166 THE BLOOD IN DISEASES OF THE HEART. [BOOK I. 



up for the waste of the body ; partly upon the presence within the 

 blood of products of waste which the organs formerly charged with 

 their excretion can no longer get rid of; but doubtless in great measure 

 to the disturbance in the nutrition of all tissues and organs consequent 

 upon the altered relation between arterial and venous pressure ; the 

 arteries are never as full of blood as they normally should be, and, 

 as a mere consequence of this, nutrition must suffer, even were all 

 other conditions to remain normal. The increased pressure in the 

 venous system may, in addition, hinder, in some measure, the discharge 

 of lymph and chyle into the blood. 



Becquerel Becquerel and Rodier made a very complete in- 



and Roller's vestigation into the changes which the blood undergoes 

 classification - n fo^ disease ; they classified these cases into three 

 Anaemia in categories, in the first of which whilst a definite lesion 

 Heart disease, existed it had not made itself manifest by any pro- 

 nounced symptoms. In the second category the general 

 health had become impaired ; there was some anaemia, breathlessness, 

 and palpitation, and oedema had supervened ; whilst the cases in the 

 third category were accompanied by great dyspnoea, by abundant 

 dropsy and by a markedly cachectic pallid skin. 



In heart diseases belonging to the first category, according to 

 Becquerel and Rodier, there is a slight increase in the water of the 

 blood, and a tendency to diminution of both blood-corpuscles and 

 albumin. In the second stage the corpuscles and the serum-albumin 

 continue to decrease, and consequently the mean density of both blood 

 and serum falls. The fibrin of the blood often increases in quantity 

 though there be no localized inflammatory lesion. The fall in the 

 number of the blood-corpuscles is evidenced by the anaemic look of the 

 patient, and the diminution in the amount of serum-albumin by the 

 dropsy which supervenes. 



The following table exhibits the mean composition of tlie blood, with 



the maxima and minima in 24 cases of heart disease in the third stage. 



Of the 24, 16 were cases of auriculo-ventricular (presumedly mitral) 



stenosis ; in 10 cases anaemia existed, and in 11 dropsy. 



Analysis of 1000 parts of blood : 



Mean. Maxima. Minima. 



Density of the blood 1052-54 1066-86 1040-88 

 Water 801-96 



Blood-corpuscles 117*05 149*42 54-00 



Solids of the Serum 77'53 99-52 61-74 



Fibrin 3-46 646 1-25 



Density of Serum 1027'60 1035-10 1020-10 



In the third stage, whilst the water of the blood increases, and 

 corpuscles undergo a further diminution, the chief changes are per- 

 ceived in the serum, in which, whilst the water increases, the amount 

 of albumin, fats and salts diminishes more and more. 



The following table exhibits the mean composition of the blood, 

 with the maxima and minima, in 31 cases of heart disease in the third stage. 





