Page:EB1911 - Volume 04.djvu/98

 Leucocytosis occurs under a great variety of conditions, normally to a slight extent during digestion, during pregnancy, and after violent exercise, and abnormally after haemorrhage, in the course of inflammations and many infective diseases, in malignant disease, in such toxic states as uraemia, and after the ingestion of nuclein and other substances. It does not occur in some infective diseases, the most important of which are typhoid fever, malaria, influenza, measles and uncomplicated tuberculosis. In all cases where it is sufficiently severe and long continued, the reserve space in the bone-marrow is filled up by the active proliferation of the leucocytes normally found there, and is used as a nursery for the leucocytes required in the blood. In many cases leucocytosis is known to be associated with the defence of the organism from injurious influences, and its amount depends on the relation between the severity of the attack and the power of resistance. There may be an increase in the proportions present in the blood of lymphocytes (lymphocytosis), and of eosinophile cells (eosinophilia). This latter change is associated specially with some forms of asthma, with certain skin diseases, and with the presence of animal parasites in the body, such as ankylostoma and filaria.

The disease in which the number of leucocytes in the blood is greatest is leucocythaemia or leucaemia. There are two main forms of this disease, in both of which there are anaemia, enlargement of the spleen and lymphatic glands, or of either of them, leucocytic hypertrophy of the bone-marrow, and deposits of leucocytes in the liver, kidney and other organs. The difference lies in the kind of leucocytes present in excess in the blood, blood-forming organs and deposits in the tissues. In the one form these are lymphocytes, which are found in health mainly in the marrow, the blood itself, the lymph glands and in the lymphatic tissue round the alimentary canal; in the other they are the kinds of leucocytes normally found in the bone-marrow-myelocytes, neutrophile, basophile and eosinophile, and polymorphonuclear cells, also neutrophile, basophile and eosinophile. The clinical course of the two forms may differ. The first, known as lymphatic leucaemia or lymphaemia, may be acute, and prove fatal in a few weeks or even days with rapidly advancing anaemia, or may be chronic and last for one or two years or longer. The second, known as spleno-myelogenous leucaemia or myelaemia, is almost always chronic, and may last for several years. Recovery does not take place, though remissions may occur. The use of the X-rays has been found to influence the course of this disease very favourably. The most recent view of the pathology of the disease is that it is due to an overgrowth of the bone-marrow leucocytes, analogous in some respects to tumour growth and caused by the removal of some controlling mechanism rather than by stimulation. The anaemia accompanying the disease is due partly to the leucocyte overgrowth, which takes up the space in the marrow belonging of right to red corpuscle formation and interferes with it.

 BLOOD-LETTING. There are certain morbid conditions when a patient may obtain marked relief from the abstraction of a certain amount of blood, from three or four ounces up to twenty or even thirty in extreme cases. This may be effected by venesection, or the application of leeches, or more rarely by (q.v.). Unfortunately, in years gone by, blood-letting was used to such excess, as a cure for almost every known disease, that public opinion is now extremely opposed to it. In certain pathological conditions, however, it brings relief and saves life when no other means would act with sufficient promptness to take its place.

Venesection, in which the blood is usually withdrawn from the median-basilic vein of the arm, has the disadvantage that it can only be performed by the medical man, and that the patient’s friends are generally very much opposed to the idea. But the public are not nearly so prejudiced against the use of leeches; and as the nurse in charge can be instructed to use these if occasion arises, this is the form of blood-letting usually practised to-day. From one to twelve leeches are applied at the time, the average leech withdrawing some two drachms of blood. Should this prove insufficient, as much again can be abstracted by the immediate application of hot fomentations to the wounds. They should always be applied over some bony prominence, that pressure may be effectively used to stop the haemorrhage afterwards. They should never be placed over superficial veins, or where there is much loose subcutaneous tissue. If, as is often the case, there is any difficulty in making them bite, the skin should be pricked at the desired spot with the point of a sterilized needle, and the leech will then attach itself without further trouble. Also they must be left to fall off of their own accord, the nurse never dragging them forcibly off. If cold and pressure fail to stop the subsequent haemorrhage, a little powdered alum or other styptic may be inserted in the wound. The following are the main indications for their use, though in some cases they are better replaced by venesection, (1) For stagnation of blood on the right side of the heart with constant dyspnoea, cyanosis, &c. In acute lung disease, the sudden obstruction to the passage of blood through the lungs throws such an increased strain on the right ventricle that it may dilate to the verge of paralysis; but by lessening the total volume of blood, the heart’s work is lightened for a time, and the danger at the moment tided over. This is a condition frequently met with in the early stages of acute pneumonia, pleurisy and bronchitis, when the obstruction is in the lungs, the heart being normal. But the same result is also met with as a result of failure of compensation with back pressure in certain forms of (q.v.). (2) To lower arterial tension. In the early stages of cerebral haemorrhage (before coma has supervened), when the heart is working vigorously and the tension of the pulse is high, a timely venesection may lead to arrest of the haemorrhage by lowering the blood pressure and so giving the blood in the ruptured vessel an opportunity to coagulate. (3) In various convulsive attacks, as in acute uraemia.

 BLOOD-MONEY, colloquially, the reward for betraying a criminal to justice. More strictly it is used of the money-penalty paid in old days by a murderer to the kinsfolk of his victim. These fines completely protected the offender from the vengeance of the injured family. The system was common among the Scandinavian and Teutonic races previous to the introduction of Christianity, and a scale of payments, graduated according to the heinousness of the crime, was fixed by laws, which further settled who could exact the blood-money, and who were entitled to share it. Homicide was not the only crime thus expiable: blood-money could be exacted for all crimes of violence. Some acts, such as killing any one in a church or while asleep, or within the precincts of the royal palace, were “bot-less”; and the death penalty was inflicted. Such a criminal was outlawed, and his enemies could kill him wherever they found him.

 BLOODSTONE, the popular name of the mineral heliotrope, which is a variety of dark green chalcedony or plasma, with bright red spots, splashes and streaks. The green colour is due to a chloritic mineral; the red to haematite. Some coarse kinds are opaque, resembling in this respect jasper, and some writers have sought to restrict the name “bloodstone” to green jasper, with red markings, thus making heliotrope a translucent and bloodstone an opaque stone, but, though convenient, such a distinction is not generally recognized. A good deal of bloodstone comes from India, where it occurs in the Deccan traps, and is cut and polished at Cambay. The stone is used for seals, knife-handles and various trivial ornaments. Bloodstone is not very widely distributed, but is found in the basaltic rocks of the Isle of Rum in the west of Scotland, and in a few other localities. Haematite (Gr. , blood), or native peroxide of iron, is also sometimes called “bloodstone.”

 BLOOM (from A.S. blôma, a flower), the blossom of flowering plants, or the powdery film on the skin of fresh-picked fruit; hence applied to the surface of newly-minted coins or to a cloudy appearance on the varnish of painting due to moisture; also, in metallurgy, a term used of the rough billets of iron and steel, which have undergone a preliminary hammering or rolling, and are ready for further working.

 BLOOMER, AMELIA JENKS (1818–1894), American dress-reformer and women’s rights advocate, was born at Homer, New