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UNITED STATES OF AMERICA
*  ME
WASHINGTON,  D. C.
GPO  16—67244-1
62 
 
 
      AN ESSAY
          OX THE

BLOOD  IN  DISEASE.
           BY

        G. ANDEAL.     |

   TRANSLATED FROM THE FRENCH§

  J.^f MEIGS, M.D., AND ALFRED STILLE, M.J). 
 
PATHOLOGICAL  HEMATOLOGY.
AN   ESSAY   »
BLOOD   IN   DISEASE.
BY G.  ANDKAL,'
PROFESSOR OP GENERAL PATHOLOGY AND THERAPEUTICS IN THE UNIVERSITY OP PARIS,
                     ETC. ETC.
TRANSLATED FROM THE FRENCH
J. F. MEIGS, M.D. AND ALFRED STILLE, M.D.
 Non ideo analyses sanguinis utilitate sua destituuntur, diim sapienter noverimus spes nos-
tras recidere, neque plura docere quam a natura discimus.—Haller, Elem. Physiol-, lib. v.
\&P
h

<c;
... n"- ■-:«
        PHILADELPHIA:

LEA  AND BLANCHARD.

            1844. 
TABLE  OF  CONTENTS.
                        CHAPTER I.
Of the best method to puksue in the study of Pathological Hema-
     tology,  -----------   15

                        CHAPTER II.
Of the Blood is Diseases,......---36
Article I.—Of the blood in Plethora,......38
  "   II.—Of the blood in Anaemia,......43
  "   III.—Of the blood in Pyrexias,......52
  "   IV.—Of the blood in the Phlegmasiae,......60
  "   V.—Of the blood in Hemorrhages,.....92
  "   VI.—Of the blood in Dropsies,......107
  "  VII.—Of the blood in certain diseases commonly called organic,  117
  "  VHL—Of the blood in the Neuroses,......128

                        WH

                        A SS4e 
           ESSAY
                  UPON

PATHOLOGICAL   HEMATOLOGY.
  Hematology is  that branch of the natural sciences the
subject of which is  the study of the blood.  This expression
is not a new one in  science :  about a century since, an author
now but  little  known,  Thomas Schwenke, published, under
the title of Hsematology, a treatise  as complete as it could
then be, upon the blood considered in its state of health and of
disease.*
  Before this author, and since  his period, many works, some
theoretical, some experimental, have been published on the
blood; their simple enumeration would be a considerable un-
dertaking, and one  not  without utility; such however is not
the end that I  seek: but I come to add to all these works, of
various importance, a new one, in which I design to make
known the alterations that the blood has presented me in dif-
ferent diseases, under the triple view of its physical proper-
ties, and of its chemical  and microscopic constitution. I shall
endeavour to estimate the importance of these alterations in
regard to semeiology and  pathogeny; and  I shall discuss
finally the value of the  methods that have been followed at
different periods for the purpose of discovering the facts  of
pathological hsematology.

  *  Thomae Schwenk Hocmatologia, sive  sanguinis historia, experimentis
passim superstructa, in 8° Hagaecomituni, 1748.
       2 
14
PATHOLOGICAL HEMATOLOGY.
  Already in two memoirs read at the Academy of Sciences
in 1840  and  1842,  I have exhibited the results  that I ob-
tained, in seeking to appreciate the variations of proportion,
that some of the principles of the blood, to wit, the fibrine, the
globules, the solid elements of the serum, and  the water, may
offer, whether in disease, or in different states of the physio-
logical condition.  To accomplish these researches I have fol-
lowed the method indicated by M. Dumas, one which he him-
self advised me to have recourse to, as answering the end that
I sought to  attain.  May he permit me to  express to him on
this occasion my gratitude for all his kind advice.
  In the work that I now publish, I have sought  to give a
greater development to the facts and ideas contained in my
preceding  memoirs:  there will be found in addition a certain
number of results that I have obtained more  recently, and
which have not yet been made public.   For many of the de-
tails and ciphers I will  refer the reader to the two  other me-
moirs ;* for  I do not pretend to give to the world a finished
and complete  essay—even while continuing my researches, I
desired to indicate the point to which they had attained, what
results they had yielded, and what it may be possible to arrive
at,  if the pursuit does not become wearisome.

  * Recherches sur les modifications de proportion de quelques principes
de sang (fibrine, globules, materiaux solides du  s£rum, et eau) dans  les
maladies, par MM. Andral  et Gavarret {Annates de chimie et  de physique,
tome LXXV).  Recherches sur la  composition du sang de quelques ani-
maux domestiques dans l'etat de sante et de maladie, par MM. Andral, Ga-
varret et de la Fond (Annates de chimie et de physique, 3d serie torn. v.).
  The results detailed in these two  memoirs, as well as those contained in
this new work, are the fruit  of researches common to myself and to M. Ga-
varret, to whose learned  and devoted collaboration I am greatly indebted.
For the facts relating to animals, M. de la Fond, professor at the veterinary
school of Alfort, kindly lent us the aid of his time and experience.
  The method that we have  followed, and the results that it has given us,
having been the subject of several criticisms, we have thought proper to an-
swer these in a separate work, to which I shall also refer from time to time,
and which has for title: Reponse aux principales objections dirigees contre
les procedes suivis dans les analyses du sang, et contre I'exactitude de leura resul-
tats, brochure in 8°, 1842, chez Fortin et Masson. 
THE BEST METHOD OF STUDY.              15
                      CHAPTER I.

  OP THE BEST METHOD TO  PURSUE IN THE STUDY OF PATHO-
                   LOGICAL HEMATOLOGY.

