4.9
1.9
2.4
..
4.4
1.9
1.9
. .
5.1
2.0
2.6
. .
From these findings it seems evident that though the num- ber of red cells in the blood is an important factor, it cannot be the dominant element in determining the viscosity of the blood. The significance of the plasma is also well shown, and variation in its composition must be of no little moment in causing fluctuations in the coefficient for the whole blood.
The influence of hæmoglobin on the viscosity has been demonstrated by Adam (l. c.). This author noted that in centrifugating blood, whenever slight hæmolysis occurred, the coefficient of the tinted plasma was higher than when a clear plasma was obtained. In order to prove whether the increased viscosity was due to hæmoglobin, he dissolved crystals of horse hæmoglobin in human plasma and found rising values with increasing concentrations. He then laked blood by alternately freezing and warming it, and found on centrifugation two layers-the upper, a colloidal fluid free of corpuscles with a coefficient higher than that of the whole blood; the lower layer was so thick with the stroma of the cells that its viscosity was extremely great. The increased viscosity of the laked blood is probably due largely to the increased protein content of the plasma, consisting mainly of hæmoglobin. That this last is true, he showed by demonstrating that, whereas carbon dioxide passed into normal plasma had no effect on its coefficient, when it was passed into the plasma of hæmolyzed blood a rise in viscosity occurred.
The observations on the plasma of whole and of laked blood we have been able to confirm in a series of ten cases.
Case.
Normal blood. Laked blood.
Normal plasma.
Laked blood plasma.
I
4.9
5.7
1.9
5.1
II
4.5
5.2
1.8
4.7
III
4.0
5.9
1.9
4.3
IV
4.6
5.2
1.7
4.8
V
5.0
5.9
2.0
5.1
VI
4.3
5.0
1.8
4.4
VII
4.4
5.1
1.7
4.6
VIII
4.6
5.3
2.0
4.7
IX
4.7
5.4
1.8
4.8
X
4.5
5.6
1.9
4.8
This relation between whole and laked blood had previously been pointed out by Determann (l. c.8). who explained the higher readings in the hæmolyzed blood as due to the libera-
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Saline.
5.2
1.9
1
12
JOHNS HOPKINS HOSPITAL BULLETIN.
[No. 238
tion of highly viseid substances, normally contained within the stroma of the erythrocytes, and thus prevented from influenc- ing the viscosity of the whole blood. He found clinical evi- dence to support this view in observations on a case of black water fever with hæmoglobinæmia, in which, while the patient was well, the laked and the whole blood differed greatly in viscosity, whereas during an attack of hæmoglobinuria the difference was less marked. In this instance, too, he had an indication that the viscosity of the blood is to some extent at least dependent on the osmotic tension between the plasma and the red corpuscles, and the difference between the coefficients of whole and of laked blood may perhaps be an expression of the resistance or fragility of the red corpuscles in health and in disease.
A priori, the proteid content of the blood would be an im- portant element in the production of the viscosity of the blood, and support is given this hypothesis by the experiments of Burton-Opitz " on animals and by the observations of Deter- mann (l. c.") on man.
The former noted that the blood of dogs fed on meat has a higher viscosity than that of dogs, hungry, or on a low proteid diet. He also found that food rich in fat raises the coefficient of the serum especially, whereas proteid food raises that of the whole blood.
Determann (l. c.8), studying the viscosity in vegetarians and in meat eaters, found that the coefficient in the former was low compared to that of the latter-4.32 : 4.85, though the hæmoglobin, specific gravity, and the number of the formed elements of the blood were not different. If these findings stand the test of further observations, they may furnish a valu- able clue to dietetic regulation in those diseases in which it seems advisable to reduce the viscosity of the blood. The metabolic experiments of Bence (l. c.), however, showed no changes in the viscosity of the blood after the use of diets over short periods of time. Similarly, in 35 cases of cardiac disease in the Johns Hopkins Hospital, the feeding of a modi- fied Oertel diet, over periods of from two to six weeks caused no appreciable alteration in the viscosity coefficients.
The influence of various salts has also been studied by Adam (l. c.). In a series of careful experiments, this author found that the viscosity of a solution rises with the increase of its proteid content and in general with the salt concentration. " But all salts do not influence viscosity to the same degree, the multivalent salts having a greater influence than the uni- valent. Among the latter, the iodides and potassium bromide are unique, in that they decrease the viscosity." This last observation lends support to the work of Müller and Inada 14 that iodides, given therapeutically, diminish the viscosity of the blood, but Adam asserts " that ordinary doses of the iodides rarely have a viscosity-lowering action, and at times even a viscosity-raising effect may be noted."
That the gascous content of the blood is important in its effect on viscosity, has long been recognized. Koryani and Bence " found maximal values when saturation of the blood with carbon dioxide was reached, and that as this gas was replaced by oxygen, the viscosity decreased to a minimum
beyond which the further addition of oxygen caused it to rise again. The work of Hamburger 16 and of Limbeck " indicated that as the carbonic acid content of the blood increases, the red corpuscles take up water and anions from the plasma, whereby the volume of each cell becomes greater, while the proteid, fat and sugar content, the mass of dry residue, specific gravity and osmotic pressure of the plasma rise, to fall again when the carbon dioxide is driven out.
Burton-Opitz " demonstrated similar changes by having dogs breathe alternately normal air and air surcharged with carbon dioxide, and Rotky (l. c.) noted a decrease in the vis- cosity of the blood when a patient with emphysema and cyanosis was given oxygen inhalations.
The viscosity-raising action of carbon dioxide we have demonstrated by rebreathing experiments.
