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MICROCOPY RESOIUTION TEST CHART 
 
 ^SSI and ISO TEST CHART No ? 
 
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 ^ /APPLIED INA4GE Inc 
 
A Method for the Determination of 
 Plasma and Blood Volume 
 
 X. -M K 111 il, M I) 
 
 1- <■.. \< < I W X T k i; j-. Ml) 
 
 AM) 
 
 .1. T i; I", k \ I. II T >-, M h 
 
 h\-rniil,;l in. Ill ih,- .hrliitrs ,<f Inlcninl Mcdicun' 
 Oi-l,thi-r. !'>l\ l',>!. xi-i. /-/>. ^47-^71, 
 
 AMtuirAN Mkdicai AssoriAT 
 
 li^' Hrv,,,, ,. T Minvl-ivi Nmbtm I), vk 
 
 I'llS 
 
 '■'"' .^TRtF.T 
 
I 
 
 A Ml-.TilOD I'(_)R TIIF. DETERMIXATlUX 
 AXb BLijOD volume* 
 
 OF PLASMA 
 
 X. M. KEITH, M D., L. G. ROWXTREE, M.D. 
 
 AND 
 
 J. T. GI-RAGHTV, M.D. 
 
 ISALTIMORi; 
 
 Rrnuinc red cell (.ount^ and iR'innfjldliin dcterniinations yield iiit'or- 
 niation that is valuable but \ery incomplete. This information con- 
 cerns on.ly the concentration of the blood. The.-;e routine methods do 
 not furnish us absolute \alues for hemofjldbin, for red cells, or for the 
 oxygen-carryinrj cajiacity of the blood. With them, an anemia may 
 be more aii]iarent than real, as it may be dependent on or associated 
 w ith a marked increase in plasma volume, while a polycythemia does 
 not necessarily indicate an absolute increase in reil cells, as it inay be 
 dependent on a decrease in plasma. In order to obtain absolute values 
 for either red cells or hcmoi^dobin. data relative to plasma volume or 
 total blood volume are essential. 
 
 The volume as well as the concentration of the blood must play a 
 role in ])atholos;ical physiology. Absolute values are essential to the 
 ]>roper intcri)retation of certain pathological findings. Is an increase 
 in the blood mass with overfilling of tin- vascular system m any way 
 responsible for hypertension? Is the large heart frequently seen in 
 pernicious anemia due to a large blood volume? Is the large heart 
 sometimes seen in myocardial insufticicncy (unassociated with hyper- 
 tension or nephritis) due to an increase in blood mass? Questions 
 such as these must remain unanswered until data concerning absolute 
 \aiues are correlated with pathological findings. 
 
 \\ ith so great variations in size and weight of in(lividuals, the 
 normal xalucs f^r plasma and blood are best expressed in percentages 
 cir fr.iclion- i.f the body \veit;ht. or a^ the numi)er of cubic centimeters 
 ])cr kilogram of b(jdv weight. Since the work of W'elcker. tiie bloo.I 
 has been considered to constitute one-thirteenth of the body weight. 
 Recently, the values obtained by Ilaldane and Smitii (one-twenty- 
 lust), and by Plesch (one-nineteenth) have been frequently accepted. 
 The methods affording these la>t values are not without serious draw- 
 backs from the jioints of view of inherent technical error, complicated 
 nature of apparatus re(iuired and the possibility of injury or discom- 
 fort atiendintr their use. 
 
 * From the Modiral ;in(l J.imes riiuhaiMii Br.iily Urclogical Clinics of tlie 
 [lilin^ Hopkins Ho-pitnl. 
 
TIrtc i- a (li-liiul uvlA inr a >iiii|ilc iihiIkhI fcr tlic (k'lcniiinaliuii 
 of pla.-iiKi and MiukI miUiiih', |i,inicularly lor a iiKilnMl thai can lie 
 rcpcatt'ilh' a|ijilicil witlmnt iniur_\- ti> the patient. 
 
 I 111. n;iM iri.r i<v \ in: mi.tiihh 
 
 Ihi' priiuiple miMerlx iii<4 thi- mrthnd i> the inlr(]<lmiiiin direilly 
 intn the eirciilatidii nl' a nnn-tcxie. -lowly ali-nrhahle dye, whicii 
 remains in the ])la>nia km,!,' encju^h for ihorou.u'h niixint;, and the deter- 
 mination of its concentration in tlie pla-ma colorinietrically by coni- 
 pari-on with a -iiitahle >tamlard mixture of dye and -enim. 
 
 A d\e whicli would fiillil the>e conditions wa- r-ouj^ht. Certain of 
 the plilhaleins were tried and di-car<led het-ause of the rapidit_\- with 
 whicli t!ie\- lease the \a-cular -y-tem. i >r. lierl)ert M. I'van.-. of the 
 Anatiiliiical 1 )epartnieiit. when coiiMilled in re;;ani to dye- reinaiiiin.t,' 
 for a loiii; time in the «. irculation, -iit^i^e-led the ]io--.ihilitie- ol vital 
 red. ami -llp])lied ii- with tiie d\e ii-etl in thi:^ work. It i- with yreat 
 p!ea--ure that we acknowledi;e our indebtedness to him. 
 
 soMi- I'Koi'ijM ir.s OF Tin: i)\i-: 
 
 \ ilal red i- di-odium di-ulphoiiaphlhol azolelramelhyl tri[)hen}l 
 melhane. 
 
 C!In V . CHa 
 
 XaOSV/ 
 
 so X.i 
 
 H 
 
 ] 
 
 ■C- 
 
 CM,, ^.^ n, 
 
 >C = X 
 
 i 
 
 ID 
 
 xao,.s\y\y -^L'N'a 
 
 It i- water -olulile to die exlent of 1 ' .■ per cent, in dilute solulioii> 
 of cud jier cent,, it doe- not dialw.e at;ain-t water tliroii^h collodion 
 -ac- e\eii in fort\ ei;^ht hour-. I'lider -nch condition-, the dye i- 
 practicallv ad-orhed h_\- the dial_\zini;- memlirane. 
 
 When it.- toxicitx' wa- delerniincij hy iiitraxenou- injection into 
 animals, it was found thai do-r- exceeding; from .^ to Id nii;. per kilo 
 sometimes resulted in .a -lii^hl tf.in-ient alluuuiiiuria. Smaller di,-e- 
 wcre harnile--. -o f;ir a- could he a-certained. 'I'hree m'^. ]ier kilip 
 w,a- cho-en as tlu' mo>t -uilahle amount for our jmrposes. I'rolocol- 
 of cat- and doi,'- -tudid! for loxicitv appear helow. 
 
 ToXK 1 1 ^ I \ri:i;i .\ii:n l.s 
 rR'Ti'c iii.s 
 
 C\T ! — \\\ii;lit. 2 4 kir. : given 750 ni;;. intravenously; kilUiI in tlinr Imiirs. 
 
 C.\r 2. — \\\ii:bt. 2.75 kg.; given "Id nip. intravrnmi-ly : kilKil in twenty 
 hours. 
 
 C\i ^ — W'li'jtit, k".- ki;.; iziven 6 mv.. tn kik'grain intr.aveniiii-ls' : i:n effect; 
 urine free frmn .illmniin afierward 
 
DiKi 5. — W'cinlit, " lig X'lv. 4, 1''I4: (mmp COO mg. ; vitally ^tniiud ; iii) 
 toxic manifestation?. One wctk later, 41) per cent, of (l\e still in circiilaticn. 
 
 Dec. 17, 1914: lilood .still contains consiilerablc ilv.-. 
 
 M;irrh 1, IOI.t- .\nimal still slightly vitally staim d after a period of fonr 
 iiionth-. On only one occasion during this whole period was a trace of albninin 
 found in the urine. 
 
 Dog 8.— Weight. 6.8.^ kg. Xov. 17, l'yl4; Given .3.^0 mg. 
 
 Xov. 18, 1'I14: C'on^iilerahle alliiiniiii in urine; tm casts; some red hlood 
 celK. 
 
 Xov. 22. 1'I14: Advanced distemper. Urine free from alhiimin. 
 
 Xov. 26. 1914: Dieil with disteuipci. 
 
 Do,; ').— Weight. '1.0 kg. Xuv. 21. 1''14: fiiven '■') mg. Dog was normal 
 except for a l:iint traee uf allnunin fmnid in tlie urine mi lir^t and --I'eond clay-;. 
 
 Dog 10. — Weight, ,^.5 kg. Xov. 21, 1914: Given 55 mg. ; normal; no alhumin. 
 
 Til orck'r tu \ itallv siaiii tin ii-^ucs t-vcti sjitrlitlv, it was loutnl 
 ticecssary to ii'C at loast 10 m^ per kilo. If a strong soltitioii is 
 injected locally into the subciitaneou.s tissues, the ti-sucs are stained 
 a licaiitifi'l l)rii;lit red ccilor, which iiersist, tmaltercd tor ir.any months. 
 This accident happened with patients on two or three occasions early 
 in this work, hut since has been avoided by ascertaining with certainty 
 tli.'it the needle was in the liinien of the ve'iti 'elore the cl_\e was 
 injected. 
 
 Traces of the d\e ;ippe;ir in the urine ;ind in the Ivinph llowitig 
 from tile thiir.icic duct at the end of ten niimite^. The dye coiuimies 
 to be excreted in the urine of patients for from three to lour days fol- 
 lowing a (l(jsc ^f .S mg. per kg. Following this amount no evidence 
 of the dye in the tissue cell> or white blood cells could be found with 
 the oil immersion. I'he fate of all the dye li;is not been detenuined, 
 iiul con>ider,'ililc amount- can be found in the plasma for three or four 
 days following il> inicclion. 
 
 TI-CHMC 
 
 .\ 1..^ per cent, -ululinn nl the dve in frohlv di-tilled water i> p,rc- 
 [lared and sterilized bv boiling for from live to ten minutes, and nsep- 
 licallv -till perrd in a sterile I .rionnieyer tlask. liii- snluli.iti is made 
 u]) as rei|uireil. 
 
 Ihe patient is wcigheil i-triiiped) and the do-e dete'rniined on a .5 
 mg. ]ier kiln basis. 'I'hc skin ove'- the anterior surf.ace of both elbows 
 is cleaned up in the usual manner fur \ eiiepunelure. L'nder aseptic 
 teclmic. ;i small platimim-iridium needle (20 gauge I to whicii is 
 allaclied ;i -hurt ]iiece of rubber tubing ( from J to ,i cm. in lengdi ) is 
 inserted into the \ein. Ten c.c. of blood are withdr.iwn iiUo a ]iipet 
 and emptied into a ?0 c.c. centrifuge tube containing iust sufticient 
 powdered -mliuni ox.alate to prevent coagulation. The pkisma so 
 ol'.tained i- u-ed in the ptLiiaralion of the standard which is described 
 
later.' Tlu- nililiir tuliins; i-> rL-niovcd from the iicciUf, tue latter liein.i:; 
 left in the \eiii and a 31 e.c. Recnnl >yrini:;e containing; the exact dose- 
 ot the (iye is attaehed. and its e()ntent^ injected, after ^\•hiell the needle 
 is withdrawn. Three minutes later, a needle is inserted into the \ ein of 
 the oppo-ite ,inn. Wiihoul iniiiedinj,' the venous return, 10 c.e. of 
 blood art withdrawn iniinediately hy means of a iiipet; two or three 
 niinu'e- later, h' e.c. more are witiidr.'iw n. The lir^t i.-' placeil in a 
 50 c.e. i-enlrifu,i,'e tuhe. the .'-eeond in a 15 c.c. s,Madiiated ceiUrifusc 
 tuhe. To each, MitVieient dry oxalate is added to prevent clotting, and 
 the tnlie> .are eapjied with rnl)her to prevent ev.iporatinn during' cen- 
 trifn,L,'aliz,i'Li<jn. 
 
 The three luhes are placed in a hi,i;h'iiower centrifn,L;e and suh- 
 jccted to .\0n() re\()lutions per minute for twenty minutes.' After 
 remtjval from the centrifuije, the relative iJrojKjriions of erythrocytes 
 and plasma in the .graduated tuhe are noted. Without di-turhin.i; the 
 red cell-, the pla-ma i- carefully pipetted uii from each tube and placed 
 in a clean test tuhe. We now have three tot tube-, ( 1 ) contaiuins 
 pla-ma without dye; ( _' and .i I containin,<2; i)la-ma with dye in an 
 unknown concentration. A suitable dye-plasma standard mixture of 
 known cl\e contein nui-t be prepared, and with it 2 and 3 arc coni- 
 
 The siaiidnrd dvc preiiaration' is made ;is follows: 0.5 c.c. of the 
 dve solution u.~ed for the injection is hrou^lit up accurately to 1(«) c.c. 
 
 1. This procoihire of taking pia-ma lor inixiiiv; llu- statular.l in each ca~o 
 was louiul necessary on acconnt ot the great variation in tlie color ni ikc plasma 
 ni (iiffercnt iniliviiUials. 
 
 2. Tlie anionnt injected is 3 mg. per kg. The wri«ht in pouiuls diviileJ l)y 
 elevor. gixes tlic niunhcr of cubic centinu-lers of a 1.5 per cent. soUition to be 
 injected. 
 
 3. To prevent hemolysis, all pipets at.l CLntrifuiie tubes must be thoroughly 
 washed with normal saline solution and dried before use It is obvious that 
 tlie slightest hemolysis will alter the color of the plasma and make accurate 
 colorimctirc readings impossible. 
 
 4. Obviously the standard must be sulVieicntly intense in color to insure the 
 patient's readings falling on the scale Since the smaller the amount of plasma 
 in relation to the body weight the greater will be the intensity of the dye. a 
 standard must be chosen which will be more intense than the plasma-dye mix- 
 lure obtained from normal patients having the smallest proportion of plasma 
 in rt-lation to body weight. 1 be standard selected has bedi prepared on the 
 following basis: The amount of drug injected is placed in the number of cubic 
 centimeters of salt solution corresponding to the number of grams represented 
 by 4 per cent, of the body weight, or, expresse<l difTerently, in the amouu; of 
 salt solution represented by 40 c.c. for every kilogram of hody weight: this 
 amounts to 5 c.c. (7.5 mg. of dye) of the solution inlccted, to 100 c.c. ot 0.8 
 per cent, sodium chlorid. For example, a man weighing "0 kilos would be given 
 210 mg. of dye (3 mg. per kg.), which is equal to 14 c c. of a 1.5 per cent, solu- 
 tion. Four per cent, of 70 kg, is equal to 2.8 kg., and without making a correc- 
 tion for the difference in spceilie hetween the hlo.id plasma and water, tins 
 would amount to, roughly, 2,81K) c.c. If 210 mg. are diss.dved in 2.8m) c c, 
 then 7.5 mg. should be dissolved in 100 c.c. 
 
with O.S |icr cert. ■-:iliiio. • »inj part m' tlii-, is iiiixi-d \\itli niic p:irt of 
 the |.ititiil"s ; : i and two jjarts ot salt sohltidii, vicliliiii,' a dilution 
 
 of 1 in 4. W; . . lb solution, the prism of the colorimeter (Rowntree 
 and Gcrajihty's inndiiication (jf the Auten.ieih-Konigsberger appara- 
 tus) is filled. This dilution has been found to be well adapted to 
 idlorimctric deterniiiialicns. Each of the sjn'cimens (2 and 3 of the 
 iiaiient's ]ila-nia i i-> diluted with thnc jiarts valine and ii'aced in the 
 cup of th ■ colorimeter and read ;,,i,'ainst the above standard. 
 