  It was one of the dogmas professed by the school of Cos,
that  in order to explain the phenomena of health and of dis-
ease, we must take equally into consideration the solids which
enter into the composition of the human body, the fluids with
which it is so abundantly provided, and the forces which con-
trol it.   But few physicians  however remained faithful to these
principles, which Hippocrates has declared in several of his
works, and particularly in his book on ancient medicine; and
we find Galen reproaching' his contemporaries with some bit-
terness, for  having  broken  this beautiful ensemble of the an-
cient Grecian school, in order to interpose in  their explanation
of disease,  some only the-solids, others  only the fluids, and
others again only the forces which pervade and animate or-
ganized matter.*  And thus were determined from those ancient
times, the three great points of view, which, now abandoned,
and  now again adopted, have produced the three systems of
solidism, humorism, and vitalism.
  One of the characteristics, and I venture  to  say one of the
glories of the present medical epoch, is to have understood to

  * Hippocrates, cum trifariam hominis elementa divisisset, in continentia,
contenta, et ea quce impetum faciunt....., haud scio quomodo successores
ejus unam illam  revera divinam  ^Esculapii  medicinam in tres partes sibi
cohaerentes distribuerint atque divulserint.  Alii enim humidis, turn causam
eorum quae secundum naturam habent constitutionem, turn causam eorum
quae practer naturam, solis attribuere, ut Praxagoras etHerophilus.  Alii, soli-
dis corporibus initia et elementa attribuentes, ex his turn qua? natura consis-
tunt, turn  morborum causas inde capiunt, et Erasistrates  et Asclepiades,
Athenaei vero et Archigenis imitatores, spiritu solo ea penetrante, turn  natu-
ralia consistere ac gubernari, turn  morbos universos hoc prius oflenso creari
dixerunt. (Medicus.) 
 16            PATHOLOGICAL HEMATOLOGY.

 what incomplete and necessarily erroneous results these minute
 subdivisions of the science  conduce; and, at the same time
 that it has given a due degree of importance to dynamism and
 solidism in pathogenic theories, it has returned to the study
 of the alterations of the blood; it has recognized their exist-
 ence, and has accorded them an influence in the production
 of disease.  But,  singular  fact! these alterations, of which
 the  reality and importance  are no longer denied by any, are
 nevertheless scarcely known, and but few facts could be cited
 in proof of the convictions arrived  at on this subject; direct
 observation of the blood has thus far been much more rarely
 invoked than theory, and when recourse has been had to ob-
 servation, it has been made use of most frequently only to study
 in the sanguine fluid, the simple alterations of its physical pro-
 perties.  But  thus we remain ever in the infancy of the sci-
 ence ;  to progress, we must analyze the blood: such  is the
 idea which guided M. Magendie when, by  modifying artifi-
 cially its composition, he proved that we can by these means
 create disease.  Pathological hsematology will begin  to be
 enriched with  facts of some  value, only when the blood  of a
 great number of patients shall  have been submitted both to
 chemical investigation, and  that by the microscope.   Doubt-
 less, while studying  by this double  means  of analysis the
 different elements of that fluid, and while thus following them
 one by one in all  their  possible variations of proportion  and
 nature, we must not neglect the study of the changes it may
 undergo in^its  physical properties; but we soon discover that
 this latter mode of examination is  almost always insufficient,
 and that when employed alone, without the control of analysis,
 it may often become a source of error. For we should be un-
 able to give an exact account of the different modifications that
the blood is susceptible of in its physical properties, unless we
have learned to connect  these changes with others more inti-
mate occurring in the  composition of that fluid, and of which
the first are but the effects.  Thus it may happen  that the
blood shall present an identical appearance, and be equally
buffed in diseases as different as are chlorosis on the one, hand, 
THE BEST METHOD OF STUDY.
17
and  pneumonia or acute  articular rheumatism on the other.
But is the blood alike in chlorosis and pneumonia ?  Does the
buff in these two diseases  have the same  signification?   This
the simple consideration of the  aspect of  the  fluid could not
inform us; analysis alone can  reveal it to us, as I  shall
show farther on.  At other times it is  the microscope which
becomes our chief means of analysis; it is  this, for example,
which will reveal to us alterations of quality in the globules, or
which will show us pus in the blood, etc.   Finally, in these dif-
ficult researches, where no source of light  should be neglected,
chemical and  microscopic  investigation will find at times a
useful aid in physiological experiments. By these  last, in fact,
we can modify in  animals the composition of the blood, and
as a consequence its physical properties,  in such a way as to
render this fluid more or less similar to what it is in certain
diseases.   Once these modifications produced, we observe
what are  the phenomena that result in different parts of the
organism, and we can  draw conclusions relative to the influ-
ence that  modifications of the same  nature occurring sponta-
neously in the  blood of man, may exercise in the production
of various morbid conditions.  It is by  acting in this way that
M. Magendie has shown the influence that blood, less than
usually charged with fibrine, may  have in the  production of
sanguine congestions and hemorrhages.  By the direct analy-
sis of the blood of the sick, I  have arrived, in this respect,
at results similar to his own.
   Such are the modes  in which we must  necessarily proceed,
if we seek to give some impetus to pathological haematology.
Of what use is it, indeed, to waste our time, as.has often been
done, in mere speculations, on the part played by the blood in
the economy, on the reciprocal influence of this fluid upon the
solids, or of the solids upon it ?  Of what use  is it again to
deduce, by reasoning, the  existence  of alterations of its com-
position and their influence in disease, from a consideration of
the causes and symptoms of these last ?  Without doubt we
may there find strong arguments to bring forward; but they
can conduct only to simple probabilities, or else we should in
                            2* 
18
PATHOLOGICAL HEMATOLOGY.
this way always remain with notions so incomplete as to be
most frequently useless, and sometimes even dangerous. It is by
this method that some have supposed the blood to be changed,
and this change to be the point of departure of the disease, when
this disease recognizes as cause the absorption of a miasm,
of a virus, or of a  poison.  Yet that is only a presumption, and
we might just as well admit that the blood, in cases of this kind,
serves merely as a vehicle to the deleterious agent which has
traversed without altering it, in order to pass on  with greater
or less rapidity to  attack the solids alone.  I might  cite many
other examples of the deplorable uncertainty in which we are
forced to remain, while from the nature of the causes or of the
symptoms we seek to adduce directly the nature  of the alter-
ation that the blood may have undergone; would it have been
possible, for example, by this method, to recognize the difference
between the alteration of the blood in scurvy and  in chlorosis ?
What has been said indeed of the state of  the blood in these
two diseases ?  Nothing more than that it was deteriorated, and
on this deterioration all the symptoms of scurvy and of chlorosis
were made to depend.  But why then are these symptoms so
very different?   It is because the nature of the deterioration is
not the same in the two diseases;  in each of them there is a
different element of the blood in fault, and thus analysis teaches
us that scurvy and chlorosis are not diseases of the same nature,
and by this means we can explain the great difference in  their
symptoms, notwithstanding the fact that a  deteriorated blood
exists in both.  Thus, when anatomy fails to disclose to us
any change, chemistry brings it to light, and I doubt not that
it will become more and more one of the bases of pathogeny,
not only as is the  case particularly at present by analyzing the
fluids modified by disease, but also by tracing  in the solids
themselves the important study of the changes in proportion
and nature of the elementary principles  which compose these
solids.
   Besides, it is not only in our day that the idea  has arisen of
seeking the origin of diseases in some alteration of the element-
ary principles which enter into the composition of the bodies of 
THE BEST METHOD OF STUDY.
19
animals: this idea was brought to light in the earliest periods
of science; but for a long time remained without  results, be-
cause in place of seeking to establish experimentally the alter-
ation of these principles, nothing more  was  done generally
than to suppose it. The ancient humorism, during every epoch
when it has prevailed, was but the exaggerated and hypotheti-
cal expression of this idea.  It is found entire in the dogmas of
the Grecian philosophy, which attributed diseases to a certain
number of modifications occurring in the elements, of which it
supposed the  human body to be primarily composed.   This
doctrine ruled in  science without control  from the  time of
Thales down to  that of  Galen, and from Galen to the chemists
of the  sixteenth century.  These  latter,  in  destroying the
ancient doctrine of the  four elements, overthrew likewise the
medical theories that were attached to  it; but they preserved
its original idea; for they also determined that the origin of
diseases ought to be referred to a vicious combination, or to
some alteration of the simple principles which they thought to
have discovered in nature at large, and in organized bodies in
particular.  They troubled themselves but little, however, to
make experiments for the purpose of proving  their assertions;
what they saw  take place in their crucibles, they boldly con-
cluded must occur also in the living body; they made the acids,
alkalies and  salts, which they had discovered in  the organs,
react in their interior, without endeavouring by experiment to
prove the  reality of these reactions; and in this way they
arrived in  their  pathogenic doctrines, at the strangest concep-
tions : there  remains to us for example, a nosology of this
epoch, by Schenneman, a disciple of Paracelsus, in which that
author makes ten classes of diseases, which he founds upon  a
certain number  of modifications  occurring in three principal
constituents of the body, to wit:  mercury, sulphur, and salt.*
  At this period, Sylvius Deleboe sought to found a complete
medical system, by ascribing diseases  to an alteration of the

