Critical review : polycythaemia, erythrocytosis and erythraemia.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1908
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Licence: In copyright

Credit: Critical review : polycythaemia, erythrocytosis and erythraemia. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    expression, appears, as far as our present knowledge goes, to be the primary disorder, just as in leukaemia the increased formation of white cells appears to be the primary disorder. On the other hand the word c erythrocytosis ’, as suggested by Hirschfeld, is applied to cases in which the polycythaemia is secondary and in which it generally appears to represent a conservative vital reaction, i. e. an effort on the part of the organism to compensate for some difficulty in the oxygenation of the blood and tissues of the body. Erythro- cytosis is thus analogous to leucocytosis in the more recent sense of the latter term, namely as signifying a secondary or symptomatic (generally a reactive or conservative) increase of the white corpuscles, such as may result from strepto- coccal or other microbic invasions of the body.1 Thus, in all cases of erythro- cytosis there is as much cause for the hyperplasia of the red blood-corpuscles to occur as in cases of renal or valvular disease there is for the heart to become hypertrophied. The best known forms of erythrocytosis are those connected with residence at high altitudes and diminished oxygen-tension in the inspired air and those due to imperfect oxygenation of the blood and tissues owing to circulatory disturbance in chronic cardiac and pulmonary complaints, especially cases of congenital stenosis of the pulmonary orifice of the heart. The causes of Polycythaemia in cases of Erythrocytosis AND IN CASES OF ErYTHRAEMIA. In regard to the polycythaemia of chronic cardiac and pulmonary diseases there can now be no doubt that imperfect oxygenation of the blood and tissues is the exciting cause of the polycythaemia, in fact that deficiency of oxygen, as was many years ago suggested, stimulates the functions of the red bone-marrow so as to cause an increased formation of red cells. According to this view the polycythaemia is a ‘ conservative ’ or ‘ compensatory ’ vital reaction on the part of the individual, an automatic attempt to make up for deficient oxygenation of the tissues by increase in the number of the red blood-cells, which are the oxygen-carriers of the blood. Post-mortem examinations in cases of chronic cyanosis of cardiac or pulmonary origin help to confirm this hypothesis, for, in such cases, although the red colour of the bone-marrow of the shafts of the long bones is partly due, as I have satisfied myself, merely to engorgement with blood, evidence of abnormal haemopoietic activity is likewise obtained. It is surprising that in this respect very few exact observations have as yet been recorded, but E. Weil (1901), in post-mortem examinations on two children with congenital stenosis of the pulmonary orifice of the heart and chronic cyanosis, found that there was red transformation of the bone-marrow, microscopic sections 1 It must, however, be remembered that the word ‘ leucocytosis ’ is still sometimes employed to signify a moderate increase in the number of white blood-cells, whether reactive in nature (constituting a ‘leucocytosis’ in the modern sense of the term) or arising as an early stage of leukaemia (the so-called ‘ leucocytic stage of leukaemia ’).