New ideas are first resented, second tolerated and finally adopted.

Men may come and men may go, but I go on forever. - Tennyson's Brook.
 

    The functions of the tractus vascularis are peristalsis (rhythm), secretion, absorption, sensation.  Its object is to transport universal nourishing fluid, the blood, to the general body.  In pathologic physiology of the tractus vascularis there are two concomitant factors with which to deal, viz., (A) the vascular tract; (B) its contents.  The pathologic physiology of the tractus vascularis and its contents each possess a wide range.

(A) THE VASCULAR TRACT.

    The tractus vascularis is a cylindrical tube possessing the form of a complete circle, with localized constrictions (capillaries) and dilatations (heart-arteries, and veins).  This vascular canal circulates universal fluid tissue through the body.  It has a dual object for tissue, viz., that of import and export service.  The tractus vascularis will become of vast therapeutic utility.  Dr. Bier, a man of forty-five years of age, Professor of Surgery in Bonn, Germany, has preached for years the value of artificial congestion in the cure of disease.  Bier's introduction of artificial congestion is one of the greatest contributions to medicine of the present century.  Lister's contribution was but a temporary matter, for now we do not need it, as we have learned asepsis.  Bier's method will always be useful while the tractus vascularis remains.  Men may come and men may go, but the tractus vascularis goes on forever.  Bier suggests to the profession to control the segments of the tractus vascularis and its contents for therapeutic purposes.
    In the study of the pathologic physiology of the hemogenous tract the exact functions must be held in view, viz., peristalsis, secretion, absorption and sensation.  The condition of the arterial wall and the diameter of the lumen influence the flow of blood.  The lumen of the artery is controlled by a plexiform, nodular, fenestrated network of nerves and ganglia which ensheaths the artery.  The lumen of the artery is regulated chiefly by reflexes that arise in different regions of the body.  Stimulation of peripheral nerve will induce generally reflex arterial constriction and this elevates blood pressure.  All nervous impulses from the heart are capable of governing the calibre of arteries; therefore, the degree of arterial contraction depends chiefly on the nervous impulses which they receive.  For the theme of our subject - the abdominal vessels - the condition of the numerous abdominal arteries innervated by the splanchnic nerves is of significant importance in regard to maintaining peripheral resistance, as opposed to the splanchnic innervation.  A brief discussion of the four physiologic functions of the tractus vascularis in a condition of pathologic physiology will suffice to present our views.

(1)  PERISTALSIS (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).