  * See Sennerti opera, torn,  i, de chemicorum cum Aristotelicis et Galenicis
consensu ac dissensu liber, cap. iii. 
20
PATHOLOGICAL HEMATOLOGY.
 principles which chemistry had just discovered.   He assigned
 a prominent part in the  production  of diseases to the state
 of acidity or alkalinity of the humours.   One of the most fre-
 quent causes of fever, according to him, was an dcre, possessed
 of different chemical properties, which irritated the heart. *  He
 made inflammation to depend upon stagnation of the blood in
 the vessels,  in consequence of which its more volatile and sub-
 tile parts which commonly dilute the acid or  alkaline portions,
 evaporated; then these latter became  more acrid, produced a
 hot effervescence, because of the  oleaginous  molecules they
 contained, and the blood  might  in this way arrive at such a
 degree of inflammation as to be transformed into pus.t  These
 doctrines and this language are scarcely intelligible  to us; and
 yet, amid so many vain hypotheses, one is often surprised to
 find from time to time propositions  which  deserve a serious
 examination, and to which pathological physiology  has of late
 returned.  It is in this  way that Sylvius  explains a consider-
 able number of disorders of the digestive functions, sometimes
 by the unusual chemical  reactions which take  place in the
 stomach  or  in the intestines, sometimes  by the formation in
 these parts,  of  an excess of acid, sometimes, on the contrary,
 by the diminution of the acid or alkaline materials which ought
 naturally  to be formed in the digestive  tract.J  Elsewhere,
  * Quolibet acre, nunc acidum, nunc lixivo-salsum, nunc muriatico-salsum,
 par venas una  cum sanguine ad cor propulsum, atque interne cordis paren-
 chyma mordicans. Francisci Sylvii Deleboe praxeos medicae liber primus,
 caput xxvii. de Febribus in genere.
  f Arbitror autem incendi ac inflammationem parere sanguinem, quatenus
 ex ipso in vasis  suis valde distentis, partibusve quibusdam  aliis  subsis-
 tente, hoc est  stagnante, mox incipiunt evanescere partes spirituosos, ma-
 gisque volatiles ac subfiles turn acidas, turn salinas temperare solitae; unde
 utraeque acriores factae acrius in se mutuo insurgunt, eflfervescentiamque ob
 partes sanguinis oleosas praesentes calidam excitant;  quin paulatim  san-
 guinem ita corrumpunt, ut in pus vertatur. Sylvius Deleboe, loc. cit., lib. i.
 cap. xl.
  i Idem, ibid,  cap. i, de siti lassa.—cap. vii, de alimentorum fermentatione in
 ventriculo laesa.—Cap. ix, de nausea, eructatione et vomitu.—Cap. x, de chyli
 a fcecibus alvinis  secretione laesa.—Cap. xi, de vitiosa bilis, et succi pan-
creatici una cum pituita continuo excitatain tenui intestino effervescentia.__
Cap. xiv, de variis  intestinorum doloribus.
  Might not several of the subjects announced in these titles of chapters be- 
THE BEST METHOD OF STUDY.
21
Sylvius seeks to account for the fluidity of the blood in malig-
nant fevers and in the plague, by the  presence in the mass  of
that fluid, of an excess of alkaline principles, formed in the
economy, or introduced from the exterior;  and what occurs
rarely in his works, he cites here seven experiments; he says on
the one hand, that the injection of acid substances into the veins
of a living animal produces instantly  coagulation of the blood,
and on the other hand, that the blood becomes dissolved on the
contrary, when the injection is made with alkaline substances.*
These facts  are amongst those which have been in a measure
rediscovered by  modern  observers:  and  M. Magendie has
proved that by effecting in living animals a true dissolution of
the blood, by means of an alkaline substance mingled with  it,
we produce in them several of the symptoms that belong  to
typhus fever.t  Such was this Sylvius Deleboe, whose opinions
long  exercised so powerful an influence on the theory and
practice of medicine;  a truly  distinguished  man, whom the
insufficient light of chemistry in its infancy, and of an imperfect
method of investigation, led to the most singular illusions, but
who had the merit of discovering some truths, of foreseeing a
great number, and of forming a body of doctrine, the founda-
tions  of which, some one may perhaps seek to reconstruct with
more solid  and more  durable materials.  It may be that I
deceive myself, but it seems to me that while meditating on
these hypotheses of the chemical physicians  of the sixteenth
century, though we may recognize most generally their futility,
the mind is nevertheless arrested and returns to them, as though
conscious that they place  it upon a point of  view, where im-
portant truths are about to be disclosed to it.
   I do  not pretend to pass in review the numerous  authors
come material for interesting works'? this it is which attracts so strongly to
the study of the works of Sylvius, and of many other of his contemporaries,
though we feel that they do no more than propose problems without resolving
them.
  * Sylvius Deleboe,praxis medica, lib. i, cap. xxxiii, de febribus malignis.—
De peste, sectio iii.—Praxeos medica; appendix, tractatus ii.—De methodo
medendi, lib. ii, cap. xxvi.
  f Magendie, lecons sur les phenomenes physiques de la vie, passim. 
22
PATHOLOGICAL HEMATOLOGY.
who,  before  or after Sylvius, sought like him  to determine
through chemistry the seat  and nature of diseases.   On this
list would appear the most illustrious  names, such as those of
Van-Helmont, of Willis, of Boerhaave and of his commentator
Van-Swieten:  so natural did  it appear  to these men, who
followed  in other respects  such different doctrines, to bring
into play, in  their theories of  disease, the consideration of  the
principles which the chemistry of their day showed to exist in
the human body!*

