THE BLOOD. 93 



alone which are affected, and that in it, as in plethora, the 

 other elements of the blood undergo neither augmentation 

 nor diminution : in accidental anaemia, however, resulting from 

 direct losses of the vital fluid, the normal standard is of 

 course disturbed : for in haemorrhages, and especially in first 

 bleedings, it is chiefly the globules which escape, and this 

 would lead to the relatively higher scale for the fibrin. 



As anaemia depends upon a condition of the blood the very 

 opposite of that which exists in plethora, the symptoms also 

 in these two constitutional conditions are the reverse of 

 each other ; instead of the vascular and injected skin, we find 

 it to be livid and exsanguine, these appearances extending also 

 to the mucous membranes ; in place of the accelerated func- 

 tions, we notice that the vital actions are sluggishly per- 

 formed, and that the mental powers are feeble. 



The blood abstracted from the system exhibits a paler 

 tint than is usual, and the clot is small and floats in the 

 midst of the serum, which is very abundant ; small, however, 

 as the crassamentum is, it is yet of considerable density, as 

 might be expected from the remark which has already been 

 made, viz. that the fibrin exists in its normal proportion, and 

 therefore is in excess over the globular element of the blood 

 which is deficient ; it is for the same reason also that we fre- 

 quently notice upon the surface of the clot the buffy coat : 

 the density of the clot, and of the crust which covers it, are so 

 much the more marked as the anaemia is considerable. 



The existence of the miscalled iiiflammatory crust in 

 anaemic states has long been known, although not satisfac- 

 torily accounted for. 



The pathological disorders to which anaemia gives origin 

 are numerous : the general debility, the disordered digestion, 

 the difficult respiration, the palpitations of the heart, the 

 faintings, are well remembered. 



There is a state of the system, well described by Andral, 

 which simulates plethora, but which is really allied to 

 anaemia, and to which the term false plethora might be given ; 

 in this we have the injected skin and many other indications 

 of plethora ; it is to be diagnosed, however, by means of the 



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