Hyperemia

“ There seems to [249] be a tendency on the part of nature to take care of a foreign body, and I think the reënforcement of connective tissue that grows into this mass requires an increased blood supply, and later, when the blood supply is no longer necessary, the redness will disappear.”
The latter is true where the hyperemia is either acute or subacute, but in chronic cases where the capillaries have become distended and show plainly there is little to be hoped through the effort of nature. ”

“ Hyperemia is produced, and this leads to over-action of the glands of the large intestine. These glands secrete a glairy mucus which is necessary to protect the bowel from the offensive material that is always present, and from the hardened material that is so often there when there is a tendency to constipation. This mucus is secreted in large quantities, while at the same time a hyperemia of the colon tends to interfere with peristalsis and consequently to delay the passage of contents and to keep the mucus in place. ”

“ Congestion of the brain consists in an accumulation of blood in the vessels, also called hyperemia, or engorgement. It may be active or passive—active when there is an undue accumulation of blood or diminished arterial resistance, and passive when it accumulates in the vessels of the brain, owing to some obstacle to its return by the veins. ”

“ The passive, venous or obstructive form of hyperemia is absolutely contraindicated in this class of ulcers. The initial cause of the trouble must receive attention, because upon its successful management depends the cure, much more so than upon the local measures. ”

“ Moist dressings favour the removal of bacteria by promoting the escape of the inflammatory exudate, in which they are washed out.
Artificial Hyperaemia.#--When such direct means as the above are impracticable, much can be done to aid the tissues in their struggle by improving the condition of the circulation in the inflamed area, so as to ensure that a plentiful supply of fresh arterial blood reaches it. The beneficial effects of _hot fomentations and poultices_ depend on their causing a dilatation of the vessels, and so inducing a hyperaemia in the affected area. ”

“ Associated with progressive anemia is mal-assimilation, improper nutrition, ebbing of the nervous and vital forces and the lessening of the secretory, excretory and digestive powers. By the time the poor victim is weighing fifteen to twenty-five pounds less than he ought to the symptoms of ill-health are sufficiently alarming to compel the sufferer to seek medical aid for disease of the stomach, bowels, liver, kidneys, lungs, etc. ”

“ Adjusting the Proteins in Diet.—If the individual shows a definite anemia, as is often the case after acute attacks, either as a result of the disease itself or the [Pg 347] necessarily low diet, which the acute symptoms of uremia and edema made necessary, other measures are necessary to bring the body back to a normal condition. It has been found that in these cases where there has been no permanent damage to the renal organs, but merely a temporary impairment of the functioning power, the treatment must be, first, a rest to the affected parts ”

“ According to the nature of the effects which this variety in blood deficiency (dysaemia) produces, we distinguish certain groups of degenerations in the body, for which names were established at a time when the unity of these forms of disease had not yet been recognized. Thus, where dysaemia produces only general debility, we call it anaemia, which may gradually become destructive and develop into "pernicious" anaemia. When it affects girls with all kinds of disturbances in menstruation, perverting their appetite and causing a greenish color of the skin, it is called "chlorosis." ”

“ Diabetes generally, on the other hand, causes a low blood pressure. Patients with this trouble and with hypertension, and without nephritis, probably have an increased secretion from the suprarenals.
We may sum up the prognosis in hypertension as follows: Hypertension alone is not of unfavorable omen; if it is not readily reduced by ordinary means, it is more serious. If associated with kidney, heart or liver defect, it is most serious. If there are such serious conditions as edema, ascites, lung congestion, cyanosis and great dyspnea, the prognosis is dire. ”

“ The rare and rapidly fatal anemia which has been described under the name of aplastic anemia is probably a variety of pernicious anemia. Absence of any attempt at blood regeneration explains the marked difference in the blood picture. Red corpuscles and hemoglobin are rapidly diminished to an extreme degree. The color index is normal or low. The leukocyte count is normal or low, with relative increase of lymphocytes. Stained smears show only slight variations in size, shape, and staining properties of the red cells. ”

“ Change of air and change of scene are of special importance in these cases and will frequently cure. The general condition of course must not be overlooked. The diet, exercise, bowels, habits, should receive careful attention. Iron should be continued for a number of months after all traces of the anemia have disappeared.
Pernicious Anemia.—For this condition arsenic is the one remedy needful. In all conditions of poor blood the most careful attention should be given to the general health. Colds must be guarded against. The patients should never get their feet or their clothes wet. ”

“ It is a rare condition, and must be distinguished from hematuria, or blood in the urine, which is common. In both conditions chemic tests will show hemoglobin, but in the latter the microscope will reveal the presence of red corpuscles. Urines which contain notable amounts of hemoglobin have a reddish or brown color, and may deposit a sediment of brown, granular pigment.
Hemoglobinuria occurs when there is such extensive destruction of red blood-cells within the body that the liver cannot transform all the hemoglobin set free into bile-pigment. ”

“ The tendency for hypertension and arteriosclerosis to occur early in life in patients who have suffered some serious acute infection, whether blood poisoning, typhoid fever, or other, shows that in all probability in these acute illnesses the internal secretions are so disturbed that the suprarenal activity is greater than normal, while the thyroid activity may be less than normal, and hypertension is the consequence. ”

“ In acute anaemias, such as those associated with septicaemia, there is no doubt that blood destruction plays the principal part. But if the cause of anaemia is a chronic one, a gastric cancer, for instance, though there may possibly be an increased amount of destruction of corpuscles in some cases, and though there is often loss by haemorrhage, the cancer interferes with nutrition, the blood is impoverished and does not nourish the erythroblasts in the marrow sufficiently, and the new corpuscles which are turned out are few and poor in haemoglobin. ”