  • To comprehend these authors, we must not deceive ourselves upon the
meaning  that they attached  to the word so often repeated by them of ele-
ments or  principles; here is  the signification given to it by Willis, (de fer-
mentatione, cap. I):
  " Principiorum nomine intelligo haud entia simplicissima et omnino in-
composita, sed tantum substantias, in quas veluti partes ultimo sensibiles,
res physicae resolvuntur.  Harum combinatione  et motu intestino corpora
gignuntur et accrescunt; harum mutuo ab invicem discessu et dissolutione
alterantur et intereunt."
  But besides, the  chimiatric doctrines of the three last centuries would be
unintelligible for him who did not know, that in the language of those times,
the expressions  by which were designated  the elements of the bodies  then
admitted,  had a sense  totally different from that we give  to them at present.
For Sylvius, for Willis, as well as for Paracelsus, the words mercury, sulphur,
and salt, were employed  in a sense altogether metaphorical, as may be seen
by the following passage from the chemistry of  Sylvius, which I  translate
literally:
  Chemistry, says  Sylvius, is nothing more than the separation of compound
bodies into their principles: these latter are five in number, to wit: mercury,
sulphur, salt, phlegm, and earth.
  Mercury is the name given by chemists to spirit, because, like mercury, it
is volatile.  This spirit or mercury is any subtle or penetrating liquor, as the
spirit of rectified wine, or the spirit of salt of nitre.  We call that also spirit
which disengages itself from bodies in a state of  fermentation, but we ought
more particularly to confine this term to whatever is volatile in its material,
no matter what may be its origin.  In this way we find three  spirits;  an in-
sipid, a sulphurous, and  a saline one.
  Sulphur is whatever is inflammable; it is sweet or bitter; the first exists
in fat and in flesh, the second in  absynthium and in bile:  there is one sul-
phur which is volatile, and another which  is fixed.
  Salt is whatever can be incinerated; it is acrid,  sometimes fixed and some-
times volatile; a fixed salt is  one, which may four times be exposed to  heat
without change; a volatile salt is  one which when exposed to a slight heat, 
THE BEST METHOD OF STUDY.
23
  Nevertheless, even during their greatest development, these
doctrines were not adopted without opposition;  they met with
numerous and able  opponents,  amongst whom  we find a
learned natural philosopher, Robert  Boyle,* and a celebrated
observer,  Thomas Sydenham.  The  first brought  forward
doubts on the reality of the existence of the chemical princi-
ples admitted by his contemporaries; he demanded that they
should verify by  experiment  so  many gratuitous  assertions,
and in this way made a wide breach in the applications  that
had been made of them in medicine.  The second  strongly
opposed the physicians, who according more, said he, to specu-
lation, than to  practical observation, long sought to explain
diseases by the new inventions of the chemists ; he accepted
the aid of chemistry only to enlighten  physicians in  the  pre-
paration of remedies.!   The absolute aversion, manifested by
Sydenham for every application of chemistry to medical theo-
ries, was certainly in him  the very natural result of the im-
pression that had been  made upon  his mind by the hypothe-
ses of the iatrochemists, and  particularly by the  conclusions
that they had deduced from them for the treatment of diseases,
a treatment in flagrant opposition to that the power of which