 C:.\LClLATI(l\ ul- KK.SLLTS 
 
 The method described above furnishes volume \;dues for plasma 
 and total blnod. When it is desired to express values a^ ])er cent, of 
 body wci,L;ht. the formulas ^iven bebjw can be utilized. Since the 
 s]K'cilic gravities of tile pla.-ma and of the blood were not ascertained 
 in this study, one of 1.050 for the whole blood and of l.U30 for the 
 ]ila~nia have been used. 
 
 Inli.\u;i..\S 
 
 I'Idsimi i'fluinc. — Weight of pati!.-tu in kt;. = W. 
 
 Standard prepared su that amount oi dye injected i~ diluted in -iil c.c. for 
 every k^. of body weight. 
 
 Reading of standard prepared as directed = 1(HJ. 
 
 Reading of patient's plasma against standard = R. 
 
 The number of c.c. of plasma in patient's Iiodv = 100/ R X 40 \V = 
 4.1 iOO W/R. 
 
 Percentage of BoJy li'eiijhl. — Plasma volume in c.c. X Sp. G. of pla-ma/l.OOO 
 := u eight of plasma = M. 
 
 X X 100/\V = per cent, of body weight. 
 
 Cubic centimeters of plasma per kg. = Xo. c.c. in body/W. 
 
 Total Blood I'olume. — Let hematocrit reading of the volmnc occupied by 
 corpuscles = P. 
 
 Volume of plasma = 100 — P. 
 
 Total blood volume = iilasma volume X 100/100— P. 
 
 Total Blood as Per Cent, of Body \\'ei(jht. — Total blood volume in c.c. X 
 Sp. G./1,000 = weight of total blood" = Y'. 
 
 V X I00/\V — " per cent, of body weight. 
 
 Cubic ccn'imctcis per kg. ;= number c.c. in body/W. 
 
 VMii;s!K.\i;i.i: ii:.\TLRi.s OI" tiik .Mi;Tiion 
 
 llciuolysis. — .'sometimes the colors do not match perfectly in qual- 
 ity. This is the result (jf hemolysis and of necessity makes the (|uan- 
 titati\e determination more difticult. It is extremely infrequent, how- 
 ever, to lind this failure with lioth s])ccimeiis. and on the one or two 
 occasions when this has occurred, the determination was not attempted. 
 Records have been kept throughout as tn the matching of the colors. 
 In ,-i large jirojiortion of instances the ef)lors in both specimens were 
 perfect. Where the matching was only slightly imperfect, readings 
 were m.ade and in m.anv instances tliese have closclv apprriximated 
 readings of the other specimen in which the color was perfect. In 
 
sj-ito 111' the iiK-l i-:irvful tixliiiii.-. incxiilicalilc iiciiidlyM-; (HTurK-d at 
 tiiiK'-. It i- O'iiM.k-i-ahly ntdfc fR'i|lK'iil in tlu- iiarruw Ljraduatud 
 cciitrit'iim' lulir ii-i'il inr tb.c iRiiialocrit valiK'-. 
 
 I.il^rui'ui. l.i|i(.iiiia, if \lv\ niarkcil, make- tlic iKlornimati<Mi 
 inipn-Mlik'. < iiilv iiiu-i' ha- thi< l)t--oii cin-otmlrrcM. In a ivw iii-lancL-- 
 it olTi'n.l Minic -hi;ht ilirtanilty. I'.y \>rn\,^v altiiitioii tn ilii'l aii.l l<> 
 the time Hi" niakiiii; tlio (knermiiialinii. ihi- cliftk'ulty can he reaihty 
 ,,h\iale(l. In (lur -erie- il ha- iml heen suUieiently IroiiliK'M.nie \o 
 rei|nire -leh niea-lire--. 
 
 I>iSi-,>iiif,>it tc l\itii)it. AM(k' fnmi the -hght I'ain nt the venc- 
 piinetine. tlie iialiiiil n-na!ly Miller- nci ih-ecinldrl (if inennvenienec. 
 In aii|ir(i\nnalelv 'i per cent, (if llie ea-e-, ehillv -en-alion- (icelirreil. 
 wink- ill Ir.e iii-laiue-. ehill-, wilh fe\er reaeliini; In ll'l. wife -een. 
 X.me of th.- maiiial ea-e- e\hihite.l tliermie re-iioii-e-. iliey are 
 appareiith nmre e<imniiin in ea-i i anemia. 
 
 I (IN ll;( l.S el" Mil'- MITildl) 
 (.'iiiun.k (111 th( iiielhiMl iia\e hi en iiia.k' in (irder l^ (klefimne the 
 I- taiu-v (if il- liiKhii'^- liinKr xanon- ecnditiMii- aii.l in (.r(k'r Ki 
 jn-lify eellain -i n- in ihe lnhnie, l hi -e -llldii- are h,ie iire-eiiled 
 unikr -iihhea(hiiL:-. iniilrdk (Hi ihe pla-ma niethdd are lir~l emi 
 -idered and later th.. e on ihe heinaiuerit ilielhod of .kterniiilins4 loial 
 blond \ iihinie 
 
 ./ A',//,' .■/■ n'\s,\p^,\i)iiiiir of Ihi- fi-'Uii l'l,u'd. I'hi-()iii;li(nit iho 
 wmk. na.hnu;- have heen in,i(k- al three iniiiiile and -i\ minute inter 
 xal-. Till f.dliiwiiiu alford -tiikini; ]in".l of ihe -l.iwiu-- with whi.h 
 the d\i i|i~appiai' fnmi the eniulalii'ii In i -i i ie- "I ihirly d\ 
 ea-e- ill whieli the mliir iiiatilnni^ \\a- ei|naily jmmhI in hclh determilia- 
 tidii-. nine ea-e- -h"\\ed iilenlual readiii!.; fcr llie twn di li i nun ili( itis. 
 nine .Imwed hii:hir reading;- fur ihe -eeiii'd, llic a\i ra-e anii.nnl ahdve 
 the tir-l heiny I'r ]'er eent . while eiuhlien dinwe,! InLlhei r'a(hn;4- lur 
 tlie In ~1 detenuinaliiMi. the a\iraL;i anicuni ahcM llii -iidid heini,' .1 
 ]ier lent. I hi- iiiduale- thai -nine d\e dee- di-,i|ipear I K >m ihe i ir 
 eillalidii (Iiiiiiil; llie lime "f diU rminalii m, hut al-n in. hi ale- that ihi 
 III-, 1- HI, ..ii-lanl and -mall ' hi rare (Hia-Kni-. maiked di-ire|ianeics 
 in ihe \\\n reailinu- (Haur ^m h del' 1 ininal 1..11- -hdllld he discarded. 
 I'.eldw is shown the r,il( d di-appe iraiice dl ihe (i\« fn.iii pla nia 
 in a mail <i\er a periml cf iwilve niiimte-. readinu- hemi; m.,di al 
 approxitll.iIeK 1 ud mniiite inli r\al-, .md I in amniml of d\e <'\ liie lirst 
 di-t<Tniinalidii heiiii; lon-idiiid 1"" per eiiil. 
 
» 
 
 I I • 
 
 » 
 
 J C, u(if;lit 55.4 kg.; 178 nij,' dye injectcl. 
 Time l-'.lap'-ing 
 
 4 
 6 
 8 
 
 10 
 
 12 
 
 Pir Cent. 
 
 .... 100 
 
 104 
 
 103 
 
 102 
 
 102 
 
 ''7 
 
 luHr of Pisi!fpi\iiaiu-r uf Pyr from the C cuhitioii in /'.i.;.v, I'ro- 
 luiiil- 1 ami 2 indii-alc tlu' -Inw r.itc nf ili-.i|iii(.'arancc of (l\r frciii 
 llic MihmI (if iluM- the aHiHunt lUT-riit on tir-t (Ictcnniiiatioii luinj,' 
 foii^idfix-il a- 11 II I iicr cent. 
 
 Dill, I. -W'ligl.t. 7 7 Kij.; 2.1 mg d.M iiijiiiid. 
 Time Iilap>inR 
 Hour;, Minutes 
 
 13 
 
 30 
 
 2 20 
 
 3 
 
 • 6 
 
 24 ; 
 
 IVr Ciiit. 
 
 'n 
 
 i)2 
 
 65 
 
 60 
 
 52 
 
 26 
 
 Uoi; 2.— Weiglit. ''.5 kn ; \''0 me. ilye injectcM. 
 
 Time I^lapiiiiiK 
 Hours, Minutes 
 
 * 
 
 10 
 
 , 
 
 12 
 
 , 
 
 15 
 
 1 
 
 (i 
 
 1 
 
 s 
 
 I'er Ci'lit 
 
 Sii 
 SI 
 
 "3 
 
 Tlie-r (lata lUiiion-liMle ill. it llii aKMiriitjoii from tin liloo,! -trr.im 
 i~ >l(i\\ . .111(1 m-lif\ 11- 111 an'e|(liiiL; (IcUi illill.il i( dl- ni.idi- williiil -i\ 
 niilimt- ((f the lillli of inintioll of llie dvr 1 llllliil ](r((((l (d tile 
 -lowiie-- of lln' ali-((r]'li((ii i- -liowii li\ llir l.i't tliil n\\ -imimI i)cc;i- 
 -jod^ tlu- )(1 i-ni.i ill 111 to f((iir (la\ - ,ifur tnie. lioii -li((\\i (1 a i oii-ickT- 
 
 ;iMe ai ml ol llir (Ui II ' illi'u .il-o -liow- tl.m- lor -((llir d.'N - 
 
 after llic iiiie(lioii 
 
 /: i'iiliirs loiiiii! on A'i7'i((/('(/ Pi-t,-i niiiiiititiiis lselie.Hi(| deltr- 
 mm.ilKdi- .(|| llie -.iliie indi\idll.d vieM pi ,(( tu ,dl\ idiiHi. 'I re--nits, 
 |,iii\ i,l( (1 11(1 .i|(|(M ( i.ilile , liani;e in llie iialieiir- ( on(|itioii li.( oo lirred, 
 >nnie ol llic-e pel ( (11- are IMdm.il .ind (dlh 1 - .He -lllli 1 llli; I idll i ar((llic 
 ilisea-e m \\lii( li no .ippreeiaKU' < li.inue o( ( iirie(| dm in- ilie ml< run 
 
 5. The first rcailinK nt two inirutci was lower than siiliscqucnt ones. Mixing 
 was protialily not eimipKii' m tun iiimnti -. 
 
8 
 
 TABLl". 1 — Ri:pi:ati.d DktkkminaTiONS on Mkn 
 
 Cubic- 
 Snim' Date Woight Volumi' ccnti- 
 
 in e.c. meters 
 ptr Kg. 
 
 CI 2; 2,15 M 2.I122 50 
 
 2, 4 15 OS J.ii:iil ;V.' 
 
 Fl . 2' 2 15 <'.; 2.!«;'.i 41 
 
 2 4 15 lit 3.037 t:, 
 
 |. 3 1115 57 2,(ai5 47 
 
 3 12 15 67 2.liM 17 
 
 r, 3 1115 M 3.171; r-o 
 
 3 12,15 M 3.0S3 4.- 
 
 U 1' 7,15 61 3.03« 4!i 
 
 2,' li 13 04 3,11)5 lU 
 
 T 2 •215 50 1.H75 4u 
 
 2, 25, 15 50 I.IW 4U 
 
 Kr 120 15 (VJ 3.0.V1 411 
 
 3 18, 15 t)3 3.I(iO 50 
 
 I , 1 12 15 81 3.172 3il 
 
 i,' 3,15 N) 3.0ii4 :» 
 
 w 4,22,15 1-4 r..:',r, ,^3 
 
 6/ S/I5 '..-, ".1'-' ."3 
 
 1 )(iy- lid iKil L;i\f -o ri.ii-laiit ii-iill- liiit il i~ all' i^llii r innliahlc 
 ill, it llu' ilii^-' ],la-ni:i \(ihiinr i^ -iiliU'it I'l r''lali\cl\ i;ri.attr .iml ill'. re 
 -U'l'Un iliaiiL;i- lliaii ili.al of man. ."^i.iiic inuri.>li;i^' lindiiii;- uu dw^i 
 ail itU'l:iiK(l in I .alilf J, 
 
 T M'.l.l-'. 2 — RllMMIIi III 1 I UMIN \ I MN-- (fN I )(ir,S 
 
 riiiMii::, Ce, per 
 .Nil, liuir WciKlil c.l'. Kc UiiiKiiLr 
 
 1 1 l:< 111,,'. (Ot 911.3 
 
 1,27 ■' :". (12S mii |ii.|.lii|.iT 
 
 2/ 1 ,■• 1 ,-.72 70,1. 
 
 2/ a 7.I1S 4D1 02,'- I'.illiiKinK immnllnK'lv a lili'edlng til 
 
 11;:. tvc, 
 1/ 4 T.BS lal S55 Ni-,\t liny 
 
 l»8 120 .\((iT infilrliill •>( 32'. 11 
 
 2 1 2T ».(» OOS tKl 
 ■ 15 U.02 033 111 
 
 4 1/11) 15 1.202 Ml lilnifiuirtT bliil .iMi le. »is iMlniilf* 
 
 Itefuro tint fiainple 
 1,'21 15 1.137 70 4 
 
 ( . I'ht.uuti I'i'liiiif,- / 'rli-i iiinu-il T> i//( rinviiii .liiu'ioil of P\r. 
 'I'lio '..■inu' \;ilii<' fur lilnm! \(ilii!iu 1- ulit.iitu.i \\liillnr im".- wmk^ willi 
 J. .? 1.1 1 Ml:; I'll kill. '^r.ini I lua < |ir.i. li. .illx ninin.il nu n w < n -Uiilu.l 
 
 • 
 
in tlii> coniKclicin. I Jiicniini.itinn-- mailc after injection ni 2 and 
 .^ nit;. (IdNC-- yic'liif(l \ahii.'> within 7i^ c.c. in two instances, while in 
 the tiiird. J and -i nij,'. per kiit>L;rain were used, the resuUs agreeinjj 
 within I per cent. Three nit;, per kt;. is ciinNidered nbscjlutely ^atistac- 
 ti^ry, xu'liUnt; culur^ well adajited tn culcirinietric determination. 
 
