PATHOLOGICAL CHANGES IN THE BLOOD. 449 



proportion of the Globules to the Fibrin. When, however, a local Inflammatory affection 

 develops itself during the course of the Fever, the amount of Fibrin increases; but its 

 augmentation seems to be kept down by the febrile condition. In Typhoid Fever,* the 

 decrease in the proportion of Fibrin is much more decidedly marked; this dues not 

 depend upon abstinence; for it ceases as soon as a favourable change occurs in the 

 disease, long before the effect of food could show itself. In the various cases examined 

 by Andral, the blood furnished a maximum of 37 of Fibrin, and a minimum of 0-9; in 

 this last case, the Typhoid condition existed in extreme intensity, yet the patient recovered. 

 The proportion of Globules varies considerably; in an early stage of the disease it is 

 usually found to be absolutely high; and it always remains high relatively to the amount 

 of Fibrin. In Typhoid Fever, then, the abnormal condition of the Blood, in regard to 

 the disproportion between the Globules and the Fibrin, is more strongly marked than in 

 ordinary Continued Fever: yet the usual augmentation of Fibrin will take place, if a 

 local inflammation develops itself. In the Eruptive Fevers, it does not appear that the 

 proportion between the Fibrin and the Globules undergoes so striking a change, as in 

 Ordinary continued Fever; but the number of cases examined was too small to admit 

 of decided conclusions. It was evident, however, that the specific Inflammations proper 

 to, and characteristic of, these Fevers, have not the same effect in occasioning an increase 

 of the Fibrin, as an intercurrent Inflammation of an extraneous character. By the expe- 

 riments of Magendie it has been ascertained, that one of the effects of a diminution in 

 the proportion of Fibrin is a tendency to the occurrence of Hemorrhage or of Conges- 

 tion, either in the parenchymatous tissue, or on the surface of membranes: these con- 

 ditions are well known to be of frequent occurrence, as complications of febrile disorders. 

 A marked diminution of Fibrin was noticed also in many cases of the disorder termed 

 Cerebral Congestion, which commences with headache, vertigo, and tendency to epis- 

 taxis, and not unfrequently passes into coma and apoplexy. In Apoplexy, the diminution 

 of Fibrin was still more striking; and in general, there was found to be an increase of 

 the Globules. In one instance, the quantity of Fibrin on the second day of the attack 

 was found to have fallen to 1-9, whilst that of the Globules had risen to 175-5; but on the 

 third day, when the patient's consciousness began to return, the quantity of Fibrin was 

 3-5, whilst that of the Globules had fallen to 137-7. It would seem, from the great change 

 in the character of the Blood, which was noticed in this and in other instances, that the 

 want of due proportion between the Fibrin and the Globules was the cause, rather than 

 the effect, of the Apoplectic attack. 



c. The amount of Globules seems to be subject to greater variation within the limits of 

 ordinary health, than is that of Fibrin. In the condition which is ordinarily termed a 

 highly sanguineous temperament, or Plethora, it is chiefly the former that undergoes an 

 increase. Plethoric persons are not more liable to Inflammation, than are those of 

 weaker constitution; but, from the quantity of Fibrin in their blood being small rela- 

 tively to that of the Globules, they are liable to Congestion, especially of the brain, and 

 to apoplexy or other Hemorrhage. The effect of Bleeding in diminishing this tendency 

 is now intelligible; since we know that loss of blood reduces the number of Globules. 

 On the other hand, in that temperament,f which, when exaggerated, becomes Anaemia, 

 there is a marked diminution of the globules; this temperament may lead to two dif- 

 ferent conditions of the system. In Chlorosis, the Globules are diminished, whilst the 

 Fibrin remains the same; so that the clot, though small, is firm, and not unfrequently 

 exhibits the buffy coat; in some extreme cases of this disease, the Globules have been 

 found as low as 27. The influence of the remedial administration of Iron, in increasing 

 the quantity of Globules, was rendered extremely perceptible by Andral's analyses; in 

 one instance, after iron had been taken for a short time, the proportion of Globules was 

 found to have risen from 49-7 to 64-3; whilst in another, in which it had been longer con- 

 tinued, it had risen from 46-6 to 95-7. On the other hand, Bleeding reduced still lower 

 the proportion of Globules; thus, in one instance, their amount was found, on a second 

 bleeding, to have sunk from 62-8 to 49. The full proportion of Fibrin in the blood of 

 Chlorotic patients accounts for the infrequency of Hemorrhage in them; whilst it also 

 leads us to perceive that they may be, equally with others, the subjects of acute Inflam- 

 mation, which we know to be the fact. A diminution of Globules may also coexist with 

 a diminution in the amount, or in the degree of elaboration, of the Fibrin ; and this 

 degree seems to be characteristic of Scrofula. Andral has noticed a diminution in the 

 proportion of Globules in other Cachectic states, resulting from the influence of various 

 depressing causes on the nutritive powers ; as in a case of Diabetes Mellitus, in which 



* M. Andral confines this term to the species characterized by ulceration of the mucous 

 follicles of the intestinal canal. 



f The term lymphatic has been applied to this temperament; by which term was 

 meant a predominance of lymph in the absorbent vessels. 



38* 