    (a)  Excessive peristalsis of the vascular tract is a common occurrence in life.  The marble paleness of fright and fear present excessive contraction of vessels.  The cold hands and feet of certain persons show spasm of vessels.  Excessive cardiac activity is frequently noted.  The cardiac hypertrophics remain long in the stage of pathologic physiology as compensatory hypertrophies.  In certain renal diseases the arterial pressure (arterial peristalsis) increases gradually until the myocardium has attained maximum dimensions for the coronary arteries to nourish.  Excessive arterial peristalsis may be an indefinite time in the stage of pathologic physiology, as cardiac hypertrophy, arterial sclerosis, nephritis.  It is during the stage of pathologic physiology of the previous immediately noted disease that medical treatment is of practical value by the therapeutic application of appropriate dietetics, fluids and methods of living.  Vigorous exercise will produce excessive peristalsis of the tractus vascularis.  Not infrequently we observe the abdominal aorta maintaining an extraordinarily vigorous peristalsis for hours - in fact, it performs with such vigor that the inexperienced may diagnose abdominal aneurism.  It is the detection of excessive vascular peristalsis (pathologic physiology) in its incipient stage that allows ample time to remove the causes of disease before the destructive pathologic anatomy has appeared in the line that renders utility to medical skill.
    Excessive peristalsis does not always result in forcing excessive blood to tissue, because the arterial pulse caused mainly by the variation of pressure within the artery and the results of intermittent expulsion of blood jets from the heart may become so deranged and disordered that blood pressure is low.  Arterial blood pressure depends on the amount of blood forced into the arteries by the heart and the peripheral arterial resistance.  In other words, blood pressure depends on the blood volume, rigidity of arterial walls and opportunity of escape.  Age influences blood pressure.  We note pathologic physiology of the tractus vascularis in asphyxia.  Lead colic is usually associated with high arterial pressure as well as the early stages of peritonitis Renal disease may induce high arterial pressure, i. e., an excessive vascular peristalsis.
    (b)  Deficient peristalsis of the vascular system is frequently encountered.  The myocardium and arterial muscularis may be diminutive.  The vascular lumen may be limited.  The nervus vasomotorius may be inactive, sluggish, of minimum power.  We frequently meet the small, weak cardiac and pulse action.  Deficient arterial peristalsis results in deficient tissue nourishment and cerebral action.  We frequently meet persons with deficient vascular peristalsis from dietetic and habitat errors.  The subjects consume concentrated foods and insufficient fluids, with a resulting pulse of limited volume and power.  This deficient arterial peristalsis and power is pathologic.  Physiology, however, sooner or later passes from the incipient stage to that of established pathologic anatomy by continued repetition.   The employment of ingesta, which leaves a large indigestible residue, and ample fluids at regular intervals, quickly restores a pulse of full volume, i. e., vigorous arterial peristalsis presenting volume and power.  Errors of habitat, inactivity, sedentary, may be accompanied by deficient arterial peristalsis, which are promptly improved by appropriate exercise.  Deficient peristalsis of the heart or inability to drive the congested blood through the lungs will, however, act as a prophylaxis against pulmonary tuberculosis (it is a cure by congestion).
    Extensive areas of blood vessel dilatation may initiate a marked fall in arterial pressure and slowing of circulation, for the quantity of blood is insufficient to occupy the entire vascular calibre if dilated.  General vascular dilatation may result from general loss of vascular elasticity and consequent expansion of the vessel lumen.  A general loss of vascular tonus may occur.  If the splanchnic vessels lose their tonus they become distended with blood, while the arteries, especially to the periphery, skin, become but partially depleted.  In certain autopsies the splanchnic vessels appear so extensively distended with blood that the subject seemed as if he had bled to death in his own abdominal vessel.  Deficient peristalsis may be due to paresis of the vaso-motor centre.
(c)  Disproportionate peristalsis of the tractus vascularis consists in irregularity of action in different segments of the vascular tract, e. g., the blushing of embarrassment, the flushing of the climacterium, is local dilatation of the vascular tracts.  The clubbed fingers of the subject with patent foramen ovaleis pathologic physiology of the blood channel.  The most patent example of disproportionate peristalsis of the vascular tract is the defective cardiac valves - the cardiac insufficiency.  The disproportionate arterial peristalsis is due to abnormal volumes of blood in local segments of the tractus vascularis, e. g., in insufficiency of the aortic valves the coronary arteries receive excessive blood and produce cardiac hypertrophy.  The volume of blood remains excessive in the heart and dependent portions of the body, while in portions of the body where force is required to propel the blood, it is deficient.
    Disproportionate arterial peristalsis may be observed during gestation when the arteria uterina ovarica sports an excessive volume of blood.  During constipation the arteria mesenterica inferior is transporting insufficient blood, and hence inducing insufficient colonic peristalsis for regular fecal evacuations.  The giant hypertrophic member of the body presents an excellent example of disproportionate vascular peristalsis.  The mottled surface is disproportionate circulation.  Disproportionate arterial peristalsis may be observed in the maximum functions of the several visceral organs, e. g., food in the gastrium or enteron entices extra blood.  Extra fluids increase especially the activity of the arteria renalis.  Excessive, deficient, disproportionate vascular peristalsis may long remain in the field of pathologic physiology - functional  disease - allowing ample time for diagnosis and therapeutic correction before the field of pathologic anatomy - compromised structure - is reached.
 

LYMPHATICS      Fig. 139.

(2)  SECRETION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).

    (d)  Excessive secretion of the vascular tract may be observed in edema, ascites.
    (e)  Deficient secretion presents few practical examples.
    (f)  Disproportionate secretion is irregular secretion in different segments of the vascular tract.

(3)  ABSORPTION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).

SENSATION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE).