 /'. ('I'Htruls till the Colmiiiicti'r. In the jja-t. in niakini; ]iarallel 
 -•eric- of reaihnL;- witii \ariotis phtiialein- and with l''ohn'> niicro- 
 isji'ldahl nuihod. practically identical reading;- were obtained with 
 iwci in-tniiiient--, the linlio-ci| and our colorimeter. In a >niall -crie- 
 of ]iarallel reacliiiL;- made in thi> investigation, identical readini;-. were 
 .aNo (ilii.'uneii with both. 
 
 /;. 'I It,- /.'M-.v (i/ I'ltiiu! at rnirsrctiiiii /''LHUiii.itidtril. The nicUiod 
 \\a- applied to three men before .ind after phlebotomy, ihe re-illls 
 appear in 1 able .v \o- 1 and _' were normal donor- lor Iran-fn-ioii 
 and Xo. ,1 w,i- a hypcrten-i\i' p.atient. the -nbjcct ol .i ihcr.ipetitic 
 \ene-eclion," 
 
 T Mil.H 3. — Lnss MK Bi.iion at Vi msictihv 
 
 
 Xeme 
 
 Volume Bctore 
 
 Amt. Bled 
 
 Volume After 
 
 1. (i . 
 
 
 l'I;>siim, 
 
 3.180 
 
 SIX) 
 
 riiifliin. 
 
 2.S«2 
 
 •:. ii 
 
 
 I'liisin.i. 
 
 e.Tao 
 
 620 
 
 Plasma. 
 
 ;,:t3 
 
 
 
 Bli.o.l. 
 
 .i.osa 
 
 
 Bloud. 
 
 4.2T4 
 
 3. A. . 
 
 
 I'lil-illUl. 
 
 3,STL' 
 
 SOO 
 
 rin.«imi, 
 
 :i.cri 
 
 
 
 Ill 1. 
 
 li.U.I 
 
 
 lil.i,,.|. 
 
 .434 
 
 A dccua-c corr( -ponding t.uilv well to the aniolliu of blood 
 rcniii\cd i- d( nion-tr lied in ,ill ihrcc cases. 
 
 /■ I Iriihil.u I :l The wlioU- IiIihhI \cilnmc i- c.ilciilated from the 
 [ilasina \ohime on ihe b.i-i- of the 1 .'m.iiocni tindiiii;-. .ifiir ceil- 
 triftlRali/.ition ni !,'radn,ile'! tnbe- for ,\<kk) re\ohuion- per niimile for 
 
 » 
 
 • 
 • 
 
 twenty minnle- A longer peii".! \\,i- nnnei c--ar\ , llie p.ickiny .ilw.iv^ 
 re.ichini: il- in.i\imnin within tin- nine The \.ilne- from the -,ime 
 individn.d v.iricd bin litlle. whclhcr ihc -.imples were obl.iined with 
 lice circnlalioi! ol blood or .iller inipt'dinLT Ihi' \inon- nturn for a- 
 long ;i5 lifleeii miiuilc-. When llie Miioii- return w,i- ml olf. ihe red 
 cells increased 4 per cent. ,ind .^ per cent, in two in-i,ince- .ind 
 decreased 2 j)er cent, .and .^ per cent in U\o other- Wlnie po--ii)le. 
 it is better tj take sample lur heiiuuocni determination from the freely 
 
 • 
 
 6. The Litulcm.m mctlioil of traiisfifinn was ii'cil and the amount nf hlood 
 niMSurcil. 
 
• 
 
 10 
 
 cin-ulntint,' IiI.hhI. Rfin',iU-<I .UtcrniiiiaU(>n< im ihc same normal \u<U- 
 viihial t;i\r v!n-c Inil ii.ii iikntirt il valm-. rnd.'ulili'dl) --m.' uvyvr- 
 timil\- fir ■ rrnr i- lu'rc all^rcUd. 
 
 (,. Is llir /'\v l\i,..-ni I't /'•, llir h'^'i !'!>'<"l d'lls.' I'-arly in the 
 Cdur-r nt ihi- work it i.r. aii.e e>.iauil that ihr dvc wa.- iini rcadilv 
 taken U]. kv ti--ne erlK nr tlie .-ell- in the l'k"'l -treani, iMan,! ike 
 fN]ierimem~ with eulkHhini -ae- in-e\i(mdy mentuMK-.i an.l I rum tke 
 faet tlial neilkrr ilie er\tkrne\u- nn,- irnknevle- were -lained. when 
 
 nkM-i\e.l in (re-h hi 1 i.rq arali'in-, it -ernieil fair U, -nrmi-e 'hat 
 
 most nf the ihr ninanie.l in the pkiMna .Inrinu ;lu -Iiorl lime oi the 
 (lelerminati.ni. In "ulrr to u:<'l at llu- (|nr-linn (|nantnati\ ely, it was 
 lir-t ne>a->ar\- to ik.terinine ihe rrlaio.e amiuml- oi ]il.i-ni,i ,in.l veil 
 hloi.il eurpttMle- in tke wlmle IiImm,!. Se\eral metko,]- ha\e keen 
 cm|ilii\eil lor thi- pm-]iii~e, amonu- other-, the \ariou~ form- m the 
 liemaluen; .nal the nilro!,'eii mellunl ile\i-eil ky k.Kiklren' I ho 
 hematoeril metko, 1 de-eriked ahovc was loimd tn he tke nrnM -ali-lao- 
 lurv fur our liur|io-e. \ie!dinL; li^itre- that agreed eki-il) with those 
 (ihlained hv other wnrker- uilk iki- melkod. In two dillrrenl -anijile- 
 of kluod. tile relative aniolint- oi |.la-ma and erythriKXU- wrre deter- 
 mined kv llie kemal.ierit and ky tke nitro^m method. Ihe latter ,i;ave 
 a lila>ma \alue 4 Jier eeiit, t" " per emt, hiuher than liial ot the 
 liemaloeril i'deihlrelt's liuma- were .d-n kiuk enni]iar'd wnh iki-, ,,i 
 dlher iih-erver- iimul; the hemaliiein melhud. In nnr wirk". tke 
 hematoeril value- only were taken 
 
 In onler to delerminc whella r llr. ii\e i- ak-oiki-d h\ the kinod 
 eell-, and. if -o. to what extoil. the folliiwin- iivoeednre wa- ad.Mi.ud: 
 I'ifty c.e. of blooil were taken from a lieallhy man and rendered 
 incoai;ulnl)le with jMnvdereil sodinm us. date. Ten ... ni tin- hlond 
 were ll-ed for hemaloirit ik lerniinalion, 15 e.e. heini: eeiilrilnued and 
 the pla-nia pijietled olf. Ihe remainder wa- ai;ilaled mitil mea-Uied 
 out for the exiieriilieiils i;ivcn helow : 
 
 lixfi-rimeiit i.— CcntrifiiRc Tiilio 1. liiiLcn c.c. of lliis wlmle Iilooil pus 
 2 o.e. of live solution pli'S 13 c.c. of saline. 
 
 CentrifiiKC Tulie -'.— Five c.c. ot plaMHa plii" 1 c.c. of dye sclutioii plus 4 c c. 
 of valine. 
 
 After Tiilie I \v;n ctntrifntjalizcil.' llie pl.Tsnn was pipetted olT and coin- 
 parol with llie plasma ilyc mixture from Tiilie 2, which was placed as the 
 standard in pri-iii of the colorimeter. The readiiiK was 80. Therefore, in dilu- 
 tions used. Tiilie 1 contained Wl per cent, as much dye per cubic centimeter as 
 Tulic 2. The relative amount of plasma in the blood in Tube 1, as shown by 
 ihe hemalocril. is fiJ.S per cent. 
 
 Then IS X (>ii = 9-37 c.c. plasma in Tube 1. 
 
 m 
 
 7. nieibtrcu. M. ami I..: lane Mdhode xur RestimniunK dcs Vailiinis der 
 korperlichen Klenieiite im Itlut, .Arch. f. Physiol. ( rilJuer's l, IfWJ, b, 151 
 
 8. Three thousand revolutions per minute f<ir twenty minutes. 
 
11 
 
 Then 2 c.c. of <lyc solution is ililulid in 24.,^7 c.c, or 1 c.c. in 12 18 cc. 
 
 l)r there slioiild be 10/ 1 J. 18, 82.9 per cent, of dye in Tube 1. 
 
 Colorimeter reading, as calculated from hematocrit data, 82.9 [icr cent. 
 
 Colorimeter reading observed, 80 per cent. 
 
 Ext^erimciit 2. — Experiment 1 was rcpcatid with tlie Miu.rl t.ikm frnin another 
 normal individual. 
 
 Colorimeter reading, as calculated froni hiui.-it..crit dat.i, SI .'^ ptr cnit. 
 
 Colorimeter rcailin.g o!i>civcil. Si pt r cent. 
 
 Ex/'criiiictit S. — E.xperinient 1 was repeated with the IiIih.iI t.ikrn I'r'in a tliird 
 normal individual. 
 
 Colorimeter reading, as calculated t'rom lKniat"crit data. 814 lur cent. 
 
 Colorimeter reading observed, 81 per cent. 
 
 Ill coii^-iilcriiii,' the fia'cyniiii^r v.xiicriiiuiital ilata. several tactors 
 slieuiM I'c iiciicd. riic lictiiali icril iiiit-t iicce^^arily ;;i\c ti> the iiiiiii- 
 mtiiii vahic for llic ainmiin of iila--nia in the hlooil, a^ the eiir|ittseles 
 ,ire wet and tlie iiiter-lices are filled with tlitid. Therefore, the 
 hem.-iloerit lliidiiij,'s for plasma imi-t be slightly low. and the ealeulaled 
 eolorimi'ter rcadiiii; sliyhtly lii,i,di. If tlic dvc is alisdrbi'd liy or dilTuses 
 into the eor|Jtl-ele-, the oli-er\ed colorimeter ie:idiii,L;s will he low, that 
 i-, the iil.i-m.a Mihime lar<;e. .\s the ealeulaled atid observed litjttrcs 
 ai^ne x i <losely, the .-iniottiit of dye lost troiii the plasma iiiii^t be 
 ne^liuihle. Irnm the foret;oin!,'' exiierimeiit^, it wmild ~eeiii -^ale to 
 c(inclui!e di.tl in \iiro little nr none nf the d\e ]ia.-^es into the blood 
 eelN, 
 
 Ki I. \ I n i.\ oi' 
 
 "■|i ,\Mi l'l.\s\l\ \"l.l .Ml. lo III.Miili PKI ssft^I-: 
 
 \l the -tiL;L;e^liiin ui 1 ir, lanew.iy. e\|ieriinenl ~ were carried out 
 to ascertain what iIIccIn cb.inm^ in the caliber n\ ibe -mailer blood 
 \e--el- li.i\e on bldod and pla-ina \i'lttme~. \i'lttn;e determin.ations 
 were in.ide nn dni', all.icbeil to .i kMinn^raiih. I he traeini,'> with the 
 blood v.iltte- ai'pear in l'ii;itrer. I .and _'. The x.isocon-trietion was 
 obtained b\' eoiitinitou^ a(ltnini--tr,ition of ( pineplirin, ;i fairlv e<itistatit 
 le\(l beinL; mainl.iin'.d lor !i\e ininttte-. In each detennin.itmn, before 
 inpclini; the d\e, pl,i-m,i w.is removed for the •-l.ind.ird and within 
 ;i\e minttti allcr the inieciicn tlu' ■ imple-- wiTe withdrawn for the 
 \olnttie e.-timalioiis. I he dot;- weighed 14. ,i .md 12.7 k'^. re-peetively. 
 
 \o irikin'4 eb.niL;e in bh n.I di' pl,i-nu; xuhmie ,icci imjianie.! the 
 
 f:iirl\- in, irked \ .irialinn-- in bliMid pies-tirr llnwexer, tlu'-e hi 1 
 
 pte>--nrc cban'.^e- were ni -burl 'Itir.il i' 'ii. 
 
 JJr. I'. IJ. i.am-iiM.' wiukin^ in Mr. Xbel'-. l.ibi'V.iinrv. b.is liiund 
 that the polycylhen'.ia which de\-li:|i-- .ifler epiiupbrin iineclion doe- 
 nut ri acb It- inaMinnm fnr finni linieii i.. l\\cnl\ in'mUe- NUlnme 
 drieiinin.ilii in- ni.ide "ii two iln'j^^ .liter tin- inler\.il -Imwcd a .-!i;;ht 
 bnl (Kiinile deciea-e m pla-in.' \ulnine. 
 
 9. Personal cotmminication. 
 
1 
 
 
 f-i 00 ^ 
 
 lA, CJ « 
 
 c^ aa cc 
 
i 
 
 
 fr 
 
 CO 
 
 i 
 
 C C 1 
 
14 
 
 # 
 
 mi;tiiiiijs rki:vicK sl.^" i;.Mri.MVi;ii aM) \ \i.ri:> hihaim;!! 
 
 Ai'cordini,'- to \\'(.lcki.'r,'" iIk- carlit'st altcmiil to dctcrniinc the 
 IjIuoiI \oliinic was made liy Ilaller." It i,iin-i>ttjcl of bleeding t.vo 
 criminals to <kath, the nmonnts of hlood ohlaineil lieing 28 and 39 
 liotinds. 
 
 The methods tall into two general groups, only those of ("iroup 2 
 being applicable for clinical ]Uirposcs. 
 
 1. l>in\-t Method. — Welcker, in 1S54, bled aninial< to death, 
 washed out the blood vessels with water, minced and washed the 
 tissues thoroughly, brought the blood and wa-hing^ togelher and 
 detcrniined their hemoglobin content, lie concluded that the blood 
 constituted one-thirteenth <if the borly weight in mammals, .^hortlv 
 .alter tliis, ]'.i>c]ioll '- ;qiplied tlii-- method to two criminals .and obtained 
 the same \.ibie. .Modificiitious of the method were ma<le b_\' lleiden- 
 hain'-' and by I'le-cb. ' A similar preliminary jirocedure was u^ed by 
 t^'ohnstein ami Zunl/," the calculations being based on cell counts 
 instead of hemoglobin c-tim.ition>. and b\' Kottniann,'* who emplo\ed 
 the hematocrit. 
 
 2. Indirect Mrtlu'ds.- \. Infn-ion metlio.l : i ,; i llirb-t,'' in 1S22, 
 injected the \,i-cular <y--lcin of a cor])se until the \essel- seemed 
 moderately tilled. ( /) ) \'ierordt'^ experimented on animals. 1 le deter- 
 mined the .amotnit (if blood jntmped from the he.irl in one second .and 
 multiplied this by a number corresponding to the seconds recpiired for 
 a complete circulation. < )n the b.a^i ' of certain calcul.ations, he con- 
 cluded that in man the blood constituted one thirteenth of the bodv 
 
 10. Welckur. H. ■ Bcstimniunscii ikr Minuc (li,s K..riHrMiiti- und dcr Bhit- 
 tarbckr.Tlt, souic Botimimiiigcn von Zalil, M.i.tss. OlicrtlaLlic mid N'cilunuii dcs 
 (.in/cliK'n Eliitkiirpcrclicns hciin Tliicr mid liciiii Mcncluii, I'r.is^cr \"rtli-chr.. 
 
