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6
MICROCOPY RESOIUTION TEST CHART
^SSI and ISO TEST CHART No ?
1.0
m
,2.2
I.I
1-
2.0
1.8
1.25
^■\
1.6
^ /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