    (g)  Excessive sensation in the tractus vascularis indicates an irritable weakness in the nervus vasomotorius (sympathetic), which rules the visceral tract.  It appears that it is the blood in the vascular lumen which incites peristalsis, as may be demonstrated in the urine and the ureter.
    The excessive sensation in the vascular tract is synonymous with the state of the nervus vasomotorius.  Some vascular tracts with inferior anatomy and physiology execute peristalsis in a wild, irregular, violent, disordered manner on slight provocation; they possess excessive sensation, pathologic physiology, or are afflicted with a habitus nervosus, stigma nervosus.  I have observed the heart executing its action irregularly and 120 per minute for weeks with no demonstrable pathologic anatomy.  Such a person possesses an excessive sensation in the tractus vascularis.  It is an abnormal function.  The excessive beating of the abdominal aorta, and beating in various parts of the body, refers to excessive sensation - hyperesthesia - in the tractus vascularis.  Blood contents in the tractus vascularis may be waste laden, irritating, and should be sewered by fluids.
    (h)  Deficient sensation in the vascular tract may be observed in the slow, sluggish pulse.  In icterus the pulse may be 50; sensation is obtunded, dulled, by morbific elements bathing the innumerable sympathetic ganglia, checking their excitability.
    (i)  Disproportionate sensation is irregular sensation in different segments. of the tractus vascularis.  Also one may observe in certain persons local congestions or anemia.  Cold feet or hands produce disproportionate circulation in the body.

TREATMENT OF PATHOLOGIC PHYSIOLOGY OF THE TRACTUS VASCULARIS.