evaporates and is dissipated in the atmosphere, or which, when enclosed, at-
taches itself to the sides of the alembic or recipient.
  Phlegm is any aqueous, insipid fluid, that is unsusceptible of being vola-
tilized by  a very strong fire.
  An earth is a gross, dry substance  which has no other quality than that of
remaining in this latter condition, no matter to what test we submit it.
  Of these  five elements, tthe three first are  called active, because  upon
them depend all the movements  of natural  bodies; the two  last are called
passive, because they do not act in themselves, and because they receive
from the first the stations they must occupy; Paracelsus  and  others refuse
them the title of elements."  Sylvius de Leboe, de chymia in genere.
  * Robert Boyle, the sceptical chemist, 1661.
  \ Et sicuti Hippocrates eos reprehendit, qui huic in humanis corporibus
speculandis curiositati plus dant quam observationibus  praticis,.....ita
pari jure prudens vir quispiam in hoc nostro seculo eos c*ulpare possit, qui
existimant artem medicans nulla re ulla magis promoveri posse quam novis
chemicorum inventis.....at si intra pharmacopias limites centineatur chimia,
ars est satis quidem laudabilis.—(Sydenham, iractatus de hydrope.) 
24
PATHOLOGICAL HEMATOLOGY.
was daily proved to him by a most admirable observation.
Thus, this excellent genius was led to  disown  and deny the
truth of a principle, the  abuse or improper application of
which had too strongly prejudiced  him.  More recently Bor-
deu reproduced these attacks of Sydenham against the utility
of the application of chemistry to  pathogeny.*   In this way
it  happened, in consequence of the  reaction  which infal-
libly occurs against the best principles when exaggerated, that
medicine, which for two centuries had drawn most of its theo-
ries from chemistry, came  to reject  in an absolute manner all
aid from this science, excepting for pharmacology, as Syden-
ham had desired; an instrument as yet imperfect was badly
employed, it was broken.  Nevertheless, more impartial than
Sydenham or Bordeu,  because he had studied more fully,
Haller, while assigning  limits to chemical investigation, pro-
claimed it as necessary to the progress of medical doctrines;
laying aside hypothesis,  he noted with  care, in his great phy-
siology, the results of the few experiments that had been made
before his time in order to determine the normal and abnormal
                «
composition of the blood; he  pointed  out  by this  means the
true method to be pursued, and wrote this phrase full of mean-
ing: Non ideo analyses sanguinis utilitate sud distituun-
tur, dum sapienter noverimus spes nostras recidere, neque
plura docere quam a naturd discimusA
  Such were the fruits of the iatrochemical doctrines, and they
existed in science but as wrecks, so to speak, when the genius
of Lavoisier arose, to give to chemistry  a new aspect, and im-
part to  it a certainty until then unknown.  Medicine  felt its
influence, and began anew to search for the cause and seat of
diseases in the various principles which a  wonderful analysis
had just revealed. But the first essays of this kind were most un-
fortunate, for they had also for support merely pure hypotheses.
While adopting the words of Lavoisier's chemistry, physicians
took neither its spirit nor its method, and continued to advance

           * Bordeu, analyse me'dicinale du sang.
           f Haller, elementa physiologiae, lib. v. § xxxiv. 
THE BEST METHOD OF STUDY.
25
    as in the time of Paracelsus.  In this way was composed the
    strange nosography published by Baumes, in which, under the
    titles of calorineses, oxigeneses, hydrogeneses, azoteneses and
    phosphoreneses, the  professor of Montpellier, divided diseases
    into five  classes, giving to each one of them a name in relation
    with the  principle or element, which he quite gratuitously sup-
    posed to  produce them  by its modifications of quantity or  sit-
    uation.*
      Ancient chemistry has surely produced nothing more hypo-
    thetical or more extravagant than  this singular classification
    of diseases:  it is beside an  imprudent,  altogether conjectural
    application of chemical knowledge  to the science of the sick
    man.   If this method had been persevered in, the opinion of
    Sydenham,  and Bordeu  would certainly  have  triumphed;
    happily however some wise spirits perceived  all that was un-
    reasonable and dangerous in it.   A few years after  the disco-
    very of pneumatic chemistry, two  chemists,  Parmentier and
    Deyeux,  associated themselves for the purpose of discovering
.   by experiment, to what extent the normal principles  of the
    blood are susceptible  of change in disease;  but gfeeir  work
    rested on too small a number of facts to permit us toaraw any
    useful conclusion from it, and it therefore passed by unnoticed;
    no one at  that period pursued the excellent method Which
    they had just pointed out.t  On the other hand, the spirit of
    the physical sciences which began to be introduced into medi-
    cine, caused all the uncertainty of the ancient humorism to be
    felt: they thought  now only of combating and destroying  it,
    and, in the  eagerness of  the reaction  which followed, soon
    arrived at denying completely that  the  blood could,  by its
    alterations, play a part in the production of disease.  The ne-