 1554, iv. 11; Ztsclir. f. rat. Med.. 18.^8. iv, 145. 
 
 11. Qiiot d from Welcker ( N'ote 10 i. 
 
 12. r.iscliofT, L. \V. : Bestimimint; di.r lllmmcnui- lui ciiKiii 1 hni^Lih-litcn. 
 Ztsilir. f. WisseiT^cli. Zool., 1856, vii, 3M : ,\lieriii:ilii»e Hoslimmmi;.; dor Bliit- 
 mengc lui eincm ! liniacriclucteii, ibid.. 1858. ix. 65. 
 
 13. lU-idetili.Tiii : L'elicr die BIiilincnKC ikr Siingct'.iicrc init hc?ondorrr Riick- 
 sicht aiif Welikcr's Mcthoilc der Bkitbcslimmmic, .\rch. f. plivsiol. llcilk,, 1857, 
 n. f., i. 507. 
 
 14. rioscli. I.: Ibiniodvnumii-.lu' Studicn. 7t-o!ir. f. ixpii, I'alli ii. Tlicrap , 
 1509, vi, 380. 
 
 15. Colinstcin and Ziiiil/. X.: I'litrv^iirlimiReii iibci den MiiSsigk^'it- -AiHtaiiscli 
 ?wisclK'n Bliit mill Gewelien imler verschicdciicn pliysiolofii-chen mid pallio- 
 logisdicn BcdiriKmiRfii. .\rcli. f. Phy-iol, (Plluger's), 1,888, xlii, .W. 
 
 16. Kottniann. K : Ucbcr die Bcstimmmis dcr Bkitmcnge bcim Monschoii iind 
 Tier iinlcr .\invcnckinK cities neiicn Prazisionsliactnatokritcii, Arch. f. exper. 
 I'alb 11. I'liarmakol.. I'Wi. liv, ,'.-(.. 
 
 17 'Jiir.tcd from Wrlckcr 
 
 IS \'iernrdt. K. : Dns .AbbiiiiRiskeilsRc^etz der mittlereii Krei<1aiif<7citen 
 vnn den niillleren Puls-frcqueiizeii dcr Thierartcii, .\rch. f. physio!, lieilkuiulc, 
 
 1555. 11 f ii, 527. 
 
 • 
 
•' 
 
 15 
 
 wci.sjht. (c-) \'ak-miii''' reiiKJVeil a (ki'iiiitc aiiiouiil of blood (a), then 
 injoclcd a known amount of water into the va>ciilar >\>tciii and bled 
 a,i,'ain (bi. The >()lid> of a and b were detennincd, the difference 
 hein^' due to the number of cubic centimeters of water injected. \\ eber 
 and I.ehmanii,-" utilizing- tiiis method, concluded that the blood con- 
 >tituted one-ei,L,dith of the body weight. ((/| Quincke-' utilized the 
 method of Malla--e/.-- Red couiUs were made in ca-e- of ])ernicious 
 aneftna. A kiii>\\ii amount of blood with a known cell count was 
 traii-fu-ed. follnwini,' which tlie ])atienl'.- red celN were a^ain counted. 
 From the-e dat.i, the \(jlume was calculated. 
 
 1!. Inhalation Method: (irehant and Or |Uaud-' .ijave doi;s by 
 inbal.iticm :i nie.iMired Milume of carlxjii UKmo.xid and deternnned it- 
 liercer,ta,i,'e content in a -m:.II >:un]ile of the animal'.- blooil. I laldane 
 ar.:l .'^mith-' modified thi- mcth<id an<l .-ipiilied it clinically. '1 he 
 jiatienl brealhes for ti\e minutes a mea-nreil (|uantily nf carbon 
 niiinoxid from a s|)ecially de\ i>ed apparatus. A .-.ample of bI(jod is 
 remined .and its carbon miaidxid c njent e-limated by the carmin 
 titnilion method of llaldane. I'le-clr ;nid t >eruni-" have em])loyed 
 this uiciIkhI, but the former determined the carbon monoxid volumet- 
 rically. 
 
 ('. .\ntil(ixin Method; I'.ehrinii'' noted that tetanus antitoxin 
 remained in the circulaticm for lon^ periotls and made this the basis 
 fur the e-timatinn of blood \olnme. Ili> .-Indies showed the blood 
 to con-titiite 1 ll.S of the body weight. With it, Kammerer and 
 Waldmamr" in MnllerV clinic. olitaiue<l a value of 1 lO.J, while 
 l-'ries-" found a value of 1 l_'.fj. 
 
 1<). Valentin. G, : I.ilnl.iuh .kr Phy-^id'i l;!.', !S47. i. 4".i 
 
 Jll. W'Jmt. I-:, aii'l I.rhinami. C. (i. : Lclirl.ucli lUr iili> -i'i!.]gi-rlic Cheiiiie. 
 1S.=II. li, .Xullam- ii. -'.-''. 
 
 Jl. Qiiii:okL'; WVitirc lkijbaclitun;;<n ul'cr prrni/iose .Xnainic. l)oiit-cli. .Xrch. 
 f. klitrMeil.. 18", XX, 27; rcf. Plcscli. 
 
 ", Mala'.sez, L. : Xouvcaux proci-ilrs puur appii'cier la nia--c lotalc da sang. 
 .\icli, ck- pli\siol. norm, ct path.. 1S74. vi, Seric _'. 7''7. 
 
 _M. (jrcliant aii.l Qiiinqiiaif', : Mc^iire (hi M'lumc ilc saiiii ooiitttiii ilaiis 
 ror!;ani-nif il'im M.iiiimikr.' vivant. C iinpt. Kcik!. .\cacl. Sc. 1882. xciv, 1450. 
 
 24. Ilal(kinc, J., and Smith, J, Lorrain : T!ic Ma^s and Oxyscn Capacity of 
 the Hlood in .Man, Jour. I'liysinl., IS'iQ-l'idtl, xxv, .?.M. Smith, J. Lorraiti • Dis- 
 i-ii--ion in the lilood in Disease, Trans. Path. Soc, London, l^^OO, li, .Ml. 
 
 J.^. ■rarohaiinff. J. R. ; Die Be-timininiK der RlutmenKe in kliemlen Mcn-clien, 
 Ar.h. f. riiysiol. ( Pllnser'sl, 1880. xxiii. 54,>^ ; 1881, xxiv. .-.'.- 
 
 _'(i, Oiium. lb 1' T. : (JuaiUitatne IMiitiintrrsiuhunKin, Dciit-eh. .\rch, f. 
 klm M.'d,. l'-08. xriii. .W' 
 
 27, v. Ikhrini;. I-",.; Die .\ntitoxiiiniet!iode yur liUitnuimr r.c-liinniun.i,', 
 Minuiun. incd, Wkdinsclir., 1011. Iviii, 65.^. 
 
 JS, Kamnirrrr, II . and '", .ild.Tn.inr. .A ; I'.iiilnunL'i'lii'-timnuinncn naili v. 
 lltliriuL; mill :uidii-e i|n.iiililalu r unur-iiidimm.ii (kr l'.hitlie-.taniltcilo. Dcnt-idi. 
 .\rili, f, klm Mol.. I'd. I nx. ,-J4 
 
 2'' I'm-. II,: I'rlur \k i anddimmii di r I'.liitinriik'e in Si-Inv:!n};erschalt, 
 C.l.nii mid W.ulirnk.rt. /.l-.hr. f Geh. n ("i>ii. I'dl. Ixjs, .^40 
 
 • 
 
16 
 
 Tabltj 4 indicates the wide \ariatinii^ tliat lia\e Iteeii obtaiiR-d liv the 
 (HtYereiU methods. Tlie total niimher ct normal eri^e^ has heen >maH. 
 In t!ie re]>ort of Haldane and Smith.-' the Hniits for normal are very 
 wide, ihey ^tate sjieeilicallv, h(jwe\er. that one of the ea-^es was verv 
 obese, that i-^. the one in which tlie blood was only one-thiriieth of hi< 
 bodv wei<dit. 
 
 TABLK 4.— VAKiATinNs tn* Blood V^oiumk by Difffrfnt MiTimn.s 
 
 MeiliiMl 
 
 IV r 
 No. of I xtrt^inp Avor- Cent 
 
 Cases Fractions age Body 
 Weight 
 
 Ri'iiKirks 
 
 Hal!, r 
 
 W<i\ ti. .lo:itli: \MiEtii 
 i.f bloo.I 
 
 Wclckor ;iDil Hl-'I ;ind ua-!i<'.| out 
 liiMlintl v.'-M'is uf criminals, 
 
 t'oiiipart'd with hem 
 at in 
 
 lll.til i:.4 1 13 
 
 •24-."0 pounds (•i 
 hloofi. Body 
 wt. not givi'n 
 
 This was arcep- 
 tPd standard 
 from is:>s to 
 ISSl 
 
 Taichannw' SuiMtintr and coimtini: 
 K. B C. and llh. 
 before and aftt r 
 sleani b:.th 
 
 1 n.T I 21.8 1,15 
 
 Viornrdt Nn. v.c. put nut by 
 
 ht.Mt miiltiplii'd by 
 No, of M'con'Js re- 
 quired for lunipltte 
 eircuJation 
 
 1/13 
 
 W o r k (^ d (>u 
 )i o r s e s an-I 
 (ioRS. Krror, 
 riu percent. 
 
 Weber and Infnped waltr, ua?-ln'd 
 Lehuianu ont vessel-: drier 
 
 mined dry •;Mb>-tanee 
 of bloiiii 
 
 Haldaneand <."0 intmle<i. Carniin 
 Smith titration 
 
 Kidtniann + Infu-iinu uf salt nnj, 
 and ht'Miatiirrit be 
 fore iintl after 
 
 1 3i)-\ in 1 L'l s.sid: 
 ! n.rj 1 13 1 i2.'j g,2 
 
 < ' > iniMhnd. 'I'nrai u.n ii ui.nn i, 
 wdn earniiQ sid'itinn 12 iiu'ii 
 
 Cf I niiMliud. Titratinii •.' nien 
 \\u\i larnnn soliitiou 4 uniiK'n 
 
 I Intn-ii'p Mill; lib, 
 d«MernMnai;itii«^, ■'. ( > ' 
 inhalation uitti khii 
 biistiun 
 
 3.3(>.27 
 
 3.7-8.31 
 2.5-6.ti![ 
 
 1 -.ni i*;.5 1,19 4.t;iM>.o:> 
 
 i/--'o-l/iii.o 1/18 r>.o--'-t;.nj r. '; error 
 
 K a h; Ml ' r- r lleiii int' n^eihud. 
 and W;ild 
 uiaiin 
 
 Fries BeiirinK iiietlntd.. 
 
 1/17.5-1,11 i;l2.t> 
 
 • Arch. f. ptiy>i(d,. is^n, xxil. 5t8: 1S81, xxlv. 525. 
 
 t Arth. t. e.vpir. Tatli. ii. I'luirinakol.. vjcti. liv, 3j«. 
 : Tr. I'ath. Nnc. I nndon. Im«'. li, 311. 
 
 • iT. per IHt Krnins of body ueight. 
 
 O t !i e r praeti 
 (ally normal 
 patirnts gave 
 similar vain*"- 
 
 f 
 
17 
 
 NdKMAI. AND I'AT 1 1 ( ll.( ICKAL \AK 1 ATK i.NS IN lil.lidK AND I'LASMA 
 VOLUMK IN MAX 
 
 Results { Xonual) 
 
 At k'a^t 14i) ik'lcrniiiiatinn^ *or ]ila>nia voluiiK- lia\c l)(.'cn made 
 (HI iiKirc than Ino iiuli\ iiiiiaN. In the rarlicr wurk. licniatocrit -tudies 
 were not made, mi that the \ akies for t(jla,l hluud volume are con- 
 siderahly fewer. 
 
 Xoniuil / '(i/;(i\s-.- -1 he resuUs here reported are fur normal men. 
 heinj,"- obtained from jiatients attendin<; the outpatient dejiartment of 
 the t;enito-nrinarv elinie for some minor local condition, such as 
 chronic urethritis, chronic prostatitis or verumontanitis, etc. The as^'e, 
 weitiht. height anil hlood ]iresstire, as well as the blood values, will 
 be seen in the accompanvinsj tables ( .^ ;ui<l (>). 
 
 T.ABLF. ? — Plasma Values in Twenty-Four Subjects 
 
 So, 
 
 X:imc 
 
 Diiti' 
 
 Ad.' 
 
 WeiRlit, 
 
 .■*.8 
 
 Ho 
 Fl. 
 
 5 
 
 Kiit. 
 
 la. 
 3 
 
 H. v. 
 
 Sys- 
 tolic 
 
 125 
 
 Vchiiiie, 
 c c. 
 
 Co. 
 |.ir 
 Kf. 
 
 Frao- 
 lion 
 Ho.ly 
 
 W.)fc.|it 
 
 Per 
 
 Cent 
 
 Bo.iy 
 
 Wi'ignt 
 
 1 
 
 F. .1. ... 
 
 I 2 
 
 31) 
 
 3,100 
 
 45 
 
 1,21.(1 
 
 4.0 
 
 i; 
 
 K. M. . 
 
 1 <; 
 
 22 
 
 6<.l.5 
 
 5 
 
 10 
 
 
 2.T75 
 
 47 
 
 1,20.7 
 
 4.S 
 
 3 
 
 G. 1'. 
 
 1,7 
 
 40 
 
 511.1 
 
 5 
 
 6 
 
 115 
 
 3.050 
 
 53 
 
 1 1S.3 
 
 5.4 
 
 4 
 
 .M 
 
 1 7 
 
 39 
 
 .-1.8 
 
 5 
 
 11 
 
 
 2.70O 
 
 52 
 
 1 18,11 
 
 5,3 
 
 5 
 
 P 
 
 i.y 
 
 34 
 
 73.5 
 
 5 
 
 3 
 
 138 
 
 3.050 
 
 42 
 
 1,23 
 
 4,3 
 
 6 
 
 V 
 
 1,9 
 
 23 
 
 .\S.fi 
 
 5 
 
 : 
 
 ;io 
 
 3,050 
 
 52 
 
 1 is.r, 
 
 5,3 
 
 - 
 
 c 
 
 2 2 
 2/4 
 
 
 .53.4 
 53 
 
 
 
 
 2.iH5 
 3.025 
 
 55 
 
 1 17.« 
 1, 17 
 
 5.6 
 
 
 
 
 5.8 
 
 s 
 
 F 
 
 2 '2 
 2/1 
 
 
 67 
 
 67 
 
 
 
 
 3!i>50 
 
 43 
 15 
 
 1 22 
 1 21.G 
 
 4.5 
 
 
 
 
 4.6 
 
 9 
 
 S 
 
 1,29 
 
 2,'. 
 
