Chapter 7, Note I. Analyses Used For The Study Of Hemoshock

Besides body temperature and blood pressure, the following blood analyses were made: complete blood count; coagulation time; clot retracta bility; values of albumin and globulin, total and free cholesterol, free fatty acids, degradated proteins, antitryptic power of the serum, esterase amylase, potassium, sodium, calcium and glucose. Most of these analyses were made in venous blood samples obtained every five minutes, during the fifteen minutes preceding and the half hour following the noxious intervention.

Chapter 7, Note 2. Morphine And Shock

The possibility of inducing hemoshock simply through an intravenous injection of colloidal metals has provided a useful method to study the conditions under which hemoshock can be induced or suppressed. We have investigated a series of agents to determine their influence upon shock. Adrenalin, quinine, ephedrine and atropine have not changed the course of clinical and hematic manifestations. On the other hand, morphine, as well as other opium derivatives, completely prevented the development of these manifestations. Subcutaneous injection of 2 centigrams of morphine sulfate fifteen minutes before the intravenous injection of the metal always suppressed the manifestations as did an intravenous injection of 5 milligrams of morphine sulfate. Analyses have shown no leucopenia, to occur. Similar effects were obtained, with none of the changes characteristic of hemoshock, for instance in transfusions where 500 cc. were injected in less than ten minutes and where morphine prevented the frequently observed chills. The influence of morphine upon the leucocytes has been confirmed in the following experiment.

In rabbits, a pleural exudate was obtained by an intrapleural injection of broth, 16 hours later, pleural punctures furnished fluid rich in leucocytes. As we have noted above, the addition of a colloidal suspension of silver proteinate (collargol) was followed by the appearance of rapidly growing vacuoles which led to bursting of leucocytes. (Fig. 76)

The proportion of chills appearing after direct transfusion

Fig. 265. The proportion of chills appearing after direct transfusion (with the Jube syringe, injecting 500 cc in less than 10 minutes) increases manifestly after exercise (walking in the room).

The addition of even minimal amounts of morphine or other opium derivatives entirely prevented these changes in leucocytes. No lysis nor vacuoles were seen.

Chapter 7, Note 3. Physical Exercise And Shock

The study of hemoshock has shown the influence exerced by physical exercise upon shock. A leucopenia was observed in normal subjects after an intensely sustained physical effort, such as after running for five minutes, a fact which led us to try to see what influence exercise would have on the shock induced by the intravenous injection of colloidal metal. The shock was seen to be much stronger than usual. The chill which followed 25 minutes later was also proportionately severe. We have since correlated the appearance of hemoshock with exercise in patients having direct transfusion. If the patient exercised immediately after the transfusion, a chill consistently followed about a half hour later. (Fig. 265)

Chapter 7, Note 4. Lymphocytes And Effects In Vitro

The capacity of lymphocytes to hydrolyze even higher esters can be demonstrated by having lymphocytes separated and their activity tested. Fluid obtained from tuberculous pleural effusion rich in lymphocytes was centrifuged and the fluid decanted. The centrifugate was then put on a plate of beeswax, covered with a cup and left for several hours at 37°C. A clearly visible depression appeared where the lymphocyte preparation had been added.