200 OF THE BLOOD. 



they sink. Nowj as it has been found that liquor sanguinis deprived of its cor- 

 puscles coagulates more slowly than unaltered blood, it does not seem improbable, 

 as Mr. Gulliver has remarked, that this separation of the two components of 

 the crassamentum, which determines the formation of the buffy coat, is the 

 cause, rather than the consequence, of the slowness of the coagulation of inflam- 

 matory blood. It is in the buffy coat of inflammatory blood, that we see the 

 clearest indications of organization ever presented by the circulating fluid. The 

 fibrous network is frequently extremely distinct ; and it commonly includes a 

 large number of colorless corpuscles in its meshes, these, indeed, being some- 

 times so numerous, that it is almost entirely composed of them. In its Chemi- 

 cal Composition, the buffy coat of inflammatory blood appears to be peculiar ; 

 containing a larger or smaller amount of the substance, readily soluble in boil- 

 ing water, which is considered by Mulder to be the tritoxide of proteine ( 30). 



190. When the "buff" arises from other causes, however, its appearance is 

 less characteristic. It appears, from the researches of Andral, that the usual 

 condition of its production is an increase in the quantity of fibrin in proportion 

 to the red corpuscles, and not a simple augmentation of fibrin. This increase 

 may occur in two ways : either by an absolute increase in the fibrin, the amount 

 of the corpuscles remaining unchanged, or not being augmented in the same 

 proportion ; or by a diminution of the corpuscles; the quantity of fibrin re- 

 maining the same, or not diminishing in the same proportion. Hence in severe 

 Chlorosis, in which the latter condition is strongly developed ( 174), the buffy 

 coat may be as well marked as in the severest Inflammation. 1 Unless the com- 

 position of the blood be altered in one of these two ways, it is stated by An- 

 dral that the buffy coat is never formed ; the influence of circumstances which 

 favor it not being sufficient to produce it when acting alone. The absence of 

 these circumstances may prevent it, however, when it would otherwise have been 

 formed ; thus, when the blood flows slowly, the " buff" is not properly produced; 

 because the slow discharge gives one portion time to coagulate before another; 

 and only the blood last drawn furnishes the fibrin at the upper part of the ves- 

 sel. Again, in a deep narrow vessel, the " buff" will form much more decidedly 

 than in a broad shallow one ; because the thickness of the fibrinous crust will 

 be greater. 



191. It appears, then, from the foregoing facts, that we must regard the co- 

 agulation of the blood as essentially dependent upon the vital properties of its 

 Fibrin ; the tendency to aggregation which is exhibited by the Red Corpuscles, 

 having no special part in it, except when that tendency is abnormally augmented, 



1 The records of Medicine scarcely furnish a more notable example of the pernicious 

 influence of theories founded upon a shallow empiricism, and of the superiority of a 

 rational practice based on a knowledge of the real facts of the case, than is afforded by 

 the contrast between the former and the present treatment of Chlorosis. Whilst the notion 

 prevailed that the buify coat is a sign of Inflammation, and that the most powerful remedy 

 for Inflammation is loss of blood, patients already reduced to a state of anaemia, who com- 

 plained of pain in the left hypochondrium, palpitations, &c., were bled over and over again, 

 every withdrawal of blood of course seriously increasing the mischief, by producing a fur- 

 ther reduction in the proportion of red corpuscles ($ 162). The author well remembers 

 that, when a pupil in the Bristol Infirmary in the years 1833-4, he was repeatedly directed 

 by the estimable Senior Physician (long since dead) to draw eight, ten, or twelve ounces 

 of blood from patients in this condition; and that the crassamentum, after coagulation, 

 often resembled a small island floating in an ocean of serum. Yet, because this minute 

 clot exhibited the buffy coat, the bleeding was considered to be "orthodox" practice, and 

 the obstinacy of the anaemic state was attributed to the severity of the disease. If M. 

 Andral had made no other contribution to Medical Science than the demonstration of the 

 real nature of this condition of the blood, and of the influence of further withdrawal of 

 that fluid in promoting it, he would have rendered a most essential service to the multi- 

 tudes of females who are unfortunate enough to suffer from this kind of deterioration of 

 their vital fluid, 