 IIS, 4 
 
 h 
 
 r, 
 
 
 3.100 
 
 45 
 
 1 21.(1 
 
 46 
 
 10 
 
 If S. .. 
 
 I-', 28 
 
 3.i 
 
 .>.!) 
 
 -, 
 
 5 
 
 :o 
 
 2.1175 
 
 .'/> 
 
 1,20 
 
 5 
 
 11 
 
 H, .. 
 
 12 2S 
 
 51 
 
 -.1 
 
 5 
 
 1. 
 
 122 
 
 3,275 
 
 4,'p 
 
 1 21,0 
 
 4 6 
 
 12 
 
 J. J.... 
 
 12,28 
 
 22 
 
 57.5 
 
 5 
 
 
 ... 
 
 2,HiO 
 
 41) 
 
 1 i;i,s 
 
 5 
 
 13 
 
 .T. .S. ... 
 
 12 28 
 
 4''. 
 
 liS.lj 
 
 5 
 
 3 
 
 142 
 
 3,075 
 
 48 
 
 1 20.4 
 
 4.9 
 
 \{ 
 
 J. C... 
 
 I2,2i> 
 
 43 
 
 Tl 
 
 5 
 
 1! 
 
 130 
 
 3,325 
 
 4S 
 
 1, L'0.4 
 
 4.D 
 
 15 
 
 u.o. .. 
 
 12 2« 
 
 ."u 
 
 71 
 
 5 
 
 in 
 
 
 3,l,-.0 
 
 45 
 
 1 21.11 
 
 4.6 
 
 Ifi 
 
 I!. S. ... 
 
 12,:(1 
 
 32 
 
 1)5, 3 
 
 5 
 
 6 
 
 145 
 
 3,100 
 
 47 
 
 1 2u,7 
 
 4.8 
 
 i: 
 
 (i. 11. .. 
 
 12 31 
 
 .3(i 
 
 (;2.5 
 
 .-, 
 
 10 
 
 120 
 
 3,100 
 
 M 
 
 1 20 
 
 5 
 
 IS 
 
 G 
 
 12 
 
 34 
 
 60.1 
 
 4 
 
 8 
 
 130 
 
 3,300 
 
 48 
 
 1 20.4 
 
 4.9 
 
 I'.i 
 
 F. I,. . . 
 
 1,2 
 
 32 
 
 --CO 
 
 5 
 
 5 
 
 105 
 
 2,51.10 
 
 41) 
 
 1 i;).s 
 
 5 
 
 :o 
 
 F. .s. ... 
 
 12,30 
 
 49 
 
 6(1.8 
 
 fi 
 
 
 130 
 
 3.200 
 
 4.S 
 
 1 2(1.1 
 
 4.9 
 
 21 
 
 K..I. ... 
 
 1,5 
 
 
 70.5 
 
 G 
 
 2 
 
 
 S.7."K) 
 
 53 
 
 1 1S.3 
 
 5.4 
 
 "2 
 
 J. M.S. 
 
 3,11 
 3,12 
 
 
 52.3 
 62.3 
 
 
 
 
 2.(175 
 2,1175 
 
 51 
 
 61 
 
 I 10 
 
 1, 1'.' 
 
 5.2 
 
 
 
 
 5.2 
 
 L'3 
 
 D 
 
 ] 22 
 
 
 70.* 
 
 5 
 
 11 
 
 130 
 
 3,375 
 
 48 
 
 1,20.4 
 
 4.9 
 
 24 
 
 s 
 
 !,-I2 
 
 
 5r i 
 
 5 
 
 - 
 
 
 2,s;3 
 
 ia 
 
 :,2o 
 
 5 
 
 f 
 
SagSSSi!iJ5J;z"S3SX-2 3i; 
 
 i) 
 
 S 8 8 i- l-'T 3 !^ 51 S 'T " S I §K S g ¥i 
 
 '; ^ y I- i-^_ & Ti^ K © X I- ■^l c -.1- '-'= « I- 
 
 '^ — irt ^^ >.* o lO 
 
 'C >n o 
 
 h !' 
 
 -c' -c -ii oi X s ■?! -t ci t2 — — 'r '2 "C ^- !r 
 
 is I?. in ^ '" — O I.* O O -S *-. »■- "-- •— >.. '— 
 
 III c> 
 
 
 A U> I- 
 
 •^ M OC 
 
 — c; o <xi X ^ 
 
 i 5 
 
 ^-: 5 .^.? 3 
 
 i- <'. p ^r: r^ .-3 c |- ;- 5 § g ;-; it ^ 5 ;: ,=2 = 5 
 
 ■— C < - ■'* "T ' CI ■^ -t ^ X C: CI. '-\ X jC ?^_^ ' " -"^ '^ ' ~ 
 
 r; :3 CO « c-3 «■! C-: :■! 
 
 ci M M » CJ z-i z-i 'jiei CO oi n 
 
 1 i: 
 
 : ■; JD I- ts i-~ — » 
 
 X o re >~ ^_ X zi '- '-* >-•: -t> CO itt oo •-; x i--_ 
 
 1- •»• V ^ -»• f -* irt" o •- 
 
 a- o — r: I- M or;?' 
 
 Ct ») C. Ci Cl -^ ^ CO 5' 
 
 -^ I'. X T. = 
 
19 
 
 I'la.uud I'dhii-s. l''nrty-ciL;lU ilftcTinitiation- witc iikuIo on furlv- 
 t\v(i ]i:itii-m-. Tlio larL;i--t {^.77r c.c. i and snialk---t ( J,45U ca. , 
 \cihnnc-. wcru riu-nnnti'icd in llir hca'.ioi ( S5 ki,'. ) ami lii,'lite>t (47.4 
 ki,'. > palicnt> ( Xcj-. 2(> and M> rc--|iL'cti\ els l . TIk' mean weight was 
 (i\.2 kt;. and tlu- mean Vdlumc 3,123 (.'.o. ; tlie a\ iTa,i,'(.' weight, fxv.i ki,'. 
 and till.' a\(.Tai;e \iilunic .i,05i) c.c. 'I'lic i^la^ma \aried frum 4_' to rh 
 ex. \K-v kilo^rani. wliilc the frartii.n ut l)(idy \veit,dn \aricd t'rdin 1 2.i 
 III 1 17. the axirat^e lieini,'- 1 1'*.4. ( l-'fum ihi^ it a])]iear:- ll'.:il ;i normal 
 man of 140 ]Miunii- ha-- .i liter-- of pla-m.'t. or ,^l) e.e. per kt,'. ) 'I'he 
 i-on-.lanev in the r'kition ot' i)l;i>ma to body \veif,dil in health i- slrikiiii;, 
 there hein^ no i^re.il extreme.-;. 
 
 IUih',1 I'tdiirs. The niimher ot' determination- of tot.d blood 
 \alue> li:i< not heeii -o lafi^'e. 1 w enl \-i me determination^ im (.ii^hteen 
 norm.al iiii|i\ idn.d- were made, the whole hlond \ahle- lieint^ caleu- 
 lated friiin the pla-nia \iihime .-md hematoerit I'indini,'-. The plasma 
 eonbtitnie- on the a\ eraije ."' i.' ' ]ier eeiit. of the total hlood, the i \t rentes 
 Ileitis,' .^1 Jier cent. ;md d-'.ii per eenl. d'he lars^e-t and >malle-t Ndhtnie 
 ('i/i7,^ e.e. .and 4._'iWl e.e. ) were ohtained in the two patient- mentioned 
 .alio\e a- h:i\ ins; the l,ir^e-t and -malle-t ]ila-m,a \olnme-. Ihe-e 
 
 patient- -iiowed /S..- .am 
 
 ])er kilo,i,'ratn. re-peeti\ely. The 
 
 aver.iL;e Moiid \ohnne wa- .^..i.-d e c or appro.\inialely ^^.^ e.e. jier kilo- 
 t;ram. < hi a ,t^ra\ inietric ha-i-, die iilood e<iii-tituted SS per eent.. or 
 1 11.4 of the lioiK weitjht. The variations in he.iltli were not f^'real — 
 from 1 1.1 to 1 111..- of the hod\ \\ei>,dit. 
 
 The eon-t.iney of tlie-e \alue> i- in .-irikint; iontra<t to those nf 
 Haldane and .'^mith ' .and of ( lerum.-" who found the hlood l)ody-m,a--> 
 rel.ition-hip e\ieedini;ly xaria'ije. llie re-nlt- here reported -upport 
 the litiitre- of \\ eleker and I'.i-ehol'f. \ ierordt. Kotlmami, I'.ehrint,', 
 l-'iies, and Kamiiierer .iiid Waldmann. 
 
 Cliii'h\}l Studies { Palhohuiicid) 
 
 Si\t\-li\e jialieiit- were studied, the determination- mimherinj,' 
 ei^hty'eii;lit. 
 
 I'or purpo-e- of di-eussion the cases are .^roitjied aeeordiiis; to 
 elinieal eondition-. It i- to he le^retted th.it the mttuher of ea-es in 
 eaeli ^roup i- nui lart^er. dhi- wa- im]io-silile. since the dntt; is ot 
 ( lernian origin and ile-|iite repeated ellort- it wa- imiio--ihle to 
 secure .a fttrther supply. " d'he ,-co]ie of the work ha.- been limited by 
 the -mall .■inionnt ot d\e available. 
 
 ,^n It i- iinil.;iMf that many ilve; will an-«or the purpn-e ciinall;, ur!I Stmlies 
 al'iii).; ihi-c Hiu- arr ii"W m priii^ress. 
 

 i l-J « M C" 
 
 
 i^ ;i^ 
 
 5 "^ :,^ 
 
 
 — X 
 
 
 « W -M .- 
 
 ^i2 
 
 58 ill; 
 
 
 £ ? « 3 3 i 
 
 ;: « I.- ^ eo 
 
 1- n I- " '"30 Ti > 
 
 Sr: rfS3 SSi SSS S3 S3 fiS SS Si5 
 
 i='i 21--= ^3 ?TS':^ S^ sr: 
 
 M ?l OSM-r elffl P? « ^J MCI M?) 
 
 M 51 
 
 IS 
 
 3J S 
 
 0-2 
 
 1 
 
 cc 
 
 ore 
 
 C-; -1 
 
 1.1 
 
 k.-? 
 
 TI 
 
 r^ifi 
 
 lA 
 
 
 S5 
 
 sm 
 
 3 
 
 K 
 
 '~ — 
 
 ;^S 
 
 1 
 
 .•0 
 
 » : f? : : - : S 
 
 §; ^ 
 
 s; a;; ?i 
 
 i • 1 
 
 13 ; 8 
 
 — S!;- 
 
 « •- £1 
 
 • 
 
 
 lA •— ^3 I- 
 
 SS 
 
 • 
 
 f' 
 
I • 
 
 k • 
 
 t • 
 
 r • 
 
 21 
 
 I'rcmaiu-y.--^ )1,.crv;ition. l,.ivc Uecn nuulc bciurc an.l aia-r deliv- 
 ery in ckv.n' ca.u.- (Tabic 7). In tho latter months ..1 pregnancy, the 
 Mood nla^^ in pro,>.,rti.m t(. the body \veii,dit is .letinitely increased. 
 Whereas norniallv. bln,,d constitutes S,8 per cent., in twelve pregnant 
 Nvonien prior to l;ibor the blood averaged 9.50 per cent., which corre- 
 .,H,nd, to the highe.t limits of normal v.alne In tour in.tance^, the 
 1,1, ,„d valuer rose con>ider,ably above normal linntv The plaMua vol- 
 ume^ were c.rre.^pondingly increased, averaging .-S.4 c.c. per kilogram, 
 in^tea.l of .^H c.c. Determinations made .i week ti; ten days .after 
 P.lH.r d.owed tiiat a great decrease in the blood ma^s liad ,.ccurred 
 xvhich .unld n,.t be accomned for bv lo,. of weight (child, placema 
 ,,„,, ;„„„„„„. iluidi or kw, of blond .at ,.artnrit,on. .\fler labor, the 
 blood and plaMUa lormed " per cent, and 4" ,.er cent, of the body 
 
 is-ht. respectixclv. The average lo^> of biocul, .according to the 
 
 ub-t^elrical report of these ea>es. w.a. only .^(Hi c.c, wherca^ bloo.l 
 xdlnnie Mu.lie> -houcd an average lo- of l.bHi e c. 
 
 l.;,,,,,!- have been made, but uidmut -ncces-. to lind the dye in 
 ,hc placenta, i; tiie .nnnioiic ihi.d .and in the .hild^ urine. folkiwing 
 ,hc admimMralion nf the dve mtrav en. ai-ly to the mother during labor. 
 Abnormal ab-ori^no,, of ilu .l\e would not -ecm lobe the explanation 
 „f the high blond x..hic^ re.orded m pregnancy. Ihi^ . ipinmn i-li-.^d 
 „„ ,,,^. ,-.,„ ,|,.„ ,„e decrca-c m blond ma~. ,^ imt fnund imme.hately 
 
 after p.arturitinn. fnr ni t 
 
 \\.. ca^e- (J and 4 I it will be -ccn that deter- 
 
 w 1 
 w i 
 
 nnnatinn^ ma.lc tbirlN -ix hnur- in one c.a-e, .ni.l four d.ays .ilier 
 deliverv in the other, dnrvsed the -ame high v.diu^ for plaMua .md 
 l,lno,l. ' Snb>ec|tiem detcrminalion-. ten day^ alter labor, dmwed m 
 l,ntl, ca^e. the marked decrease recorded m the oihcr c.a^^e. ot (he 
 series. ■ITc consideration of blond volume in relation tn 'pregnancy 
 11 innn die subiecl ni a sejarate cnninmnicalinu m cnliuburatiun 
 th I'r, I. U. Miller, with wlmm this part nf the unrk was earned 
 ,,ut in the wards nl I'ml. J. Whnrid^c WiIIkmiis 
 
 n,ese lindini^s .nulirm ihe uidcsprci,! bebcl .inmng nbstelriciau- 
 that pregnaiU wnnun s,.,„,! lKinorrhaL;e mri-nallv uelb fomp.ara- 
 tivelv verv iarL;e bb edin.^s m eclnnpsia ,are uell bnrne. It unuki 
 .,,,,,e'.,r th.U N.unre h.is here a f.utnr ..f ^al'ety. tlic large blood vohune, 
 saleL;u.ndinL; .c.;a.nsl the effc, ts nf hemorrhage before, duriiiK or after 
 l..il„,r Or u ni.o. b.- ih.ii the l.ua^er blood supply is necessary for 
 pinper nnlrilion nf the chiid 
 
 Case II ".I- .nnipb>,ited by secondary lues and luphritis It doc-^ 
 not accord with die oiher caves nf the sitics. 
 
 t • 
 
22 
 
 I- iihh-ial'uni. Two ca^c^ (1 and J. 'i'aMc S) are iiK-link'tl: 'I'he 
 tir-t i-- in a Wdniaii wim hail lo-t 1_' to 13 ki;. llir(iu;,'li \<iliintary >lar\a- 
 linn. Tin- ]'la-nia \cilniiu' i~ ab-nluU'h niirirja!. and ^in^■l.' reel ccll^ were 
 4,1 K i(i.( i( i( I. Iiir lilocid vcilunie wa-, in all proliability, nnl much below 
 nurnial. 'I'he ^eecind ]iatient. \ery lall an.d lliin, aK( i -lidwed strictly 
 normal \ allies. 
 