    The treatment of pathologic physiology of the tractus vascularis consists in correcting the deviation of its functions (which are peristalsis, absorption, secretion and sensation).
    Since pathologic physiology of the tractus vascularis lies between physiology and pathologic anatomy, it should be amenable to treatment.  First and foremost, a diagnosis should be made and cause removed.  The treatment is accomplished through: (a) Ample fluids administered at regular intervals; (b) appropriate diet; (c) rational habitat; (d) suitable avocation.  Maximum elimination or visceral drainage is the rational treatment.
    (a)  Visceral Drainage by Fluids. - The most general feature of a patient suffering from pathologic physiology of the tractus vascularis is deficient visceral drainage.  The sovereign remedy is water.  One of the best laxatives is water.  The most rational stimulant to the renal (and intestinal) epitheilium is sodium chloride - common salt (one-fourth to one-half normal physiologic salt solution).  I administer eight ounces of one-fourth to one-half normal salt solution every two hours for six times daily, i. e., three pints daily. (Note. - NaCl is contraindicated in parenchymatous nephritis.) The three pints of normal salt solution fill the lumen of the artery and induce normal reflexes.  The pulse becomes a full volume.  The powerful arterial stream sewers the body of waste laden blood and irritating material.  The arteries functionate best with a maximum volume of blood.  Also the fluids induce maximum functions of adjacent visceral tracts - urinary, intestinal, perspiratory.  Perfect elimination - maximum visceral drainage - may prevent arterial sclerosis.  Maximum visceral drainage maintains in mechanical suspension the insoluble uric acid (preventing the formation of ureteral calculus) and the cholesterine (preventing the formation of hepatic calculus).
    It aids the sodium, potassium and ammonium salts to form combinations with uric acid, producing soluble urates.  The eight ounces of one-half or one-quarter normal salt solution six times daily stimulates the epithelium of the tractus perspiratorius (inducing sweating) and the epithelium of the tractus intestinalls, inducing secretions which liquefy feces, preventing constipation.  It also stimulates the epithelium of the tractus urinarius, inducing increased quantities of urine.  The druggist manufactures for me sodium chloride, tablets of twelve grains each, from which I can employ fragments or multiples in the treatment.
    (b)  Visceral Drainage by Foods. - The great functions of the tractus vascularis - peristalsis, absorption, secretion, sensation - are produced and maintained by fluids and foods.  To drain the tractus vascularis, the adjacent visceral tracts (intestinal, urinary, perspiratory) should be excited to peristalsis.  Hence, for the intestinal tract foods which leave an indigestible residue only are appropriate; all adjacent visceral tracts must be stimulated to maximum peristalsis, secretion, absorption, in order to aid that of the tractus vascularis.  Rational foods must contain appropriate salts whose bases may form combinations which are soluble, as sodium, potassium and ammonium combined with uric acid and urates.  The proper foods are cereals, vegetables, albuminates (milk, eggs), mixed foods.  Meats should be limited, as they enhance uric acid formation and waste-laden blood.
    In order to stimulate the epithelium (sensation) of the digestive, urinary and perspiratory tracts, with consequent increase of peristalsis, absorption and secretion, I use a part or a multiple of an alkaline tablet of the following composition: Cascara sagrada, one-fortieth of a grain; aloes, one-third of a grain; NaHCO3, one grain; KHCO3, one-half grain; MgSO4, two grains.  The tablet is used as follows:
    One-sixth to one tablet (or more as required to move the bowels freely once daily) is placed on the tongue before meals and followed by eight ounces of water (better hot).  Also at 10 A. M., 3 P. M. and at bedtime one-sixth to one tablet is placed on the tongue and followed by a glassful of any fluid (buttermilk is excellent).
    The Combined Treatmet (Sodium Chloride and Alkaline Tablets). - In the combined treatment one-third of the NaCl, the sodium chloride tablet (containing twelve grains), and one-sixth to two alkaline tablets are placed on the tongue together before each meal, followed by eight ounces of fluid (better hot), and also at 10 A. M., 3 P. M. and at bedtime, followed by eight ounces of fluid (buttermilk is excellent), i. e., every two hours, and followed by a glass of fluid.  The six eight-ounce glasses may be fluid food - as milk, buttermilk, cream, beef tea, egg-nog - fluid nourishment.  This visceral drainage treatment furnishes alkaline bases (sodium, potassium and ammonium) to combine with the free uric acid in the urine, producing soluble urates.  Besides, the alkaline laxative tablet increases the peristalsis, sensation, absorption and secretion of the intestinal tract, stimulating the sensation of the mucosa, aiding evacuation.  It ends in correcting the pathologic physiology of the tractus vascularis.  The object of the visceral drainage treatment is to improve elimination and digestion.
    I have termed the sodium chloride and alkaline laxative method the visceral drainage treatment.  The alkaline and sodium tablets take the place of the so-called mineral waters.  I continue this dietetic treatment of fluids and food for weeks, months, and the results are remarkably successful, especially in pathologic physiology of the tractus vascularis and adjacent visceral tracts.  The pulse volume becomes full.  The urine becomes clarified like spring water and increased in quantity.  The tractus intestinalis becomes freely evacuated regularly daily.  The blood is relieved of waste laden and irritating material.  The tractus cutis eliminates freely, and the skin becomes normal.  The appetite increases.  The sleep improves.  The patient becomes hopeful, natural energy returns.  The sewers of the body are drained and flushed to a maximum.
    The maximum function of viscera by means of fluid diet, activity, induces maximum drainage of viscera, eliminating irritating matters from the body and insures normal peristalsis and normal reflexes for the vascular tract.
    (c)  The habitat should be suitable.  It should allow fresh air day and night.  Environments constitute much of the essence of living.
    (d)  The avocation should suit the physique.  In maximum elimination complete visceral drainage - every visceral tract (urinary, intestinal, perspiratory) must normally functionate.  Hence all rational therapeutics (fluid, diet, habitat, avocation) must be applied to secure maximum, universal visceral drainage.  No single visceral tract can functionate defectively without damage to adjacent tracts.

(A)  PATHOLOGIC PHYSIOLOGY OF THE CONTENTS OF THE TRACTUS VASCULARIS. - THE BLOOD.

