142 PROPORTION OF BLOOD CONSTITUENTS IN DISEASE. [BOOK I. 



III. The quantity of fibrin which separates from the 

 blood during coagulation, and which normally amounts in 

 the case of man to about 2-5 parts per 1000, may increase in disease to as 

 much as 10 parts per 1000. This increase of fibrin is to a certain extent 

 characteristic of acute inflammatory affections; it is clearly not to be 

 ascribed to the pyrexia which is often a prominent feature of these diseases, 

 seeing that in the fevers the proportion of fibrin is diminished instead 

 of being increased. 



According to Becquerel and Rodier the cases in which the amount of 

 fibrin is increased may be divided into two categories. In the first 

 category the augmentation is only slight, the amount of fibrin fluctuating 

 between 3 and 5 per 1000 of blood. In the second it is considerable and 

 is comprised between 5 and 10 parts per 1000 of blood. 



A. Slight augmentation of fibrin occurs (1) in chlorosis; (2) in 

 pregnancy, especially towards the close of utero-gestation ; (3) in slight 

 inflammatory affections, if accompanied by pyrexia ; such as slight attack 

 of erysipelas of the face &c. ; (4) in certain cases of scorbutus. 



B. Considerable augmentation of fibrin (amount varying between 

 5 and 10 per 1000 of blood) is characteristic of the more serious inflammatory 

 affections. It is most marked for instance in pneumonia, pleurisy, and 

 acute rheumatism. Whenever the parenchyma of organs is implicated in 

 the inflammatory process the fibrin of the blood appears to increase. 

 Whence comes the increase 1 Seeing that we are yet in ignorance as to 

 the origin of the fibrinogen of the blood plasma, a solution of the above 

 question is impossible. In the proliferation of cellular elements which 

 accompanies the process of inflammation we have however a cause which 

 will add to the number of colourless cells of the blood, and to the amount 

 of serum-globulin which will be available in the process of coagulation. 

 Whether we admit or deny Schmidt's theory there is no question as to the 

 influence which serum-globulin exerts in increasing the amount of fibrin, 

 and this is one way (though only one) in which we may conceive that 

 inflammatory diseases cause the proportion of fibrin to increase. 



A diminution in the proportion of fibrin (so that it sinks to between 

 1 and 2 parts per 1000 of blood) has been observed in certain acute and 

 certain chronic diseases. Amongst the former are to be reckoned typhoid 

 fever, small pox, scarlet fever and measles ; amongst the latter, organic 

 affections of the heart in their last stage, certain malarial cachexiae, 

 chronic scurvy, and chronic mercurial poisoning. 



Serum-Al- ' norma l amount of serum-albumin in the 



bumin serum of the blood of man amounts on an average to 80 



parts per 1000, the limits varying between the numbers 

 70 and 90. 



An augmentation of serum-albumin has been observed to occur in 

 cholera and after the use of hydragogue cathartics 1 . To a less extent in 

 acute rheumatism and in the early stages of some intermittents (?). 



A diminution of serum-albumin occurs most markedly in Bright's 

 disease, anaemia, scurvy, dysentery, and generally in chronic diseases 

 which impair the general nutrition : for instance, in the advanced stages 

 of some cardiac affections. 



1 C. Schmidt, Characteristic dcr Cholera. 