 Obesity. Six ea-e- i Xo-. .\ 4. 12. _'(.. .^1 .md M. 'I'al.le Si >l!owed 
 in e\er\' m-lanee a ]ila-ma \ulume decidedly liejuw thai o' ib.e a\eraL;e 
 normal. 1 he average wa- .^7 .\ e.e. I'er ki;.. or .xS per eenl. ol body 
 weight, \\hieh i- le-- lli.in ihree-l'ourlh- of llu' nnrmal \alne. In llic, 
 line ea-e i .■iJ i in wbieli a hent:itoerit reailini,' wa- oblaineii, .~ 1 e.e. jier 
 kiloi;ram oi blnMii \s,i- found. 'liii> jialient had onl\ .i- niiuli blooil 
 |ier kiloi,'rani a~ the unrm.d indixidiial has ]ila-ma jier ki!oi,'ram. Case 
 .^ i~ of eNlreme inlere-t. ina-nuuli a-- the |ila~ma lovmed le-- than ,> |ier 
 eenl, of ihe limh' \\eii;lu. I'be-e tindinu:- are in barmone wilh tbo-e 
 of I hildane and .^niilb, 
 
 l-iiuhuitiiiti ,tnil .li:rii:'ii. I'en eases ( Xos. 5 to 14. inelu-i\e, 
 1 able Si exhibiiinii I'Uiaeia 'on. in i i inibin,:lion with nindrr.-iie or 
 ~e\ere -eeondary anemi;'., w e •-tudied. In tbrei' of tlie-e. in.di^nant 
 i,eo|ila-m- were pre-enl. In -i.\. ibe ]ila-ma Miluine \\a~ bii.;hi.r lli.aii 
 the ;i\erai;e normal, .and if. tline. ;tl morin.dK hit^h. ihe .i\er.aL;e in 
 eiv;hl ea-e- \\.a- r' ' e e. per ■-ili.;;ram. wbieli Midiiale< a -i fon- plrtin ir.i. 
 In four. llu total blou.l \oinine wa- -ludiid and three :'.i\e low \alue>. 
 It i- e\iiUiit. llureiore. th.at in -iieh eondition- In--, nf pl.i-ma doe< 
 
 tioi ;^ii h.ind in b.iiid with In-- of \\eiL;bl and deerea-e ol rid bl 1 
 
 cell-. I iifortmi.iIeK , In in.ili niit -ludie- were not m.ide in the ear- 
 eiiiom.i ea-e-. With the dii^ler ■.! .memi.i mdii aled in the table, it i- 
 evidetil. however, lb, it the toi.il lilmid Milnnii- nin-t ha\e bn n appro.xi- 
 iiiatelv ni inn.d 
 
 Siliei the .i\eraj;e bl 1 \.ilue w.i- 7S e.e i 1 1 .i J ol biid\ weiijht ), 
 
 instead ot S.^ e.e. ]ier k^'., it beeome- apiiamit tli.at the anemia is 
 fairly aeeurately itidieated by the tiloml eount In I ,i-i - S and 11, 
 tlierc is a dcereasc in the vdIuiik', as well ,i- in the cell eoiiieiii of 
 the bldcid. 
 
 /'(■i»iii-|(i|(.\- .hltliiia • 'nl\ three e.i-e- i Xo- 1.-. bi atiil 17, 'I'anle 
 7) were studied, .\o. ]? -hi. wed ,in i \tieinely liiL;li pl,i-m,i Milimn' of 
 72 C.e. per kj;.. the biuhe^t eiieolinlireu olll-ide of preun.iiky. Ihe 
 lilooij voluiiM' wa> normal, but sli;;hlly lulnw the .i\er.iue In the other 
 twi), ])la-in;i values were normal, and the intal Milume i ..n-ider,ililv 
 (Uvreased. 
 
 \\ illi -o y;re.it :iii iiierea-e in ]il;i-m,-; \olumi i.i * .i e I,-. It was 
 tbiiiiLiht th.at the whole blood m;i-- mii^ht be kiiu" f th.in nnrm.d .ind be 
 briiu;;lit into e.iit-.d lel.itinn-lnp with die inl,irL;id lu.irt -muelime- 
 
23 
 
 r 
 
 ■-ccn in lurnicious aiR-mia. 'I'la- two Mibscqucm ca^^•~ -hnwcd kiw 
 M,„„l vahK'. and no caniiac enlargement. FurMicr data in this con- 
 nect inn are necessarv. 
 
 y>„/v.-v//,.-,»u;.--Mnlv two ca^e^ , Xo~. IS anal 1". Tal.le S, with 
 iH-h hl.Hul counts were >tu.!ied. Patient IS, thron,t;hout several weeks 
 -tav ii, the uar.P. rrc-ented a ^er^i-tent!y hii;h red cell cotint ( S,(X)0.- 
 (KHM. Two deteniiination-. a week interv enin-. yieldo identical 
 results, that i~. hoth iila-ina and M-.od volumes were decide<lly smaller 
 ,1,:,,, normal Tlii^ valient cannot, therefore, he con-idered plethoric, 
 -ince he has ,,nlv 7.^ c c. of Mood per k-., instead of the normal S.s c.c. 
 per k};. The total niimhcr -f cells and the ahsohite hemo-lolan were 
 proh.ahlv ahoiil norm.d. The apparent j.letliora was catised hv ihe low 
 pla-ni.a "content of llie hhod. .V' c.c. instead of .-( i cc per k-. 
 
 l'.,n,,n 1" showed a red hi 1 cell connt of .^. ,( K li )( K », a count 
 
 di.'hllv ahove nornial, !T,i~ i- an in~laiice of iriie plclhor.i. 1 he 
 phM.i.a Nohime was also coiisidciahly ahove the avcia,i;e normal, hem- 
 
 o() in-tcad of .-tl cc. per kiloMnmi. The hi 1 pre--nre was l.y W, 
 
 vshile the hi 1 was 11.^ e.c. l^cr kilo-ram. mle.ad of 85 C.C. 
 
 per kilogram. 
 
 •Idiesc cases strikinulv .lenioiivtrate the necessity of total xaliie lor 
 ihe proper interpretation of the louiine methods of -in/iym..' the hlood. 
 
 ■Jiiree other c.a-c- showed counts -..mewh.! .ihove the normal, 
 h, two of ihc-c. ihc pla-ma ■.■Tniie v,a~ low ;.nd the hiood xolume 
 conseiltleiillx ni 't inciea~ed, 
 
 /)„//>,-/c.v. 'If die f..iir patients v.h.-e cases were -ludied ( -\'os. 
 M to J.v nichisixe. 1 ahlc Si, three were moderately thin nun and one 
 ,„ ohe~e woman. nie three men lu'wed .a sn^ar content m ihe hlood 
 l,elwecn D IS per cnt and <l,4.s per cent,, and .all -la.wcd plasma and 
 hlood \olninc- Ih.n wei-c' Mnclh. uiih.ir. the himt- oi norm.d. Ihe 
 ohese patienl > -N... -'-' ' showed hlno.i volmne dccidedlv l.elow normal. 
 M, tlMl llie ohesitv exerted a -n ater nitliunce on ihe hlouddiody-mass 
 relationship than did the i;l\co~nvi;. hro,,, tiu-e l-iir ,ases it appears 
 that an incre,a-c' m the hi 1 \olnnu d..e~ not ie~nh i torn or accom- 
 pany hyperL;lycemi,i. 
 
 \lxoa\rd\a\ l>L<,itiu'inuy. Nnu (Ti-ma delcnmnalion - were made 
 on .iwen eases , No.. JT to Mk nuhi-ue. lahle S, of ni>oeard,al 
 insumciencv. Nepl'nti- \^.'- •'''-"'• '"■ l''T^cd a \ . rv minor role m 
 this s^.rics,' >e\eral of thc-e patients had marked edeiii.!, and thf aver- 
 age \..llimc, 17 c- per kiloi^ram, was slighllv low, m, th.at, in general, 
 edema is not associated will, .m increase in plasma eorrespondln^; to 
 the increase in weight. Hi^ih values may occur, as is seen in I'atient 
 Mt Ihe lowest plasma value (Case 27) is associated with .i liiyh 
 r.d lilood count. 
 
Xo. Niiiiie Uato lli.-iury Agt 
 So. 
 
 TABLI". S.— Clinical ( Pathological i- 
 
 I'lilfllOSiS 
 
 Red 
 
 liloD.l Hfh. 
 Ci'lls S:lhli. 
 
 Wclglit 
 
 A tual I!c'-t 
 
 1 
 
 A. K. 
 
 1,15 
 
 33381 
 
 32 
 
 
 1 . .1 
 
 1 5 
 
 33514 
 
 ii 
 
 ;i 
 
 li. -M 
 
 1 1.'. 
 
 33.-« 
 
 a 
 
 4 
 
 1 N. 
 
 1 li 
 
 :a-io<i 
 
 ,w 
 
 5 
 
 R IJ. 
 
 10 
 
 S346T 
 
 66 
 
 ■■ 
 
 .1 II ( 
 
 1 ]■-' 
 
 :b.".".:i 
 
 ;: 
 
 ; 
 
 .1. II 
 
 1 (. 
 
 3:i4Tl 
 
 M 
 
 8 
 
 A. K. 
 
 3 la 
 
 3:!eis 
 
 31 
 
 V 
 
 ,1. X. 
 
 I 15 
 
 33j8« 
 
 48 
 
 10 
 
 II. W. 
 
 1 'J 
 
 
 'Jj 
 
 U 
 
 .Is 
 
 
 3304U 
 
 •» 
 
 I-J 
 
 H, A. 
 
 1 8 
 
 ,135J-J 
 
 :a 
 
 13 
 
 1 \1 
 
 1-' 
 
 oiN." > 
 
 
 U 
 
 1'. .S. 
 
 ■J iJ 
 
 ;!37H 
 
 31 
 
 i;, 
 
 1'. .1. U. 
 
 
 33433 
 
 4-' 
 
 w 
 
 T. A. 
 
 
 33770 
 
 33 
 
 17 
 
 W. .M. 
 
 
 •■. 11. 1. 
 
 tu 
 
 
 
 
 
 
 lu 
 
 F. O. 
 
 1 3 
 
 3;i.-.2ii 
 
 2j 
 
 ■Jl) 
 
 (i. V. H. 
 
 3 18 
 
 ■xviia 
 
 23 
 
 •Jl 
 
 1-: X. V. 
 
 3 11 
 
 337S7 
 
 <» 
 
 •£! 
 
 .M. H .1. 
 
 1 Jl 
 
 33487 
 
 37 
 
 •-•3 
 
 1 w 
 
 : 12 
 
 33617 
 
 ■::i 
 
 54 
 
 11. .s. 
 
 1 12 
 
 33.-.71 
 
 41 
 
 •a 
 
 <). O. M. 
 
 2 17 
 
 3373.-. 
 
 IX) 
 
 26 
 
 W ,I.R, 
 
 1 l.i 
 
 33M4 
 
 70 
 
 27 
 
 .I.S. 
 
 1 u 
 
 G. No. 1«72» 
 
 48 
 
 28 
 
 w. 
 
 123 
 
 
 
 29 
 
 ,1. .S. SI. 
 
 1 « 
 
 33521 
 
 59 
 
 3i> 
 
 .1. F. 
 
 I 12 
 I 22 
 
 :av!i 
 
 I ' 
 
 31 
 
 K. W. S. 
 
 54 
 
 33i;:- 
 
 
 t'liriinic panorcatilis. Malnutri- 4.022,000 82 
 
 linll. VisrProptOSiS 
 .\..ldiiil. l';iill ia siilo S.UlO.nOO 100 
 
 .Syphilis. Olii-sitj- 4.200.000 84 
 
 i:>hi'sity. Myncarrtial Insufflcl- ,i,noo,000 SO 
 
 I'Dty. hypt'rti'n.sion 
 CnriiQonui sioiiinc'li 2.i:oo.COO 4."i 
 
 Ailiylia KMslriiii: malnutrition. 4.ii0'-i.o00 80 
 
 .Vrti'ridsftrrogi!* 
 t'ul'i'innlMa prostali". Mi-tnstascs 2. 120.000 4.'j 
 
 .siviiM.lnry ani-inia. Ulnrrlii'a. S.iKxi.ooO 01 
 
 INyrliosis. .Miyraiuo 
 Cariinuiim stolii:'.i'h 3.600.000 «.» 
 
 llnlantiilMini cdI:. .Si'con.l.iry 1.072.000 20 
 
 anfiilJa 
 Si'couilary ani'lnia. Leg uleiTs L.'OO.OrtO 31 
 
 Anaildlly. Malnvitriluin. Sec- 4.ri<i(),ooo 70 
 
 mitlary aniMiiia 
 liiiipili'ual iilfiT. .Si'comlary . 3,500.000 7.'i 
 
 ani'iDJa 
 Aiuti' ni'pliritl.*. Syphilis. .Sec- 3.M0.«K) er, 
 
 miliary anemia 
 rernicioiis anemia l.l'J2.0oo 28 
 
 l'ernieioii.s anemia 1.500.000 25 
 
 Peuieious anemia. Aplastic type 1 17. 
 
