422 



BLOOD, MORBID CONDITIONS OF THE. 



the valve itself, which had taken place at the 

 time of the sudden surprise. This kind of 

 growth, as well as that which is formed on the 

 inflamed surface in endocarditis, has a suffi- 

 ciently evident origin. We can also readily 

 account for organized structures arising from 

 aneurisms of the heart or arteries, accidental 

 wounds of the latter vessels, ruptures of their 

 inner membrane by ligatures, or its destruction 

 by inflammation. I can, however, imagine 

 nothing more unlikely than that an insulated 

 mass of fibrine owing its origin to the mere 

 coagulation of the blood from rest, and there- 

 fore only by gravitation brought in contact with 

 the sides of the vessel which may contain it, 

 should assume an organized structure, and that, 

 too, at a time when the powers of life are so 

 much enfeebled that the heart itself ceases to 

 perform its office. I have looked carefully for 

 unequivocal signs of vitality in these false 

 Ptypi> an d I confess that I have never been 

 able to satisfy myself of its existence. 



The albumen has not been demonstrated to 

 be subject to alteration in quality. Its distin- 

 guishing characteristic of coagulating by heat is 

 preserved even after it has become in the high- 

 est degree offensive from putridity.* It may 

 be excessive or defective in proportion, and M. 

 Gendrin has shewn that under inflammation 

 of the system, the serum contains twice as much 

 albumen as in the healthy state. Andral affirms 

 that even by the touch, we may, from its vis- 

 cidity, recognise serum that is surcharged with 

 albumen. Its specific gravity, however, of 

 which the French writers seem to take little 

 note, would be a far better guide, and would 

 indicate alike the defect as the excess of this 

 principle. M. Gendrin has occasionally ob- 

 served a mucous layer either at the bottom of 

 the serum, or suspended in it. This is, in 

 all probability, a minute portion of fibrine se- 

 parating in the form of a flocculent cloud ; for 

 serum is capable of holding a certain portion of 

 fibrine in solution, which after a time separates 

 from it. This was first proved by Dr. Dowler,f 

 who, on pressing the buffed coat of blood, ex- 

 tracted from it a liquid serum, which, on being 

 allowed to rest for some time, exhibited signs 

 of coagulation. With regard to the relative 

 proportions of the serum and the clot, I have 

 proved elsewhere J that this depends much on 

 the vessel into which the blood is received. I 

 shall show experimentally, however, in treating 

 of diseased kidney, that an opposite state to 

 that above alluded to as occurring, according to 

 M. Gendrin, in inflammation, takes place under 

 certain forms of disease where albumen is 

 passing out of the system by the urinary pas- 

 sages. Thackrah lays it down as a law, to 

 which he has found no exception, that in all 

 cases in which the proportion of fibrine is con- 

 siderably above the normal standard, the solid 

 matter in the serum is below it. He cites ten 

 examples in proof of his assertion, and puts it 



* See a paper by IVf . Vauquelin, in the 16th 

 vol. of the Ann. de Chimie, new series, p. 363. 

 t See Med.-Chir. Trans, vol. xii. p. 89. 

 j Med.-Chir. Trans, vol. xvi. p. 296, 



as a question whether we may not hence sup- 

 pose that the albumen is taken from the serum 

 for the formation of fibrine ? The fact itself, 

 however, requires confirmation, being in direct 

 opposition to M.Gendrin's statement, that the 

 proportion of albumen is greatly increased in an 

 inflammatory condition of the system, which is 

 precisely that condition when in general we 

 find buffed blood, and therefore, according to 

 Thackrah, an increase in the proportion of 

 fibrine. 



The haematosine is the least destructible of 

 all the elements of the blood, retaining its quali- 

 ties in that fluid after having been kept for 

 several years. It is liable to much variety in 

 its proportion, and in all those diseases and 

 states of system in which hemorrhages occur, it 

 gradually diminishes, at least to a certain point, 

 in proportion to their extent and duration. 

 In what part of the system the red particles 

 are elaborated remains for the present a mys- 

 tery. That they are reproduced slowly is 

 manifested by the fact that those who have suf- 

 fered large losses of blood, remain exsanguine 

 for many months or even years afterwards. 

 The same conclusion may also be deduced 

 from the circumstance that women have a 

 smaller proportion of red particles than men, 

 the difference having been shewn by M. Le- 

 canu to be attributable to the monthly loss 

 which they habitually experience. Besides 

 change of colour, to which the red particles are 

 liable during disease, and which, among other 

 causes, may arise from an altered proportion in 

 the saline matters contained in the blood, they 

 also appear to undergo structural alterations. 

 In fevers, in malignant diseases, in sea-scurvy, in 

 cases of poisoning, and of asphyxia from light- 

 ning, a permanently liquid state of the blood 

 occurs, wherein the colouring matter of the 

 globules appears to have lost its character of 

 insolubility in the serum, and to be capable of 

 percolating those tissues which are otherwise 

 destined to contain it. Passive hemorrhages, 

 petechiae, and ecchymoses, are the results during 

 life ; and, after death, a stained condition of the 

 lining membrane of the heart, the arteries, and 

 veins, which has often been mistaken for vas- 

 cular congestion of these parts. 



The oil or unctuous soft solid which is now 

 ascertained to be one of the constituents of 

 healthy blood,* is liable to morbid increase 

 under various forms of disease. Morgagni cites 

 two cases of malignant fever in which the serum 

 was milky. Hewson, besides enumerating in- 

 stances to be met with in authors, gives three 

 cases sent him by medical friends : one of 

 amenorrhoea with dyspepsia and vicarious dis- 

 charge of blood by vomit and stool ; another of 

 violent and continued epistaxis, and a third of 

 dyspepsia with slight asthma. In all three cases 

 there were symptoms of plethora ; but milky 

 serum is by no means necessarily connected 

 with this state. The most marked instance that 

 I have met with was in a case of diabetes, where 

 bleeding was several times repeated at long in- 

 tervals, and on each occasion the same morbid 



* Med.-Chir. Trans, vol. xvi. p. 46. 