A rubber mask, such as is used in giving gas anæsthesia, was closely fitted over the nose and mouth of a patient, and 'he was made to breathe over and over again the air contained in a four-liter rubber balloon. Rebreathing was continued until tachypnœa and cyanosis were pronounced, when the mask was removed. The viscosity of the blood determined just before, during and 30 minutes after the experiments are here tab- ulated :
Before rebreathing.
During rebreathing.
After thirty minutes.
4.5
4.8
4.6
3.7
4.4
3.9
4.2
4.6
4.2
4.6
4.9
4.7
3.9
4.3
4.0
4.0
4.5
4.2
4.3
4.6
4.3
4.5
4.6
4.5
4.8
5.0
4.8
In every instance the viscosity of the blood was increased during the experiments, to decrease again when normal air had been breathed for 30 minutes.
CONCLUSIONS.
1. The viscosity of the blood is a variable factor, determined to some extent by the variations in the constituent elements of that fluid.
2. It is slightly greater in men than in women.
3. The viscosity of the blood depends on the number of the red corpuscles, the hæmoglobin content, the gaseous richness; and to a lesser degree, on the proteid, fat and salt composition of the blood. With no one of these factors does viscosity vary in direct proportion.
4. The viscosity of the plasma is normally 1.7-2.0, average 1.86.
5. The viscosity of the blood is not influenced by diets used over short periods of time.
II. THE VISCOSITY OF THE BLOOD IN DISEASE.
When the influence on the viscosity of the blood, which the factors just cited exercise is recalled, it would seem probable that in those diseases in which the blood is most affected the maximal alterations in the viscosity would be found. It would seem likely for instance, that the readings would be low in
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JANUARY, 1911.
anæmia, high in ditions with mar tent this a prior show.
Under this he grees of severity diseases.
Disease.
Ascaris lumbricoid Carcinoma of sigm Carcinoma of rect Aortic aneurism . Aortic aneurism . Dementia paralytic Tabes dorsalis Malaria
Tuberculous perito Brain tumor Myocarditis Hysteria
Chronic nephritis Chronic nephritis Tuberculosis Typhoid fever Spastic paraplegia Typhoid fever, con Malaria Syphilis tertiary . Carcinoma of stoma Tuberculous mening Typhoid fever Typhoid fever Dementia præcox Hemorrhoids Neurasthenia Psychasthenia Gastric neurosis Amebic dysentery Carcinoma of stomac Myocarditis
Diabetes mellitus Cirrhosis of liver Cirrhosis of liver Delirium tremens .
From this tabula blood is diminishe diminution is rou anæmia.
Of no little intere wards normal with rionely noted by De these two cases.
Date. November 4 November 11
Date. March 1 March &
November 18
November 25 December 2 December 9
March 15 March 22 March 29 April 6
April 13 April 20
geauspjeyunsemia; low in hydramia, high in con- th marked salt retention, and so on. To what ex- priori reasoning is valid, the following observations
A. SECONDARY ANEMIA.
his heading are collected anæmias of different de- verity occurring in diverse functional and organic
ase.
R. B. C.
W. B. C.
globin.
ity.
ibricoides
3,300,000
9,900
68%
3.2
of sigmoid
2,840,000
8,300
30
2.8
of rectum.
2,530,000
13,000
28
2.4
irism
3,496,000
8,800
40
3.6
irism
3,620,000
9,500
44
3.7
paralytica
4,220,000
5,900
50
4.1
alis
4,500,000
7,100
56
4.2
s peritonitis
2,600,000
10,600
30
2.4
ir
3,540,000
7,900
36
3.1
-
2,320,000
7,160
56
1.8
phritis
4,130,000
19,480
92
2.6
phritis
4,480,000
6,000
76
4.4
S
2,200,000
4,600
62
3.6
ver
4,320,000
6,100
70
4.4
'aplegia
3,648,000
9,000
51
3.6
ver, convalescence.
3.120,000
5,600
63
3.1
tiary
4,000,000
6,000
70
4.3
of stomach
2,700,000
11,000
50
2.9
s meningitis
3,920,000
12,100
52
3.8
ver
4,300,000
7,200
67
4.3
ver
4,000,000
6,600
63
3.9
ræcox
4,300,000
5,800
80
4.2
ds
2,160,000
9,900
40
2.0
ia
4,100,000
7,500
80
3.9
nia
3,900,000
6,380
61
3.7
trosis
4,320,000
8,100
73
4.2
sentery
4,200,000
9,600
67
4.2
of stomach
2,080,000
12,200
47
2.6
Disease.
R. B. C. W. B.C.
Hæmo- globin.
Blood. Plasma.
Mediastinal tumor .. 8.120,000
6.900
119%
18.6
2.9
Cyanosis.
Obesity
7,620 000
5,300
105
8.3
2.2
No cyanosis.
Osler-Vaquez disease 6,049,000
7,800
102
6.2
2.4
Cyanosis.
Emphysema.
6,320,000
9,400
104
6.1
2.3
Cyanosis.
In all four the viscosity of the plasma was also increased, confirming the observation of Kottmann (l. c.).
D. NEPHRITIS.
Viscosity.
Diagnosis.
R. B. C.
W. B. C.
globin.
Blood. Plasma.
Blood pressure.
Chr. nephritis
3,240,000
7,560
65%
3.2
2.1
220
Acute
5,048,000
15,400
85
3.9
2.3
108
Chr.
5,800,000
6,000
100
5.6
2.1
180
"
4,300,000
6,200
80
3.9
2.0
180
Acute
5,000,000
15,800
90
4.0
2.2
195
5,120,000
11,400
99
4.3
2.4
173
Chr.
3.640,000
9.300
60
3.8
2.1
140
=
3,230,000
7,400
75
3.6
2.0
210
2,000,000
5,900
63
3.2
2.1
192
3,720,000
9,300
60
3.9
2.3
155
66
3,500,000
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