106 ORGANISED FLUIDS. 



which a greater proportion of water than is normal exists in 

 the blood. 



The causes of impoverishment of the blood enumerated 

 therefore do not act as exciting causes of dropsy: there 

 remains but one other element of the blood, the albumen, for 

 our consideration, and this w^ have seen to be constantly 

 deficient in the blood in certain forms of dropsy, and we are 

 therefore constrained to adopt the conclusion that this de- 

 preciation in the scale of the albumen is intimately associated 

 with the occurrence of those forms. 



It does not appear, according to M. Andral, that the 

 albumen can undergo a spontaneous depreciation in the blood, 

 similar to that of which we have seen that the red globules 

 and the fibrin are susceptible ; this, if correct, is very re- 

 markable, and hence it would follow that whenever a de- 

 ficiency of the albumen of the blood exists, invariably, at the 

 same time, the urine would be found to be albuminous, pro- 

 vided always that no dropsical effusion existed, the effect of 

 some organic malady. 



In most organic dropsies the diseased organs act as exciting 

 causes of the serous effusion by the mechanical impediment 

 which their altered structure and enlarged size present to 

 the circulation in the vessels, and which, therefore, relieve 

 themselves by permitting the escape of a portion of their 

 contents. In Bright 's disease, although the kidney is 

 affected, that organ does not concur in the formation of the 

 dropsy, except in a manner altogether indirect, and to such 

 an extent only as that the pathological alteration which its 

 substance undergoes is of such a nature as to afford greater 

 facility to the passage of the albumen through it. 



The serosity effused in cases of dropsy is not identical in 

 its constitution with the serum of the blood; it contains 

 usually far less of the inorganic constituents which are held 

 in solution in healthy serum, as well as a far less proportion 

 of albumen than that which belongs to serum in its normal 

 state. The physiological standard of the albumen in the 

 blood is eighty in every thousand parts ; in sixteen cases in 

 which the serous effusion was analysed by M. Andral the 