 I,:iiio.i«K); 22 
 
 1 28. 
 800.000 15 
 
 reritoneal ailliesinns. I'uly- S.OOO.OOO 100 
 eythemiu 
 
 -Mitral In-suftlclency. Left henil- S.iiOu.OOO 101 
 
 plegiu 
 rilabeies mellitus. Pulmonary .'..400,000 !<8 
 
 lnberelllii«i|>. t'olim 
 
 Dialieifn mellitu!!. Pulmonary 1.700.000 82 
 
 tnliert'iiln<«iit. Arterioseleriipis 
 
 .Viirtie Insulllriency 
 Ulabeien mellitus. Oboslly... .S5 
 
 niabeli's mellitus 5„"<m).ih)0 8:i 
 
 Myoeanliul insiimciency. Pul- 5.2UO.OOt> lOO 
 
 mnnary tuberculosis 
 Ar,.ri .r.ler,..!- Myocardial In- 4.700.000 94 
 
 -UlluH'IU > 
 
 Myocarilial ln»iifllclency .-.,000.000 84 
 
 Syphllii". Aortic Insuflielency. ii.jOO.OOO 107 
 
 niyoeanliril insutflejency 
 Myoearillal Insullleiency » 
 
 ArterloMlerosls. Angina pec. 5,000.000 3U 
 
 K.rln Myoearillal iuHolBileney 
 syplillH ot lorla. Aortic In- 
 
 *iitlleieney 
 
 Pulmonary ttibrrciilotit. Afrrlo- 5,000,000 79 
 •cirruili. Chronic Mphrltli 
 
 36.8 
 
 48 
 
 70.5 
 
 
 05.4 
 
 100 
 
 107.7 
 
 i:u 
 
 43.0 
 43.9 
 55.9 
 
 50 
 44.5 
 
 :,9.5 
 
 13 
 ('.8.2 
 r.1.1 
 53 .li 
 
 BO.l 
 
 72 
 
 :2.5 
 
 53 
 
 58.2 
 
 70 
 
 80.9 
 
 SO 
 
 51.1 
 
 67 
 
 7">.2 
 
 8i 
 
 a:. 3 
 
 
 73.4 
 
 
 89.5 
 
 
 H8,8 
 
 
 TJ.2 
 
 
 88.5 
 
 112 
 
 00.4 
 
 
 59.1 
 
 
 00.2 
 
 
r 
 
 r 
 
 — Studiks 
 
 UN Bloou V'dLCMI. 
 
 
 
 
 
 
 
 
 Edema 
 
 l!lo.„l 
 I'rtssure 
 
 Cardlnc 
 
 l:iilart;e- 
 
 liieul 
 
 ■ 
 
 I'Uifina 
 e.e. 
 
 r,e. 
 
 I'er 
 
 Hema- 1 
 
 toerit 
 
 I'er 
 
 Cent. 
 
 riasma 
 
 lilooj 
 Vol 
 uine 
 
 C.C. 
 
 IHT 
 
 Per 
 lent, 
 li..<ly 
 Weight 
 
 Frnc- 
 
 lu.n 
 
 lioily 
 
 Weiglit 
 
 K.niarks 
 
 Nout 
 
 m> i«i 
 
 Noil.' 
 
 LS'iO 
 
 50 
 
 
 
 
 
 
 None 
 
 l-JO M) 
 
 None 
 
 o,7r>t> 
 
 53 
 
 60 
 
 6,250 
 
 89 
 
 U.3 
 
 1 10.!) 
 
 6 feet '■) inelii'-^ in 
 hi'iglit 
 
 None 
 
 1-J(i TO 
 
 None 
 
 e.T-.'.') 
 
 28.6 
 
 
 
 
 
 
 
 Slight 
 
 210 110 
 
 Mo.liTiite 
 
 i,:M 
 
 45.S 
 
 
 
 
 
 
 
 None 
 
 100, 60 
 
 None 
 
 2,j7J 
 
 66 
 
 70 
 
 3,425 
 
 88 
 
 1'.2 
 
 IIO.S 
 
 
 Xune 
 
 IM 100 
 
 Non.' 
 
 2,375 
 
 45 
 
 
 
 
 
 
 
 Kight leg 
 
 130 c:, 
 
 None 
 
 3,l.'iO 
 
 64 
 
 77.2 
 
 4,075 
 
 H 
 
 6.8 
 
 1,11.4 
 
 
 Nune 
 
 100/ 6j 
 
 None 
 
 ■:,17J 
 
 4'J 
 
 65.3 
 
 3,325 
 
 76 
 
 8 
 
 1/12,5 
 
 
 None 
 
 no 6j 
 
 Sjiiiht 
 
 3.725 
 
 0« 
 
 
 
 
 
 
 
 ModiTiite 
 
 lii.V 4,-. 
 
 Mlflit 
 
 3.42:. 
 
 60 
 
 80.6 
 
 4.025 
 
 70 
 
 7.3 
 
 1,13.6 
 
 
 None 
 
 
 None 
 
 2.'.iOO 
 
 57 
 
 78.8 
 
 3.675 
 
 72 
 
 7.5 
 
 1 13.2 
 
 
 None 
 
 i;o, IK) 
 
 MlKht 
 
 2.120 
 
 47.6 
 
 1.7.3 
 
 3.150 
 
 71 
 
 7,1 
 
 1 13.5 
 
 
 Nunc 
 
 1(10 or, 
 
 Slifllt 
 
 3.400 
 
 57 
 
 70.6 
 
 4., 'too 
 
 SS 
 
 U.2 
 
 1,10.8 
 
 
 Ni,llf 
 
 ]■'-■ 70 
 
 Mitllt 
 
 3.225 
 
 .-.1 
 
 61.3 
 
 5.025 
 
 80 
 
 8.4 
 
 1,12 
 
 
 Nn:,' 
 
 ii>> .•,:. 
 
 None 
 
 4,1)50 
 
 72 
 
 ao 
 
 :,.:m 
 
 81 
 
 8.5 
 
 1 11.7 
 
 
 None 
 
 l-JO, 70 
 
 JSligllt 
 
 3.450 
 
 04 
 
 $4 
 
 4.250 
 
 66 
 
 0.0 
 
 1,14.4 
 
 Iniprove.l 
 
 None 
 
 
 None 
 
 2.850 
 
 53 
 
 
 
 
 
 
 Ule.l 
 
 .None 
 
 lai 70 
 
 None 
 
 l.'.CS 
 
 3'J 
 
 53.2 
 
 3.725 
 
 73 
 
 7.7 
 
 1 13.5 
 
 
 
 
 
 2.000 
 
 3a 
 
 53.2 
 
 3.750 
 
 73 
 
 7.7 
 
 1,13.5 
 
 
 None 
 
 I3j; 00 
 
 Sllgllt 
 
 4.125 
 
 00.7 
 
 52.5 
 
 7.hK) 
 
 113 
 
 11.0 
 
 1 8.4 
 
 
 >Mne 
 
 HO' [10 
 
 None 
 
 2.175 
 
 51.3 
 
 57 
 
 3..»00 
 
 8U 
 
 9.3 
 
 1,10,7 
 
 Bloo.l gluec^e 
 0.25.)). 3 
 
 None 
 
 11X1, IH) 
 
 SliKiil 
 
 :;.275 
 
 56 
 
 62.1 
 
 5.375 
 
 92 
 
 9.0 
 
 1,10 
 
 Neerop!»y 
 Blr)Oil glllcos" 
 
 0.45-O.lS 
 
 None 
 
 IL'O 70 
 
 None 
 
 2.825 
 
 35 
 
 
 
 
 
 
 BUto.l gl)ico?»e 
 
 0,1"' 
 
 None 
 
 l-.'O w 
 
 None 
 
 2.775 
 
 51 
 
 
 
 
 
 
 11 loo. 1 glucose 
 0.4^1.34 
 
 None 
 
 120 70 
 
 None 
 
 2.825 
 
 35 
 
 
 
 None 
 
 120 SO 
 
 N.,no 
 
 2.775 
 
 51 
 
 
 
 .Morke.l 
 
 !«) rni 
 
 M.i.l. rale 
 
 3.!W 
 
 .'« 
 
 
 
 Murke.l 
 
 120 HI 
 
 Mark.-.l 
 
 4.375 
 
 M 
 
 51.3 
 
 s.o:.« 
 
 Might 
 
 
 .Marke.l 
 
 3.900 
 
 .03 
 
 
 
 M(.ileriite 
 
 170 120 
 
 Moilerate 
 
 3.HI0 
 
 42.5 
 
 
 
 .M.i.lenite 
 
 130 ' 90 
 
 Mirkeil 
 
 3.II.',-. 
 3.170 
 
 40 
 43 
 
 45.6 
 
 c.uoo 
 
 Mn.leratc 
 
 150 115 
 
 Markeil 
 
 3.975 
 
 43 
 
 
 
 Sllghl 
 
 130' m 
 
 115,' ? 
 
 Slight 
 
 3,3sn 
 
 2.8U 
 
 6fi 
 48 
 
 
 
 Slight 
 
 100/ w 
 
 Blight 
 
 S,300 
 
 36,7 
 
 
 
 9.0 1,10.3 Necropsy 
 
 0.1 1 u 
 
 Nerrr.psy 
 
 NVrropsy 
 
 Weight 131) lb(, 
 
 la 1903 
 
TAI'.LL'. t<.— Cl.lNIl -M- ( rATHOl-OiaCAL) — 
 
 Nil. 
 
 Niilili' 
 
 Iniii- 
 
 Hi^liiry 
 Nil. 
 
 Age 
 
 32 
 
 I., .1. 
 
 
 33777 
 
 47 
 
 S3 
 
 i:. K. 
 
 1 20 
 3. IS 
 
 33757 
 
 36 
 
 2. 
 
 i:. (1. 
 
 2 '21 
 
 33697 
 
 47 
 
 X, 
 
 (1. 1.. 
 
 1 20 
 
 33310 
 
 63 
 
 sa 
 
 R. A. 
 
 2 17 
 
 33643 
 
 45 
 
 37 
 
 F. W. 
 
 2 17 
 
 S3722 
 
 47 
 
 M 
 
 M. 1 . 
 
 1 23 
 
 C. U. I. 
 
 
 39 
 
 .1. K. A. 
 
 2 12 
 2,18 
 
 2 2.-) 
 
 30283 
 
 4U 
 
 t'l 
 
 H, (1 •■. 
 
 1 It 
 
 3fiOS2 
 
 55 
 
 41 
 
 N I'. I'. 
 
 3 18 
 
 36551 
 
 51 
 
 *:' 
 
 i:. s. II. 
 
 2 12 
 
 3(tt'J8 
 
 71 
 
 43 
 
 M. P. 
 
 1 12 
 2 3 
 
 33510 
 
 32 
 
 41 
 
 W. I.. I. 
 
 1 12 
 2 3 
 
 33424 
 
 38 
 
 4') 
 
 T. K. 
 
 1 12 
 
 33,V14 
 
 ■29 
 
 4i: 
 
 A. T. 
 
 1 3 
 
 33472 
 
 22 
 
 47 
 
 1 \V. 
 
 1 7 
 
 33479 
 
 71 
 
 48 
 
 !■ k > 
 
 1 12 
 
 33.572 
 
 .11 
 
 46 
 
 F. N 
 
 1 20 
 
 333'.iO 
 
 40 
 
 ■ii) 
 
 U. 
 
 1 7 
 
 33333 
 
 43 
 
 1 
 
 K •!■. 
 
 1 14 
 
 33545 
 
 n 
 
 62 
 
 M. 
 
 1 14 
 
 :a»r,i 
 
 18 
 
 .-.3 
 
 s II. 
 
 .1 o» 
 
 3 U 
 
 36426 
 
 48 
 
 Diagnosis 
 
 Bed 
 
 Blooil IlKh. 
 
 I'flls S;lllli. 
 
 Weight 
 
 Ailuiil Bi-t 
 
 • 
 
 HypiTtcnsiiin. Chrnnip nei)liritis. 
 
 • i-iii..;irttiritis of spiue 
 SyiOniis. ArUTiosi-lerosis. Ilyppr- 
 
 lensioii. Cliriinif lifpliri'is 
 
 AitiTiosderusis. Ctironit? in'i'li- 
 ritis. IlyptTtension. I'oly- 
 tytlK'Uiia 
 
 Syphilis. Hypirtonsiuu 
 
 Clironic nephritis. Hypertension. 
 
 MvooEirdial insuSicienoy 
 Cliroiiii: nipliritis. Hypertension. 
 
 I i'ri'!ir:il liemorriiage 
 Uypern-ii?iiin 
 
 Chronie nephritis. Hypertension. 
 Arteriosclerosis. Hematuria 
 
 Arteriosclerosis HypertenBion. 
 
 KnlHrgeil prostate 
 Arterioselerusis. Hypertension. 
 
 (.'areinonia of blaililer 
 Arteriosclerosis. Uyperten^ion .. 
 
 Chronic nephritis. Hvperlension. 
 Myucarilial insoHlclency 
 
 Chronic nephritis 
 
 (■lirnnic nephritis 
 
 Chronic prostatitis 
 
 Chronie infi'itinm' ^irtliriiis 
 
 Cerelirnl arierioseliTosis. Brain 
 
 tumor? 
 Kniphy-ema. Chronic lironehitis 
 
 s\iiiiili>. .Vneurysm of Ihoraiie 
 aiirla 
 
 Chronic iippeniliciti* 
 Typhoiil fever 
 
 Carcinoma bladder. Secondary 
 anemia 
 
 5.111*1.0(10 90 79.4 
 
 3„')0().000 05 62.3 05 
 
 5.'.'00,00i) 105 72 80 
 
 6.000,000 S3 (10.7 70 
 
 3.000,000 W 65.D 
 
 5,S0O,00O 92 X.H 
 
 a.m., 78.3 
 
 4.oiHl.(iO(\ 80 76.4 
 
 p. in., 
 
 3,700,000 75 
 
 75.9 
 
 70.1 
 
 3.800,0(10 72 OS. 4 
 
 50.1 
 
 4,4iK).lKN) 03 S7.3 
 
 70.3 
 
 4.000,000 82 80.9 
 
 79.5 
 
 4.20O.0OO 93 l!2.7 73 
 
 4.300.000 10() 52.3 61 
 
 4.st«l.()()0 75 72.7 73 
 
 .-16.4 
 
 ,5,000,000 90 51.9 
 
 4,2iiO.iKl0 92 (il.4 
 
 ii3 . . 
 
 5,000,000 iiO 4* 6 
 
 4,500,000 .■« OO 
 
 3,300,000 33 ,58 
 
 .58.4 
 
Stuuii's 
 
 ON Bi-iion \'n]X-\ii:—i Continued) 
 
 i 
 
 I 
 
 I 
 
 Kdoma 
 
 blood 
 Pres-bure 
 
 Cardiac 
 
 Kularge- 
 
 uient 
 
 Plasma 
 e.t. 
 
 C,c. 
 
 Per 
 Kg. 
 
 Bema- 
 
 tocrit 
 
 Prr 
 
 (.ent. 
 
 Plasma 
 
 Blood 
 Vol- 
 ume 
 
 C'.e, 
 per 
 Kg, 
 
 Per 
 Cent, 
 Uudy 
 Weight 
 
 Fr,ic- 
 
 tion 
 
 Hody 
 
 V. eight 
 
 Remarks 
 
 Slight 
 
 ls(i 100 
 
 Moderate 
 
 2.70O 
 
 34 
 
 66,7 
 
 4,o:)0 
 
 51 
 
 5,3 
 
 Me.7 
 
 
 Ntine 
 
 L'oo i:*) 
 
 Slight 
 
 3.050 
 3.150 
 
 49 
 
 51 
 
 
 
 
 
 
 
 None 
 
 ■JM loO 
 
 Slight 
 
 3,050 
 
 42 
 
 56.1 
 
 5,475 
 
 70 
 
 8 
 
 1,12.5 
 
 Wood glucose 
 0.12 
 
 
 
 
 
 4S 
 
 01 
 
 5,675 
 
 78 
 
 8,2 
 
 1 12 
 
 
 None 
 
 ls5 105 
 
 Slight 
 
 3.025 
 
 50 
 
 
 
 
 
 
 
 Slight 
 
 ■IV) 130 
 
 Slight 
 
 3,175 
 
 4ti 
 
 63 
 
 4,913 
 
 74 
 
 7.8 
 
 1,12,7 
 
 Blood gliicose 
 0.14. Wed 
 
 None 
 
 I'J.j, 130 
 
 Slight 
 
 2,950 
 
 52 
 
 54,3 
 
 5.425 
 
 90 
 
 10 
 
 1.10 
 
 
 None 
 
 180/ ? 
 
