THE BLOOD. 101 



Condition of the Blood in Hemorrhages. 



Reference has been made to the frequent occurrence of 

 hemorrhages in two very distinct classes of disorders, the 

 plethoric, and the febrile. In the first, we have seen that it 

 is the red element of the blood which is absolutely in excess 

 over the other constituents of that fluid, while, in the second, 

 it is the fibrin which is deficient, the globules being un- 

 affected, and existing usually in their normal proportion. 

 Thus, relatively to the fibrin in both series of affections, the 

 globules are always in excess, in reference to the first series, 

 the plethoric, being absolutely so, and to the latter, relatively 

 superabundant. 



While it is this excess of the red globules which probably 

 determines the occurrence of hemorrhages, the nature and 

 degree of these losses of blood are modified by the amount of 

 fibrin which that fluid contains. Thus the character of the 

 hemorrhages occurring in plethoric individuals is very differ- 

 ent from that encountered in persons labouring under fever 

 in most of its forms ; in the first, we have copious epistaxes and 

 the effusion of blood into the substance of the brain, consti- 

 tuting sanguineous apoplexy ; in the second, almost any tissue 

 of the body may be the seat of the effusion ; the blood may 

 escape from the nose, the gums, the throat, or the bowels, or 

 it may be poured out beneath the skin in patches, constitu- 

 ting petechia3, which we meet with so frequently in severe 

 cases of typhus, and in scurvy. The hemorrhages to which 

 the plethoric are liable are for the most part salutary, while 

 those which take place in fevers are as generally prejudicial. 

 The treatment to be adopted in the two cases is very differ- 

 ent ; in the one it may be necessary to have recourse to vene- 

 section, with the view of lessening the scale of the red glo- 

 bules, and in the other such a mode of proceeding would in 

 all probability be fatal, the object in it being to restore to 

 the blood its normal proportion of fibrin. 



The distinction which has here been dwelt upon between 

 the hemorrhages to which the plethoric arc exposed, and 

 those to which the system is obnoxious in febrile disorders at 