     * Baumes, Fondements de la science methodiqae des  maladies, 4 vol. in 8°.
    Idem, Traite sur la viee scrophuleux, disc, prelimin.  Idem, Essai (Tun systeme
    chimique de la science de I'homme, Nismes, 1788.
     | Memoir on the blood, in which the following question is answered: to
    determine by modern chemical discoveries, and by exact  experiment, what is
    the nature of the alteration that the blood undergoesin inflammatory diseases,
    in putrid febrile diseases, and in scurvy, by citizens Parmentier and Deyeux.
    This title stated the problem to be resolved in the clearest possible manner.
           3 
26
PATHOLOGICAL HEMATOLOGY.
cessary consequence of this doctrine, was the neglect of all ex-
perimental research as to the alterations of the blood, to which
they had ceased to attach the least importance.  Vainly did
Bichat at that period write thus in his general anatomy; Hu-
moral medicine has been exaggerated ivithout doubt;  but it
has solid foundations, and in a number of cases ive cannot
deny that all should be referred to a vice of the humours*
This protest from a man of genius was  not listened to by his
contemporaries, and if it had been they probably would not at
that time, have followed the proper route for discovering  and
demonstrating this vice of the humours, as Bichat expressed
himself in language borrowed from his predecessors: for at
that epoch the most absolute contempt was generally expressed
for the application of chemistry to the research of physiological
and pathological facts.
   The same occurred  as to the study of the blood .by the mi-
croscope, as had happened as to its study by chemistry.
   It was natural indeed that a short time after the discovery of
Leeuwenhoeck,men should endeavour to discover what became
of the globMes of the blood in disease; but instead of devoting
themselveswith this view to direct observation, they  still pro-
ceeded by hypotheses; and,  as they had explained  diseases
by alterations that  they supposed to occur in the chemical ele-
ments of the  blood, in the same way, they explained them by
certain alterations which  they imagined  quite as gratuitously
to occur in the globules.  It is thus that  the celebrated theory
of the error  loci, invented by Boerhaave, by which he ex-
plained  a very great  number of morbid phenomena, had its
point of departure  in  the altogether hypothetical idea of the
division of the globules into others much smaller, which could
normally penetrate only into vessels  whose diameter was
proportioned to their  own.t  Another author, Huxham, sup-
posed that, in fever, the globules  became altered by too rapid
a  movement; he  supposed  beside that,  in  diseases called

  • Anatomie generate, tome 1, considerations pre'liminaires.
  f Van. Swieten  commentar. in Herm. Boeerhaavii aphorismos, t. 1, p.
143, obstructio. 
THE BEST METHOD OF STUDY.             27
putrid, these bodies being softened, were torn and  broken
into small portions, which entering readily into the smallest
vascular ramifications, arrived at the open orifices of exhalent
vessels, and were thrown  out externally; in this way Hux-
ham explained the hemorrhages of putrid fever.*  Had this
author then seen the  globules thus broken and reduced to
fragments  in  the field of the microscope?  By no  means:
but he supposes by a pure intuition of his mind that it ought
to be thus, and does not trouble  himself to give the slightest
experimental proof of so  grave  an  assertion.  If Huxham
had examined with the microscope the blood of a patient la-
bouring  under putrid fever, he would soon have  discovered
how little foundation  there was for his opinion; for he would
have found the globules neither torn nor broken, and would
have been compelled  to  renounce his explanation of hemor-
rhages.  But just as we have seen the good sense of the pub-
lic finally render  justice to the hypotheses of iatrochemistry,
so the time at length  arrived when all the vanity of these sys-
tems erected in consequence  of the facts discovered by the
microscope was to be recognized.  Then it was that Bordeu
attacked with bitter irony those authors who, said he, went so
far as to see or imagine  the globules bursting and falling
to pieces, like so many globules of glass ;  but sensible people,
he adds, will care little for such puerilities.  All these vain
theories disappeared  then, but with them unfortunately were
dragged into oblivion the facts so full of interest and of pro-
mise upon which they had rested for half a century.  Physi-
ology and pathology rejected as useless, or dreaded as a source
of error, the employment of the microscope; and this instru-
ment was completely  abandoned, as chemistry had been before
it.   The glory of returning by the experimental method, to the
microscopic, as it has  done to the chemical study of the blood,
was reserved for our  epoch.
   Thus, by turns abandoned  and resumed, the idea of  seek-
ing  the  origin of disease  in some change of proportion or of
   • Essai sur les fievres, par Jean Huxham, traduction Francaise, 1 vol. in
 12, p. 3 et suiv., p. 68 et suiv. 
28
PATHOLOGICAL HEMATOLOGY.
nature that the elements of organized bodies may have under-
gone, has advanced with various fortune from the origin of
science down to our days; it  has  more or less swayed the
mind first by the ancient doctrine of the elements, then by iatro-
chemistry and by the microscopic researches of the three last
centuries, and finally by the applications that have been made
in medicine of the discoveries of pneumatic chemistry.   And
if, notwithstanding the many fallacies to which it has led, this
idea has never been forgotten, if at periods the most diverse,
and in spite of the falsity of the doctrines which  have often
been its fruit, it has continued to seduce and  attract the most
eminent  men, this depends in  my opinion, upon the fact that
it contains an important truth, to wit, that one of the possible
causes of disease, is some change of relation or  proportion,
which the  elementary principles  that  compose  organized
bodies under their two forms of solid and liquid, are suscepti-
ble of undergoing.  Thanks to the progress of organic chemis-
try, the moment seems to have arrived when more than ever
we may  hope to place this truth in its full light, by the rigorous
employment of experimental methods;  and it would  afford
proof of a culpable ignorance, or of a dangerous scepticism, to
refuse to accept the results of the chemical science of our day,
because those  yielded by another, which had nothing in com-
mon with it but the name, had been convicted of insufficiency
or of error.
  But in order that chemical and microscopic analysis, applied
to the study of the blood  in disease, may yield results  really
useful, one condition is indispensable: which is, to acquire pre-
viously an accurate knowledge of all the varieties of the phy-
siological condition of the blood.  For want of sufficient  ac-
quaintance with all the diversities of aspect and composition
that the  blood  may present, without health being  interfered
with, we might commit continual errors, as I am about to  show
by some  examples.
  And first of all we must not infer the composition of the
blood of  one species of animal by that of  another.  I  have
shown  in the memoir published upon this subject in connec- 
THE BEST METHOD OF STUDY.
29
tion with MM. Gavarret  and Delafond, the very remarkable
differences which exist in this respect in the various species of
animals.  We have proved in that work, that there are some
classes whose blood contains more than double as much fibrine
as that of others, and  that these differences exist also for  the
globules.   To what false results  then should we  not  arrive,
were we to take as our point of departure in diseased animals,
the physiological  proportions of  the  globules and fibrine of
man, in order to calculate the changes of composition that the
blood may have undergone in these animals, as a consequence
of disease.
   Neither is the healthy appearance of the blood the same in
different classes of animals, and that appearance of this fluid
which, in man, is the  certain expression of a morbid condition,
belongs to other beings in their physiological state: such is the
case, for example, in regard to  the buffed condition of the
blood.   In man, whenever a true  buff, such as I  shall describe
farther on, occupies the upper portion of the clot,  we may with
certainty affirm the existence of a  state of disease  ;* and, what-
ever  may have been said  about  it, this buff never  exists in
man  in  a state of health.  But mark! it  is not the same in
other  animals, for this  assertion  would not  be  tenable with
respect to them.   Thus, whenever we bleed  a horse,  and
manage so that the blood flows in a continuous stream with a
pretty strong jet, into a vessel neither too large nor too flat, we
constantly observe the upper part of the clot occupied by a
white mass,  which  resembles perfectly the  buff of  human
blood.   This was shown to me by the observations that I
made at  Alfort  with MM. Gavarret and  Delafond.  This
colourless mass constitutes a considerable portion  of the clot;
in regarding it, one would take it for the perfect  inflammatory