 Slight 
 
 1.S2') 
 
 43 
 
 1 
 
 
 
 
 
 
 None 
 
 :2r. 11(1 
 
 Moderiue 
 
 4,0,50 
 3.875 
 
 .59 
 51 
 
 d 
 
 0,150 
 
 81 
 
 s,s 
 
 1/11.9 
 
 SO*J e e. blood 
 lenioved 
 
 
 e35,'155 
 
 
 3.425 
 
 45 
 
 63 
 
 5.125 
 
 At 
 
 8.4 
 
 1,13.1 
 
 
 
 220, 125 
 
 
 4.150 
 
 55 
 
 75 
 
 5,500 
 
 72 
 
 7.0 
 
 1,13,1 
 
 
 None 
 
 175 no 
 
 Slight 
 
 3.500 
 
 ,50 
 
 60.S 
 
 5,750 
 
 81 
 
 8.5 
 
 1 11,7 
 
 
 None 
 
 i;'5, no 
 
 Slight 
 
 4.325 
 
 44 
 
 60,4 
 
 6,525 
 
 65 
 
 O.S 
 
 1,14.7 
 
 Died 
 
 None 
 
 210' 'A) 
 
 Moderate 
 
 3.150 
 
 53 
 
 
 
 
 
 
 
 Con=i'ler- 
 
 ISO 100 
 
 Marked 
 
 3.S75 
 
 44 
 
 64.1 
 
 li,025 
 
 09 
 
 7.2 
 
 1 13.9 
 
 
 Slight 
 
 115 75 
 
 Slight 
 
 4.047 
 
 53 
 
 
 
 
 
 
 
 Moderate 
 
 i."o so 
 
 Slight 
 
 3.172 
 3.0<i4 
 
 39 
 3.?, 4 
 
 
 
 
 
 
 
 None 
 
 IIX)' S". 
 
 None 
 
 2.02.5 
 
 40 
 
 
 
 
 
 
 
 None 
 
 140; 90 
 
 Slight 
 
 2.420 
 
 45 
 
 
 
 
 
 
 
 None 
 
 IW S5 
 
 None 
 
 3,450 
 
 47.0 
 
 63,7 
 
 5.425 
 
 75 
 
 7.8 
 
 1/12.8 
 
 
 None 
 
 v:o' ' 
 
 Slight 
 
 2,825 
 
 ,56.4 
 
 
 
 
 
 
 
 None 
 
 no 70 
 
 None 
 
 2.4.'ifl 
 
 45 
 
 
 
 
 
 
 
 None 
 
 120' 70 
 
 Slight 
 
 3,025 
 3,175 
 
 49 
 60 
 
 60 
 
 4,900 
 
 78 
 
 8.1 
 
 1/12.2 
 
 
 None 
 
 110' 70 
 
 None 
 
 2,200 
 
 48 
 
 
 
 
 
 
 
 None 
 
 P5' 1)0 
 
 None 
 
 3,050 
 
 50 
 
 
 
 
 
 
 
 None 
 
 1B8; 8S 
 
 Slight 
 
 3,600 
 8*» 
 
 61 
 57 
 
 70.6 
 
 4,550 
 
 7S 
 
 8,2 
 
 I 12.2 
 
 Die.l 
 
• 
 
 28 
 
 .\llli<iiii;li in an;i--,-iri';i tlii' miinhor of cubic ccmnnctcr^ nl IjUhhI ]>cr 
 kilogram iiiav iinl Ijc incrca^cil alici\c iiiirmal. llic tulal lilood vnhiiiie 
 iiiav lie larm' in rclaticm tn the iinrnial IkmIv weight. Case 25 luul a 
 liloiid ma-s <if n\(.'r S liters. With tlic disaiiiicaraiicc of his cilcnia, 
 he l(i-t 14 kij;. I diisideriui,' iiis weiuhi at thi-. time in rehttinii to the- 
 hliiod Ndhliiie. S,()5l) c.c, Idlllid (hiriiiL; edema, lie had lH'' c.c. per 
 IdliiiLjram, which is an extremely hii,'h value. I'he iialieiit died six 
 weeks later. .\t necrdjisv, the kidney showed numerous small scars 
 throuuhom. with snme atrii[)hy (if the tuhtilar lells. an<l also an actite 
 intlainmaliirv jinicess. as evidenced 1)\ inliltratiim with [lolymoriihii- 
 nuclear leukoc_\les. There wa-- a slii;ht chrdtiic nephritis with an acute 
 terminal process. Myocarditis was exten>ive am! t'lhrnus in l\|'e, with 
 h\ p'crtropln- nf muscle and small scattered scars everywhere. The 
 heart wa- df tremendous size. It is (|uite ])0ssible that in this instance 
 the Iari,'e hldud itiass stood in caudal relalidtiship to the large heart. 
 
 1 1 y^oii-Hsioi! aiui i lirciiii- \ , ["In ills. - In nineteen determinations 
 dti thirtei'ii cases ( .\'d<. M to 4.i, inclusi\e. Tahle 8), a ]ilasma volume 
 greater than nortnal wa- foimd onlv diice. while tiic total blood volume 
 was nut fcitind incri'.i-ed in nine detcnnitiatiotis uu '-ix cases. Tills 
 would appear to demoii--trate tliat in the-e ca>e- tile hypertension was 
 nut dependent on an increase in hldiid ni.i-^. in hyperten.-ioii, the 
 hlddil \iilunie is normal and I i"e>|iii niK' low. Ilic incrca>cd tcn-ion 
 wiiuli! appic.ir. tlien.'fdri\ tn lie tlepeiidciU dn a \a-cular s\.~teni that is 
 tdu -mall, r.itlur th.in dii ;i lilood \olnmc th.it i- too liruc. The 
 a\eraL;e value for jiki-ma w,i- 42,8 c.c. per kilogr.im. and fdr the \vhiile 
 hlood, 7r c,c, per kilogra.m, in both in-tance-- the lower limit of iidrmal. 
 The sm.dl \,\lue- ,ire not dependent on edenin. as will be ascertained 
 fvdiii the table, -ince in onlv three ca-e- was even ^liijlil eilein.i |'re-ent, 
 ami in onl\- one w.i- there u:reat cardiac enl.irgcment. The rc-iilts are 
 in -triking coiitra>t with i!io-e of I'lesch.'* 
 
 Scxer.d df the-e ca-c- arc of peculiar intcc-l. r.itieiil .^'>. who, 
 on one deterniination -hdwed, .an iiu rca-cd I'Li-ma \olunu. h,id a 
 marked hematuria -o that lunidrrhagc iiiav lia\e accoimtcd fdr this 
 linding. .'^iiii-ei|ncnt delermni.ilidii-. ~hdwt'd tlu' pla>nia \dluiiK> td be 
 iidrm.al. I'dlldwini; \ene-e< lidti with remocal of StXI cc, there was no 
 decre.a-c in blood iires-nic. but immediate decrease in pla-ma \(iliinie. 
 \ Week later, there wa- an inirea-e in ]ila-nia to abd\e tli.it fmind 
 befdrc the \ene-eitidn. but wilbdiil ,i cdrre-l'diiding increa-e in the 
 bk idd \ dlnnic. 
 
 i hat h\ pevtcn-idi, can e\i-t in ;i--dci,itidn widi ,a IdW bluod \dluinc 
 is clearlv indic.ated b\ ^'.i-e .U. the p.itient -lidwiiig i -y-tdlic blood 
 pressure of 1S<1 and dia-tolic of pK), Ihe pla-iiia w,a- .U c.c. per kilo- 
 L;r,aiii ami the total bl 1. .^1 c i-, per kilo^i.nn. The hypertension 
 
29 
 
 exi>tol .Ic^piU' the tact thai the i)atient's total WuiM mass was not 
 greater than the jila-ina vohinie is nurmally. (Jbcsity and a sHght 
 edema were in i>art respiin>il)le lor these low values. 
 
 Case 4;^ is al-o of great intere>t. The patient is the only one of 
 the serie:, presenting marked edema at the lime of determination. At 
 this time, he had 40 c.c. of plasma per kilogram. Following a loss of 
 11 kg, ( disippearance of edema), the [.lasma volume was found to 
 be slightly lar^. r, 4,().=l) c.e.. eoinpared with .\S75 e.e. It is evident 
 that tlie Vilasma volume remained ihe same throughout, not being 
 influenced by the presence or disappearanee of the edema, d'his does 
 not always occur, a- will be seen by contrasting with Ca-e i.->. 
 
 From' thei^e ci-e-, it would appear that true plethora is not present 
 in hvpertenMon, ;nid that a small or contracted vascular system and 
 not ini incre.a-e in liln.)d ma^:, i-. re.ponsiljle lor the increased blood 
 pressure. 
 
 Clir.'iiic .W-l^lu-itis iniliout llyfnti'iisioii. < )nly two cases ( Xos. 
 44 and 4.= , Table Si fall into lhi> group. I'atient 44 w.as an instance 
 of chronic ii.arencbx matous nephritis, wilh slight edema and very 
 marked .albumiiiuria. The i.|;i~nia w.as e-timated twice, three week.- 
 iiiter\eniiig. iM.llowing a \ .'? kg. decrea-e in weight, the ]ilasma 
 decrea-ed ItMl c.c. I'.oth ca-es gave v.alues below the normal average 
 for pla>iiia. 
 
 Miscellaneous Gii'itp. .\ -mall -erie^ of miscellaneous unrelated 
 cases (No-. 4«i to .= ,\ inchi-ive, T.able S) were -tudied. Case H). an 
 instance of aneury-in of the a-cemling arch of the aorta, and with a 
 moderate tirade of aiieiina, -hi.wed identical roults on two occasions- 
 an aNera-e normal v.ilue for the plasma, ratieiits 4'>. -uttering wuh 
 chronic bnuuhiti-; r\. with diroiiic appendicitis; 4o. a neurasUiemc. 
 .-md 4S. with cerebral arteri(r-clero-i>, all showed value- within the 
 
 limit- of normal 
 
 COM Ml' NT 
 
 Exiept in pregnancy. hyi)eneii-ion and obe>ity. the number of 
 cases sui.lic.i in any one con.iition has been so .mall that far-reaching 
 conchi-ion- .are ini'iios-ible. SutVicienl evidence has been adduced to 
 convince us n\ i ,; i an increase in blood volume just before term in 
 uncomplicated prc-nancy. ( /' ) absence of a causal relation-hip between 
 increa-vd bln...| volume .and hvperlen-ion, and ( c ) of a relativel\ 
 small blo..,l m.a-- in obe-itv. Inirther blood v<iltime -Indies in tlie-e 
 and in otiier clinical conditions i- contemplated. 
 
 I'lom ihi- -uidv. n 1- api.arent that a great variation in the blood 
 niasr, in relation to body weight nia> occur in any one disea-e. Com- 
 plication- of anv kind mav al-o exert a great inlUience on ihe bl 1 
 
 vohune. ,1- evidence,! bv Ca-e -' in T.able 7. It become- evident llial 
 
30 
 
 wo cannet lake t'dr j^ranU'd llial tlio blood Nnlumc i> iiKTcaM-'d or 
 dccrca^til in any <,'iviMi disca-c, lull inu-t ainually dticrmiiK' il in each 
 individual i-a-u. In ihc prc-cnt --talc (jI i1k- <iil)ie.:l. ,<,'cncralizations 
 arc undesirable. 
 
 SUMMARY 
 
 I. A iiKtb.nil f(,r ibc dctcniiinatioii of ]ila>ina \nhinie i^^ described. 
 I'roni tbe plasma volume and hematocrit \alue- the blood volume can 
 be calculated. 
 
 _'. W ilb tlii> mellind, duplicate determinatidiis on normal subjects 
 yield identical \alue>. 
 
 ,v I he amount nt decrease in blood \nlunie a- the result of henior- 
 rhai;e and "f increase following; iiUravenou-- infu-inn of ,-alnie has 
 been denn in-traled. 
 
 4. Chanije- in blmul \iilume are in-i,L;nilicant in experimentally 
 induced Inpcrlen.Mon and li\ pnten>ii .n. and cannot be bron,i;ht iiUO 
 cau-.il relalinn-hip with iheni. 
 
 .-. Tlie ]'laMiia nnvmallv c(in>titules apiimximately ,^ per cent, or 
 one-tuenlielh nf tbe b<"ly weight. Ndrnial iiidi\ idu.iV- liave ai)!)roxi- 
 niatelv rt> k-.k:. of pla-ma per k^., the extremes beini; irdui 4_' to .~0 c.c. 
 per kiliii;r.nri. 
 
 (.. The normal heni.itdcrit value- (iblained were appr<j\iniately 
 4.1 per cent, for erylhrncyte? and r7 per cent, fur plasma. 
 
 7. IJH. bldd.l )i(irmally con-liiules S,S per cent., or 1 11.4 of the 
 bodv weii^ht. Xnrnial individual- ba\e api>roxiuiately 8.^ c.c. <>i blood 
 per kild^ram, llie extreme- bcin^ 7S and *'" per kileigram. 
 
 8. In prei^nancv, before term, the 1)1 1 and plasma \iihnne< are 
 
 increa-ed, .\ iimditinu nf -eiou- plethora exi-t.-. Within a week or 
 iwu after deli\ery. the bbni.! value- return to ncjrmal. 
 
 '». In nbe-ii\-. the plasma and bb^od \olumes are relatixely .-mall. 
 Ill, Manv ca.-e.- of anemia, exhibit a relatively lart;e plasma volume. 
 
 II. I', ilvcythenna in the sense of a hi-h blood count may be 
 dependent nii a liiw plasma Mnnme. Il may be a-socialed with a large 
 plasma \iilume. in which ca-e true jilelhora i- indicated. 
 
 IJ. 1 lyperi;]\cemia exists wilhcut increase in blood volume. 
 
 l.v In anasarca accompanying in}oc,ardial insuhiciency the blood 
 \olnme inav be absolutely increaseil. 
 
 14 .\ small \ Illume i- -Imwu in many eases of marked hyperten- 
 -ion. Therefore so far as these studies go it would apipear that hyper- 
 ten-ion is not dependent on a large blood volume. 
 
I 
 
 I 
 
 I