424 



BLOOD, MORBID CONDITIONS OF THE. 



extraneous circumstances, such as the form of 

 the vessel in which the blood is received, the 

 time allowed for the contraction of the clot, 

 which it is well known goes on for many hours, 

 and even the quantity abstracted, that no accu- 

 rate deduction can be drawn from its appear- 

 ance. The collection of the fibrine itself is 

 easily effected, and it will thus be perceived 

 that, under inflammation, it is more abundant 

 than in the normal state. Scudamore has made 

 numerous experiments on the relative quantity of 

 fibrine contained in healthy and diseased cras- 

 samentum, and the following short list selected 

 from them satisfactorily establishes this fact. 

 In 1000 grs. of clot as deduced from 

 eight specimens of healthy blood, 



average of dry fibrine 3'53 grs. 



Maximum 4'43, minimum 2'37 

 Slight pleurisy, blood slightly buffed 7-05 



Pain in the side, ditto 11-37 



Cough 7-24 



Acute gout, blood not buffed, firm 



texture 5'88 



Disease not named, clot compact, 



buffed, and cupped 12'41 



Ditto ... 13-73 



Average 9-62 



Mr. Jennings, in his report on the blood in 

 the Transactions of the Provincial Medical As- 

 sociation for 1834, likewise gives a table, the 

 result of which is, that in eight cases of in- 

 flammation, the proportion of fibrine in the 

 blood was increased from 2'1, which is Le- 

 canu's standard of health, to 9, 8, 11, 6, 5-3, 

 7, 6-9, 7 ; average 7'525, and that the alkaline 

 salts were diminished from 8 - 37, the .healthy 

 standard, to 4'9, 4'8, 5'1, 4'3, 4% 4'4, 4, 5'6 ; 

 average 4-61. 



Among all the varieties of inflammation it is 

 in acute rheumatism where we find the blood 

 most decidedly loaded with fibrine. Owing to 

 the powerful action of the heart and arteries, it 

 is intensely arterial in character, and sometimes 

 issues from the vein with a distinct pulsation. 



Fever. In those fevers which arise from 

 marsh miasmata or from contagion, it is an 

 opinion held by Dr. Stevens, and supported at 

 great length in his work on the blood, that a 

 diseased condition of that fluid is the first in 

 the train of symptoms which occur, and the 

 immediate cause of those which follow. The 

 blood itself, says Dr. Stevens, is both black 

 and diseased even before the attack. During 

 the cold stage it is very dark. When first 

 drawn it has a peculiar smell, and coagulates 

 almost invariably without any crust. There are 

 black spots on the surface of the crassamentum, 

 the coagulum is so soft that it can easily be 

 separated by the fingers, and during its forma- 

 tion a large quantity of the black colouring 

 matter falls to the bottom of the cup. In the 

 hot stage it becomes more red, and, in some 

 cases, it is even florid for a time, but during the 

 remission it is darker in colour than the blood 

 of health, and decidedly diseased in all its 

 properties. In milder cases, the blood which 

 is drawn may coagulate without a crust on the 

 surface ; but in the more severe forms of this 

 fever, when the blood was drawn at an advanced 

 period of the disease, a part of the albumen 



coagulated on the surface of the fibrine, and 

 formed a diseased mass, which in appearance 

 had a greater resemblance to oatmeal gruel 

 than to blood drawn from a healthy person. 

 The serum which separated was also diseased ; 

 it had a brownish colour, and in some cases 

 an oily appearance, which is never met with 

 in the clear serum of healthy blood. In 

 the climate or seasoning fever of the West 

 Indies, which is not considered contagious, but 

 a fever of excitement, the blood drawn in the 

 first stage flows from the vein with great force, 

 but is neither cupped nor buffed. It is so florid, 

 being charged with salts which ought to have 

 been removed by the organs of secretion, that 

 it resembles arterial blood. The fibrine coagu- 

 lates firmly, and in some cases the serum which 

 separates from it has a bright arterial colour, 

 the colouring matter being not merely diffused 

 through, but combined with the serum. During 

 the progress of this kind of fever the blood loses 

 a large proportion of its fibrine and albumen, 

 and becomes so thin that it oozes from the mu- 

 cous membranes without any abrasion of sur- 

 face, and in the last stage turns quite black from 

 a diminution in the proportion of its salts. 



Such are the appearances which the blood 

 presents in the more severe fevers of hot cli- 

 mates. In this country, at the commencement 

 or stage of depression the blood is dark and 

 tarry, coagulates quickly, and forms a large 

 clot with but little serum. As the stage of 

 excitement advances, the blood becomes thinner 

 and more florid, and flows more freely. Coa- 

 gulation takes place more slowly, and a buffy 

 crust is frequently formed on the surface of the 

 clot. In the latter stage, when the powers 

 are giving way, the blood becomes thinner, 

 darker, and more dissolved. It scarcely coa- 

 gulates at all, and is deficient in saline matter, 

 and probably also in fibrine, thus nearly re- 

 sembling menstrual blood, or the fluid mixture 

 of serum and red particles, already mentioned 

 as often found in the larger vessels after death. 

 Such are the alterations which the blood usually 

 undergoes in the different stages of simple con- 

 tinued fever, but in its more malignant forms, as 

 in typhus, the blood is generally very watery, 

 even from the commencement. As the disease 

 advances, it gradually loses its power of coagu- 

 lation, and in the last stage seems almost en- 

 tirely deprived of fibrine. 



Magendie has artificially produced an analo- 

 gous state of blood by injecting putrid liquids 

 into the veins of animals, and the speedily fatal 

 disease which he thus caused had a strong ana- 

 logy with typhous fever.* 



To Dr. Stevens belongs the merit of having 

 especially directed general attention to the cir- 

 cumstance that the saline matter of the blood 

 gradually disappears in the progress of feTer, 

 and is almost entirely lost in its last stage. 

 This he ascertained by direct experiment,f 

 and his facts have since been confirmed by 

 Jennings, who in the interesting report already 

 alluded to, gives an analysis of the blood 

 in six cases of continued fever, in which the 



* Journal de Physiologic, torn. iii. p. 83. 

 t On the Blood, &c. page 209. 