    The pathologic physiology of the blood cannot be separated from the pathologic physiology of the several visceral organs.  The blood represents universal fluid tissue and every organ receives and emits material to it.  The blood has an import and export service (transporting oxygen to tissue and carbonic acid gas and waste products from tissue).  The significant blood - a medium of exchange between the external world and the tissues - enters every organ through the tractus vascularis, distributing nutritive material to every tissue.  It is the source of all secretion.  When one concludes the enormous amount of interchange (assimilation and waste) between the blood and tissue, it becomes evident that the pathologic physiology of the blood is a wide zone.  It also becomes evident that the zone of pathologic physiology is an incipient zone to that of pathologic anatomy.  First, in the foreground of pathologic physiology of the contents of the tractus vascularis should be included those diseases which indicate dominant, recognized changes in the blood, as anemia, chlorosis.  Second, single symptoms may represent the changes of an unknown disease, as cachexia ub carcinoma, diseases of the adrenals.
    Here projects in the foreground (primary) hemogenous disease or (secondary) visceral disease.  The composition of the blood - plasma, red and white corpuscles - depends to a certain extent on the condition of the tissue in the different districts of the body.  Though the blood contains an extensive variety of substances, its composition is relatively constant on account of the rapid flow of its current, and the rapid secretion of substances occurring in it in excess.  The composition of the blood will change when pathologic physiology arises in any organ.  The essential constituents of the blood with which the physician deals are: (a) red corpuscles (130, to 1000 parts); (b) white corpuscles (253, to 1000 reds); (c) plasma (800, to 1000 parts of blood).  The great typical fields of pathologic physiology of the contents of the tractus vascularis are 1, anemia - e. g., chlorosis; 2, leukemias. e. g., splenic and glandular diseases; 3, cachexia - e. g., carcinoma and adrenal diseases.
Changes in the blood cells and hemoglobin are recognized with relative facility and hence they are more certainly known than the changes in the plasma.  The contents of the tractus vascularis - the blood - presents a rich field for study in pathologic physiology and fortunately for prophylaxis.  The blood has an extensive range of pathologic physiology through the variation of hemoglobin, through change in number of white and red corpuscles, through changing composition of plasma.  The study of the varying stages of anemia (e. g., chlorosis) and hyperemia (congestion) present far-reaching possibilities in therapeutics.  We will first consider the red corpuscles.

I.  Red Blood Corpuscles and Hemaglobin (1000 Reds to 3 Whites).

    The red blood corpuscles constitute about 1/7 of the blood (130, to 1000 parts of blood).  The most striking feature of pathologic physiology of the blood is anemia.  In anemia the marked phenomenon is a reduction of the hemoglobin or the red corpuscles or both.  Other related changes doubtless occur in the white corpuscles and plasma.  Anemia presents many forms, acute and chronic, and grades (from delicate paleness to pernicious anemia) as well as numerous conditions of etiology (acute, or chronic loss of blood).  The simplest form of acute anemia results from sudden loss of blood, through vascular wounds, hemorrhages, e. g., during parturition excessive quantities of blood may be lost simply producing anemia.  The grades of anemia depend on the relative quantity of blood loss.  Should the hemorrhage exceed a ; certain bound the patient dies from suffocation; there are insufficient red corpuscles to transport oxygen to the tissue for internal respiration.  Should the patient lose suddenly 15 per blood, it may require weeks and months to recuperate, during which time certain phases of pathologic physiology of the tractus vascularis may be observed.  The patient presents a pale appearance.
    The simplest form of chronic anemia results from periodic, repeated or continuous loss of blood, as menorrhagia from uterine myoma, repeated loss of blood from hemorrhoids, from renal papillae.  The blood shows a diminishing quantity of hemoglobin.  Chronic and acute anemia are not independent diseases, they are clinical symptoms of pathologic physiology.  In anemia there is to consider: 1, the quantity of oxygen in the lung; 2. the quantity of hernaglobin in the blood; 3, the rate of transportation by the blood current; 4, the degree of interchange of the oxygen and carbonic acid gas with the tissue.  Anemia may arise not only from hemorrhage but from insufficient formation of red blood corpuscles.  The red blood corpuscles forming organs are acting abnormally.   Starvation as a rule does not cause anemia.  If the hemoglobin escape from the red blood corpuscles into the plasma the condition is called hemaglobinemia.  The liver forms its bile pigments from hemoglobin, hence in hemaglobinemia the bile, urine and feces will become richer in coloring matter.  The pathologic physiology of hemaglobin (albuminous coloring matter of blood) includes a wide zone.  It is impossible to assert the minimum quantity of hemoglobin compatible with life.  Anemia may progress to the stage of air hunger.  I have observed several patients recover with less than 12 per cent of hemoglobin.  Operations are dangerous with hemoglobin less than 30 per cent.  The above data demonstrate that the normal blood stream transports more oxygen than is absolutely required for tissue repair and waste.   Nature employs excessive, abundant, supplies.
    The blood relates itself differently in the various form of chronic and acute anemia.  In the field of chronic anemia, chlorosis is, clinically, a typically well-characterized anemic disease which prevails almost exclusively in females between the ages of 14 and 25 years-the developmental period.  The etiology of chlorosis is incompletely known; it is a kind of adolescent pathologic physiology of the blood - perhaps a sexual phase, like a varicocele, as it practically recovers spontaneously.  The patient presents various transition grades of color from normal rosy red to pale green.  The patient presents a plump paniculus adiposus - chlorosis is the anemia of good looking girls.  The formation of the blood volume may be normal, the plasma, white and red corpuscles, however, altered in relations.  The composition of the blood may be changed.  There may be diminished red corpuscles and hemoglobin.  Acute and chronic anemia occupy extensive zone of pathologic physiology allowing time for prophylaxis.
    A third class of anemia may be designated pernicious anemia, a disease in which the red blood discs may finally assume the highest grade of changes in dimension, form and composition-ultimately evident pathologic anatomy.  However, pernicious anemia has a considerable range of pathologic physiology.  Anemia renders in general to the diminution of the red blood disc and hemaglobin - with less reference to the white blood corpuscles of plasma.

