DISEASES OF THE BLOOD AND OF THE PREPARING ORGANS THE microscopic blood picture in infantile blood diseases becomes intelligible only through knowledge of the normal blood in infancy.
The blood of the newborn infant exhibits the following peculiar ities according to the latest publications of Schiff, Perlin, Carstanjen, Scipiades, and Takasu: 1. A very high specific gravity, 1.060-1.080, as against 1.050- 1.060 in the adult.
2. A high percentage of hcemoglobin, 1.00 to 140 per cent. of the percentage in the healthy adult.
3. A specially large number of red blood corpuscles, 5,825,000— 7,550,000.
4. An increased number of white blood cells, up to 36,000.
5. A preponderance of polynuclear cells, 73.1 per cent. polynuclear, 16.05 per cent. lymphocytes on the first day (Carstanjen).
6. Nucleated red blood corpuscles (as in the placental blood, where they are more numerous), up to the third clay; up to the sixth day only in very few cases (Takasu), afterwards hardly any.
7. All these differences are considerable up to the fourth day, then they grow less; at. the middle or end of the first month both hirmo globin and number of red blood corpuscles have arrived at about the level of the adult man; the number of polynuclear leucocytes dimin ishes likewise and the percentage of the various kinds of leucocytes from the fourth day is about the same as it will be during the first few months.
No doubt some of the blood changes in the newborn are caused by the lack of water, considerable passing out through the intestines and perspiration, and in consequence of small supply.
In infancy there are also altered blood conditions as compared to the adult (Fig. 20, and Fig. 27, page 166), as follows: 1. Decreased amount of hremoglobin down to 10.35 Gm., in the average 11.5 Gm. (as against 13-14 Gm. in the adult).
2. Often slight decrease of the red blood corpuscles.
3. Increase of the white blood cells; about 12,000 to 13,000.
4. Preponderance of lymphocytes: about. 50-55 per cent. The lymphocytes of infancy show greater differences in size than in the adult; there are also larger sizes. (These lymphocytes originate accord ing to Ehrlich exclusively from the lymph-nodes; but according to Grawitz, \Valz and Pappenheim, similar cells exist also in the bone marrow.) 5. According to some investigators (Carstanjen, Karnizki) the so-called transitional forms are increased to about S or 10 per cent. (in
the adult there are, together with the large mononuclear cells, only 2-4 per cent., according to Ehrlich-Lazarus).
6. Myelocyt es (mononuclear cells with neutrophile granulation) are sometimes found in the healthy infant during the first few weeks of life, but always in slight numbers, never later (Zelenski-Cybulski).
7. Norrnoblasts are met with but rarely (Geissler and Japha, Zelenski-Cybulski, Karnizki), although formerly their occurrence even in healthy children was considered the rule.
From the second year the blood gradually approaches the normal blood of the adult, a state which is not attained, however, until the fif teenth or twentieth year. Up to the third to sixth year there is a pre ponderance of lymphocytes. Sex does not cause any material difference in the blood picture up to the fifteenth year.
Japha has not been able to demonstrate a proper leucocytosis of digestion in the bottle-fed infant, Gregor (lid not even find it regularly in the breast-fed infant. Moro found a decrease of leucocytes one-half to two hours after ingestion of food and seems to regard this leukopenia as a regular occurrence. If, however, a breast-fed infant was given cow's milk (heterogeneous albumin), there was an immediate occurrence of leucocytosis. Unfortunately the time of day when these experiments were made, is not stated. Besides, leucocytosis of digestion does not seem to be quite regular even in the adult, and the curve of leucocytes changes also during the day.
The blood-making organs of the infant are severely affected by dis ease. The infantile blood easily takes up myelocytes and nucleated red blood corpuscles (Zelenski-Cybulski). In infectious diseases the infant is perfectly capable of producing polynuclear leucocytosis. Measles do not produce leucocytosis (Felsenthal, Plantenga, Caccia, Tschistowitch and Schestakof). In whooping-cough hyperleucocytosis, with particular increase of lymphocytes was found even in afebrile cases (up to 47,000, de Amici and Paulioni, Cima). In severe cases of diphtheria Engel found 3.6-16.4 per cent. myelocytes. In intestinal affections of infants Schlesinger and others found lymphocytosis, Japha however was unable to confirm this.