534- 



SEROUS AND SYNOVIAL MEMBRANES. 



<:reat variety in different cases. The follow- 

 ing table is an average of five analyses by 

 Quevenne, Scherer, and Vogel, which is com- 

 pared with the liquor sanguinis of healthy 

 blood, as analysed by Lecanu. This im- 

 portant comparative method of regarding 

 these fluids is due to Vogel, in whose valu- 

 able work these analyses are given at length. 



Water - 

 Fibrine - 

 Albumen 

 Extractive 

 Fat 

 Salts - 



Liquor San- 

 guinis. 



. 906 

 3-4 



77 

 3 

 3 



Fibrinous Ef- 

 fusion. 



934-936 



984 

 51-88 



12-2 



The composition of 1000-4 



1000- 



A comparison of the composition of this 

 fluid with that of the serous effusion which 

 was previously described, not only exhibits 

 the addition of a new constituent, fibrine, but 

 it shows the quantity of albumen to be in- 

 creased in an important degree ; it being, on 

 the average, nearly trebled. Contrasting it 

 with the normal liquor sanguinis, it is seen to 

 possess a considerable proportion of its albu- 

 men and fibrine, although less than this fluid 

 itself contains. And it is important to notice, 

 that the former of these two constituents is 

 not only present in larger quantity than the 

 latter, as might be expected from its very 

 different amount in the parent fluid, but in a 

 much greater proportion of its respective 

 quantity, i. e. that only two-sevenths of the 

 fibrine of the liquor sanguinis appears in the 

 inflammatory exsudation, while five-sevenths 

 of its albumen is present. And in all proba- 

 bility, were the diseased liquor sanguinis of 

 the same subjects the object of comparison, 

 its increased quantity of fibrine would render 

 the disproportionately small transudation of 

 this constituent a still smaller one. Although 

 the number of analyses from which the average 

 is taken will allow little stress to be laid upon 

 these facts, yet they have seemed to deserve 

 especial notice, as having some bearing upon 

 a question which is of the greatest importance 

 to pathology, and which cannot yet be con- 

 sidered as settled, viz. " What is the relation 

 of fibrine to the process of organization ?" 



The further progress of the exsudation 

 arranges the plastic or fibrinous constituent 

 as a more complete coagulum, which is in 

 contact with the inner surface of the serous 

 membrane. The colour of this portion of the 

 exsudation is yellowish, or sometimes reddish 

 from mixed blood ; its thickness varies from 

 that of a scarcely perceptible deposit to one 

 of half an inch or more in thickness. The 

 uniformity with which it covers the interior 

 of the membrane is also subject to great 

 differences ; sometimes it is arranged as a 

 stratum of tolerably equal thickness over the 

 whole or a greater part of its extent, at others 

 it is limited to the formation of raised points 

 or patches which here and there stud its 

 surface. These conditions apparently indicate 

 a corresponding diffusion or limitation of the 

 inflammation. In like manner, the state of 



surface of this stratum is liable to great dif- 

 ferences, being sometimes level and compara- 

 tively smooth, while in other instances it 

 offers every conceivable degree of roughness, 

 from a trifling irregularity of surface to those 

 long, large, and shaggy processes which are 

 so often seen in acute pericarditis, and 

 which have been well compared to the villi 

 of an ox's tongue. Considerable difference 

 of opinion prevails as to the exact mode in 

 which this curious state is produced : thus 

 some imagine it to be the result of the mutual 

 movements of the visceral and parietal layers 

 of the membrane ; or that, in separating from 

 each other, they draw out a thread of the 

 viscid and coagulating paste, until it breaks, 

 and thus leaves a projecting process attached 

 to each of these surfaces. But the fact, that 

 an elongation very similar to that of those 

 processes is seen in solitary warty deposits 

 on the valves of the heart, in situations where 

 no such physical causes as this can be 

 supposed to obtain, renders this explanation 

 more than doubtful ; and, on the whole, the 

 interpretation of Vogel seems much more 

 probable, that they result from a want of 

 uniformity of the effusion in the first instance 

 forming small scattered patches of lymph, on 

 and around which, as around foreign bodies, 

 the subsequent continuous effusion tends to 

 deposit itself. 



The first layer of fibrine thus deposited on 

 the inner surface of the membrane forms, if 

 it is complete, a kind of sac, in which the 

 more serous part of the exsudation is included. 

 But this liquid part generally contains a con- 

 siderable further portion of the fibrinous 

 element ; and the resulting phenomena appear 

 to depend in some measure on its amount. 

 Thus, if the exsudation be almost wholly of 

 plastic material, large irregular masses of 

 fibrine are found in the cavity of the mem- 

 brane ; the serous fluid being only in sufficient 

 quantity to moisten these loose coagula. If 

 the serum be superabundant, the fibrine 

 may remain almost or entirely dissolved in it ; 

 or may only be visible as a slight disturbance 

 of its transparency, imparting to it a white 

 colour, or forming a few scattered flakes which 

 float hither and thither in the fluid. A medium 

 between these two extremes is perhaps more 

 common, in which the plastic element coa- 

 gulates in a loose irregular kind of net-work, 

 the meshes of which enclose the serum. And 

 with this more general precipitation there is 

 usually a special deposit upon the peripheric 

 or oldest layer before mentioned, which 

 imitates its irregular or shaggy form. But as 

 this process of coagulation is often a very 

 slow one, the extent of lamination is by no 

 means limited to these two layers ; five, ten, 

 or twenty thin strata often appearing to be 

 laid down from the fluid, one after another. 

 In all these cases, the denser and stronger 

 layer, in contact with the surface of the 

 serous membrane, is the original plasma, the 

 first which was deposited, and the earliest to 

 be organized. Rarely the completeness of 

 this coagulation leaves the serous part entirely 