II.  White Blood Corpuscles (Leucocytes).

    The normal relation of white to red is 3 in 1000.  The pathologic anatomy relation is 50 to 1000.  The zone of pathologic physiology of the blood extends through a range of 4 to 40 whites to 1000 reds.  In other words, leucocytosis is 1000 reds to 4 whites.  From these data the leucocytes of the blood are labile elements markedly influenced by conditions.  Leucocytosis is pathologic anatomy where there are 50 whites per 1000 reds.  In leucocytosis there exists an abnormal number of white blood corpuscles.  There are mononuclear and polynuclear white corpuscles.  The origin of the white corpuscle is not definitely settled (spleen, bone marrow, lymphoid tissue).  Leucocytes is supposed by some to be the rupture of hypoplastic gland tissue into the circulation.  This accounts for the various kinds of cells found in the blood.  On account of the variation of the number of leucocytes from different normal conditions of life - digestion, gestation, age, sex - there will be physiologic leucocytosis.  The leucocytosis of pathologic physiology is of special interest to us, though its signification is not always understood.  For example, is the leucocytosis of infectious disease of utility to the patient?  The leucocytes may rise to 30 whites to 1000 reds.  Does it furnish a clue for diagnostic and therapeutic purposes?  Pathologic physiology as regards leucocytosis is prevalent in middle life.  Unfortunately the pathologic physiology of leucocytosis frequently merges into pathologic anatomy before diagnosis has been established and when treatment becomes of little avail in an advanced terminal disease.  With established pathologic anatomy in leucocytosis (especially and splenic hypertrophy) the termination of the disease is generally fatal in a couple of years.  The hope of treatment benefiting a leucocytotic is while the disease is in the plane of pathologic physiology.
    Leucocytosis was first observed bv Xavier Bichat (1771-1802) in 1800.  Velpeau observed the hypertrophy of the spleen in relation to leucocytosis.  Donne in 1844 thought that leucocytosis was due to imperfect transformation of white into red corpuscles.  In 1845 Dr. Hughes Bennett and Dr. Craigie each published a case.  To Dr. Hughes Bennett is due the credit of recognizing the salient features of leucocytosis and he proposed the term leticocythemia.  In 1845 Rudolph Virchow published, originally and independently, excellent details and comprehensive views of a case.  To this date the changes in the blood had been recognized only after death.  The changes of the blood during life in leucocytosis was first observed by Dr. H.W. Fuller.  The first case of leucocytosis diagnosed during life in Germany was by Dr. Vogel in 1848.  At present writing no known remedy is capable of checking the fatal course of leucocytosis.
    Cachexia presenting a peculiar white, waxy color of the skin depends on the deteriorating effect of the disease on individual organs as from malignancy, tuberculosis, arsenic, malaria, alcohol, goiter, etc.  Cachexia is associated with a condition of chronic ill health depending on depraved state of blood, from loss of blood elements, malnutrition or the presence of morbific elements (uremia, defective elimination).  Pathologic physiology plays a considerable role in the pre-cachectic stage, previous to the establishment of recognizable pathologic anatomy.  The term cachexia and constitutional disease are with some synonymous.