“ It is much more frequent in men than in women. Its most common cause is hypertension; in fact, hypertension generally precedes it. The most frequent cause of hypertension today is the strenuousness of life, the next most frequent cause being the toxins circulating in the blood from overeating, overdrinking, overuse of tobacco and the overuse of caffein in the form of coffee, tea or caffein drinks. Another common cause of arteriosclerosis occurring too early is the occurrence of some serious infection in a person, typhoid fever and sepsis being most frequent. ”

“ Most cases of arteriosclerosis sooner or later present symptoms referable to the heart. When the organ is hypertrophied and is already working against an enormous peripheral resistance, a slight excess of work put upon it may cause a dilatation of the chambers with the resulting broken compensation. There is dyspnea on slight exertion, possibly some precordial distress, slight edema of the ankles and lower legs and possibly scanty urine. With proper care, a patient with such symptoms may recover, but the danger of another break in compensation is enhanced. The next attack is more severe. ”

“ The cause is most probably to be sought in the anemia which results from the narrowing of the channels through which the blood reaches the part. The stiff, much narrowed arteries allow sufficient blood to pass along for the nutrition of the part at rest or in quiet motion. Just as soon as more violent exercise is taken, calling for more blood, an ischemia of the part supervenes, for the stiff vessels can not accommodate themselves to changes in the necessary vascularity of the part. ”

“ Where the malnutrition is the effect of poorness in the quality of the blood, the results are of course more widespread. The muscles suffer at an early period: they fall off in bulk, and later suffer from fatty degeneration, the heart being probably the first muscle to give way. Indeed, all tissues when under-nourished, either locally as the result of an ischaemia, or generally as from some impairment of the blood, such as that prevailing in pernicious anaemia, tend to suffer from fatty degeneration ”

“ We must, therefore, always take this special duty into consideration, when the question of recuperation, convalescence, feeding, and the administration of blood foods and tonics comes up.
It is not necessary to specify the diseases from which a child may suffer and recover, in an anemic condition. Any disease may leave a child with temporarily poor blood. The conditions which most frequently produce anemia in childhood are improper feeding and unhealthy surroundings. It is not fully appreciated how seriously these conditions can affect the health of growing children. ”

“ Increase of hemoglobin, or hyperchromemia, is uncommon, and is probably more apparent than real. It accompanies an increase in number of erythrocytes, and may be noted in change of residence from a lower to a higher altitude; in poorly compensated heart disease with cyanosis; in concentration of the blood from any cause, as the severe diarrhea of cholera ”

“ Malarial Cachexia.—Although the malignant tertian infection has the greatest tendency to produce anaemia yet any type may, when untreated, bring about the more or less profound anaemia with earthy skin, enlarged spleen, dyspnoea on slight exertion, and oedema of the ankles characteristic of malarial cachexia.
Oroya Fever.—In this disease we have what might well be termed a fulminating pernicious anaemia. The rod-shaped protozoon which attacks the red cells seems to be peculiarly active in the bone marrow, excruciating bone pains being quite a feature of the disease. ”

“ As a consequence of this tension, the blood-pressure on the brain is well sustained; and a free supply of arterial blood, rendered perhaps more than ordinarily stimulating by the presence of nitrogen in excess, evokes a heightened activity of the cerebral cells. Simple hypertrophy of the heart is mostly found in the subjects of chronic renal changes. That there is a certain explosiveness in the gouty, together with much mental activity, is simply a clinical fact. ”

“ The lesson is, that boys who are bleeders may marry, because they will most likely not transmit the disease; but girls who come from a hemophilic family, irrespective of whether they themselves are hemophilics or not, must not marry, because most likely they will transmit the disease.
Anemia
Anemia is a poor condition of the blood. The blood may contain an insufficient number of red blood cells or an insufficient percentage of the coloring matter of the blood, that is, hemoglobin. A special kind of anemia affecting young girls is called chlorosis. ”

“ A man of fifty years of age, five feet ten in height and 164 lbs. in weight, was brought for examination. In his youth [251] there was a history of a mild attack of scarlet fever. He was almost a total abstainer, rarely taking liquor in any form. Physically he appeared to be an excellent risk. However, on examining the heart it was found that there was slight hypertrophy with an accentuated second aortic sound at the base, and the blood pressure was 180 mm. of Hg. Some sclerosis of the radial arteries was found. One company had refused him on account of albumin in the urine. ”

“ ETIOLOGY One of the most common causes of hypertension is clue to excess of eating and drinking. The products caused by maldigestion of proteins, and the toxins formed and absorbed especially from meat proteins, particularly when the excretions are insufficient, are the most frequent causes of hypertension. Whatever other element or condition may have caused increased blood pressure, the first step toward improving and lowering this pressure is to diminish the amount of meat eaten or to remove it entirely from the diet. ”

“ That is to say, it is the attempt on the part of the body to equalize the distribution of blood in the body when there is some poison causing constriction of the small arteries. In this sense hypertension is not only essential, but actually life-saving. A heart which is so diseased that it can not respond to the call for increased action by hypertrophy of its fibers, would shortly wear out. The very fact that the heart becomes enlarged and the tension in the arteries becomes high, indicates that in such a heart there was great reserve power. ”

“ The dangerous forms of degeneration—the edematous, the cystic, the telangiectatic, and the sarcomatous—occur with sufficient frequency always to be dreaded; and, even though these dangers be avoided, the anemia from the continual hemorrhage exposes the woman to fatal results from the diseases and accidents of daily life. ”