   • We must distinguish between the true buff of the blood, and those trans-
parent pellicles, or irisations, which have not the same meaning, and which
may be found on the upper surface of the clot in the most diverse conditions
of health and of disease.  I have shown elsewhere (Reponse aux objections
dirig^es contre les analyses du sang, etc.) the causes which  produce these
discolorations of the clot.
                             3*
• 
30             PATHOLOGICAL HEMATOLOGY.

buff found in a man  labouring under intense pneumonia, or
acute articular rheumatism.   Why then does  the buff belong
to the  physiological condition of the blood of the horse ?  I
shall endeavour after  a while to give the reason.
  In different individuals of the same species, supposed always
to be in a healthy condition, the different elements of the blood
may present variations  in their quantity, which  however al-
ways remain within  certain limits.  There results from this,
for each of these elements, a maximum and a  minimum above
and below which the physiological condition can no longer
exist, while that condition is compatible with this maximum
and minimum, as well as with all the intermediate  propor-
tions.
  The average of the fibrine, in  human blood, is in the phy-
siological condition, j^Vo*  I nave shown elsewhere  that the
value of this proportion could not be impaired by other num-
bers that have been given by some experimentalists as repre-
senting the normal quantity of the fibrine of the blood.  (See
answer to objections brought against the analysis of the blood,
etc.)  In healthy individuals, the fibrine may vibrate about
this average, so as to fall  to the proportion of 2.5, or to rise to
the proportion 3.5, without the physiological state  being there-
by destroyed.   There are some persons evej^ who, without
being sick, may have in their blood nearly 4 in fibrine, or in
whom this element may fall as low as 2.  But these  are, we
must admit, maxima and minima very rarely compatible with
the physiological condition; they should be regarded as a kind
of exceptional proportions which belong only to true idiosyn-
crasies.
  In taking  the proportion T\^ as that which represents the
average of the globules in human blood, we  find, in the phy-
siological condition, as the maximum of the  globules the pro-
portion 140, and as minimum the  proportion 110.  But this
maximum 140 is linked with the plethoric condition, which,
by development becomes a true morbid state. Force of con-
stitution is the condition of the economy which most contributes
to raise the globules towards  their  maximum, while congeni-
• 
THE BEST METHOD OF STUDY.
31
tal or  acquired  debihty is  that which lowers them towards
the minimum.
  The solid materials of the serum, which are composed almost
exclusively of albumen, present, above and below their mean
80,* a certain number of proportions which are  equally com-
patible with the preservation of health; but there  is likewise
for these materials, and consequently for the albumen a certain
degree of diminution which  I have never met with, without
their being at the same time disease.
  Independently of the individual constitutions which intro-
duce into these proportions the variations that I have just sig-
nalized,  there are still, independent of disease, some circum-
stances which may equally cause  these proportions to rise or
to fall, without our being able to accuse therefrom any disease.
Thus I have  shown in my first memoir that emissions of blood
and  the  deprivation of aliment have  for constant  effect to di-
minish the amount of the globules, while the fibrine is much
less  rapidly and necessarily  influenced in this way.  I have
begun some experiments with  a view to determine to what
point we may succeed in modifying the proportion of the va-
rious elements of the blood, by giving to animals a more or
less  substantial nutriment.   These experiments are not  yet
sufficiently advanced to enable me to make  known positively
the results: they will be published in a subsequent work, but
I have thought proper to mention them  here, as entering into
the general plan of the researches in which I am engaged.
   Happen what may, what  I have just said suffices to show
how important it is to have  determined with some rigour, for
the physiological condition, the possible variations of quantity
that the  different  elements of the blood may present,  before
pursuing these analyses in the pathological condition.
   The same  is true in regard to the microscopic examination