III. Plasma (Liquor Sanguinis).

    Blood plasma is composed of blood serum and fibrin.  Fibrin constitutes about 2/5 of 1 percent of blood.  If blood contains 1 percent of fibrin it has merged into pathologic anatomy, which is especially observed in inflammatory states.  The range of pathologic physiology as regards fibrin is from ½ of 1 per cent to 3/4 of 1 per cent in the ascending scale.  In the descending scale it may be less than 1/10 of 1 per cent, as in the anemias and septicaemias.  The knowledge of pathologic physiology of blood coagulation is defective, hence our knowledge of the pathologic physiology of blood coagulation is likewise defective.  The plasma of the blood is of significance on account of the contained fibrin which is the base of thrombosis and ultimate embolism.  The blood serum is able to destroy varieties of foreign cells and bacteria.  The blood plasma contains numerous ferments. which act as an enzyme, alexin or complement.  Some suppose that the leucocytes produce the alexins.  The signification of the blood plasma may be noted in the ideal administration of certain so-called anti-toxins to cure disease, as, diphtheria, tetanus.  If foreign cells, as bacteria, be injected into an animal the blood serum of the animal acquires the property of causing the cells to agglutinate.  The blood serum contains a variety of substances with a variety of function.  It is well for the practitioner to remember for practical purposes, that the chief salts of the serum are sodium chloride (NaCI), sodium carbonate (NaHCO3) with phosphates and alkalies.  If the blood plasma becomes diluted, attenuated, it is said to be in a state of hydraemia, as in kidney and heart disease.  The blood may become thick, excessively condensed, as in Asiatic Cholera or in extensive watery diarrhea.

Treatment of Pathologic Physiology of the Blood.

    The treatment of pathologic physiology of the blood demands a knowledge of etiology.  When the red corpuscle, white corpuscle or plasma manifests abnormal function (pathologic physiology), first and foremost must we begin the search for the diagnosis with vigor, as the diagnostic data are still few and somewhat uncertain.  If it be anemia from loss of blood (uterine sarcoma, myoma, hemorrhoids, the condition may be palliated or cured.  If it be anemia from chlorosis, a sexual phase, the health can be improved by treatment, and also it is a self limited disease (15 to 24 years).  The associated conditions of glandular hypertrophy may aid as a general hyperplasia, splenic or hepatic hypertrophy.  The pathologic physiology of the blood should allot the physician ample time to diagnose and institute appropriate treatment before the destructive fatal pathologic anatomy dominates the field.  When the fatalistic cachexia presents its specter, pathologic physiology of the blood has generally merged into hopeless pathologic anatomy.

PATHOLOGIC ANATOMY.

    The detection of the terminal disease (pathologic anatomy) from the pathologic physiology of the blood requires the best heads and the finest of skill.  If the terminal carcinoma could be detected in the stage of pathologic physiology, i. e., in the precarcinomatous stage, it could be practically cured, as it is in the incipient stage - a local disease.  The diagnosis of the pathologic physiology of the blood cannot be separated from the pathologic physiology of individual viscera.  For example, carcinoma of any viscus produces pathologic physiology of the blood (cachexia).  Again, pathologic physiology of the blood may arise with no palpable course until hypertrophy of the glands, spleen, or liver appears.
    Leukemia, a disease of middle life, though in the incipient stage is that of pathologic physiology, yet leads later to pathologic anatomy and generally to a fatal issue, however, through a chronic course.  Leukemic changes arise through rupture of the hyperplastic tissue in the vascular tract.  This explains the variety of cells found in the blood.  The etiology of leukemia is unknown.  Some consider it an infectious disease.  Leukemia was, originally, chiefly referred to the spleen but other sources, as the bone marrow, account for a share.  The various forms of leucocytosis mav exist as long as pathologic physiology endures - ultimately pathologic anatomy appears.  Whether the origin of the leucocytes be the spleen or glands one cannot decide until physical symptoms arise.  The study of pathologic physiology of the blood will progress when physicians practically examine all patients, and the subject of hematology is constantly taught as a required curriculum in the colleges.  It is by cultivation of the study of pathologic physiology of the blood that we may hope for early diagnosis of impending disease, the application of effective remedies as well as rational prophylaxis.   When pathologic physiology of the blood can only be discovered, the aim of the clinician must be to correct the abnormal deviation, the abnormal function, of plasma, red or white corpuscle.  These consist in the application of therapeutics, as diet (food and fluid), induction of maximum visceral function (visceral drainage), recognized remedies, (habitat, avocation), prophylaxis.