  * Pure albumen constitutes of this mean about 68 or 70.  When, in the
following portion of this work, I mention this principle, I refer to pure albu-
men, separated from the organic and inorganic elements to which it is united
in the serum; in case this separation have not been made, I shall employ
the expression of solid materials of the serum. 
32
PATHOLOGICAL HEMATOLOGY.
of the blood.   This examination should be made with much
time and care for  healthy blood, before we think of  studying
by the microscope the changes which this fluid  may have
undergone.
  It is for want of having engaged in this preliminary exami-
nation of the physiological condition, that so many erroneous
assertions have been emitted upon the changes that the condi-
tion of disease may produce in the globules.  I do not fear to
affirm that up to  the present time, no one has  observed in a
positive manner any alteration of form or texture in these little
bodies, which can be regarded as the result of a  diseased influ-
ence, and that all their modifications of appearance which have
been described, and others which have been less dwelt upon,
result, some from  the progressive  destruction that they have
undergone in proportion to the length of time that they have
been removed  from the influence of vitality, and others from
some circumstances altogether peculiar, which act upon them,
but which are not circumstances of disease.  These circum-
stances  have not, in  my opinion, been properly appreciated :
some have considered, for  example, as  an indication of the
destruction of the globules, that  granular or  raspberry-like
appearance which we so often find, sometimes in the blood of
subjects, and sometimes even  in  the  recent fluid, %examined
shortly after it has been extracted from a living vessel.   The
researches in which I have been engaged upon this subject, do
not allow me  to  accept this opinion.  The globules which
assume the raspberry-like appearance have not been changed
by disease, nor are they globules in one of the phases of their
period of destruction.
  When we place in the field of the microscope, between two
pieces of glass, a  drop of blood immediately upon its escape
from the vessel, we readily perceive near the globules properly
so called, rounded, white  corpuscles,  Tfg- of a  millimetre in
diameter, the  existence of  which has been proved by all
observers.  The red globules, which are at first  perfectly regu-
lar, with abruptly terminated outlines, soon become changed
in their exterior shape.  Some present upon their surfaces, one, 
THE BEST METHOD OF STUDY.
33
two, or three little protuberances, and are called raspberry-like;
others, resembling iron cog-wheels, seem regularly festooned
and cut upon their edges.  So long as the desiccation of the
drop of blood is not complete, the number of red globules thus
deformed augments in proportion  to the length of time from
the commencement of the experiment.  As to the white cor-
puscles, they become  more rare as the preceding alteration
advances and becomes general.
   The rapidity of formation of the kind of nipples or protu-
berances which stud the red  globule^, and  the important fact
that their exterior aspect and dimensions  are absolutely the
same as those of the white corpuscles, all led me to think that
this deterioration of the globules was due to  a simple attach-
ment of the white corpuscles which surrounded them.  By
following attentively all the movements of displacement which
occur in the field of the microscope, I have been enabled to
witness the production of the phenomena, to see the white
corpuscles approach the red globules, dispose themselves upon
their  surfaces, adhere to their  edges, and in this way  to form
every possible  variety of the raspberry-like  and festooned
globules.  This mamelonated appearance,  which some have
regarded as the commencement of their destruction, and others
as the result of a pathological influence, is but the result when
strictly examined of the precipitation of the white corpuscles
upon and around the red globules.
  But what is the nature of these white corpuscles?   Here a
general fact is about to  appear.  Whenever  we examine blood
as it escapes from the vessels, we establish first the presence of
isolated white corpuscles, and afterwards  the raspberry-like
and festooned appearance of a  certain number of red globules.
When, on the contrary, we, in any way, deprive the blood of
all its fibrine, before spontaneous coagulation, we no longer find
white corpuscles in the field of the microscope, and  the red
globules present neither the raspberry-like,  nor the festooned
appearance.  When left a long time to themselves, these glo-
bules, thus separated from the fibrine, diminish .gradually in
size, become reduced to a kind of central nucleus, and finish 
34             PATHOLOGICAL HEMATOLOGY.

by disappearing entirely, but in no case are either their sur-
faces or their edges studded with prominences.   The presence
of fibrine then is necessary in order that the drop of blood should
contain white corpuscles, and without these the alteration of
the globules is not produced.
  The fibrine may likewise be studied under the  microscope
before it has spontaneously concreted into thick and resisting
membrane, in that semi-transparent and seemingly oleaginous
layer, known under the name of liquid buff, which constantly
and normally forms on ihe surface of blood drawn from  the
horse, and only in well-determined pathological conditions in
man.   This fluid buff, it is well known, is nothing more than
serum holding in  suspension an enormous quantity of fibrine,
and this latter  principle  presents  itself in the form of white
corpuscles of the same exterior aspect and dimensions as those
of blood not deprived of fibrine.   In order to study the fibrine
before its complete coagulation with yet greater ease, it is only
necessary to mix some blood as it escapes from the vein with
one-seventh its volume of a saturated solution of  sulphate of
soda.   The mixture rapidly divides into two portions, one be-
low consisting of perfectly unaltered globules; the other above,
formed of an opaline  fluid, where the whole of the fibrine is
held in suspension, under the form of white corpuscles -g^th of
a millimetre in  diameter, as  in the fluid buff.  The solidifica-
tion of the fibrine goes on very slowly, and one can readily
trace the different phases through which it passes, while chang-
ing from the liquid to the solid state.
  If we take a drop of blood deprived of fibrine, the globules
of which are in consequence perfectly pure, and can no longer
undergo the change known under the name of the raspberry-
like and festooned appearance, and add to it some fibrine in
the condition of corpuscles prepared with the sulphate of soda,
or taken directly from the fluid buff, we see reproduced all the
phenomena  of  which I have spoken, in regard to blood not
previously deprived of its spontaneously coagulable element.
  This granted, it is very easy to understand what happens
when we place a drop of blood on a  plate  of glass, and blow 
               THE BEST METHOD OF STUDY.             35

strongly upon it, in such a way as to spread it out into an
extremely thin layer.   If the operation be well done and with
rapidity, the  globules remain perfectly unchanged, their  sur-
faces are  smooth, their  edges  very cleanly cut, and left to
themselves, they  never become either raspberry-like or fes-
tooned.  In these circumstances the evaporation of the serum
is almost  instantaneous, its solidification, so to speak, imme-
diate, and  the fibrine has not time, as in the case where the
blood is placed between two plates of glass, to oscillate about
the red globules under the form of white corpuscles, and de-
posit themselves  on their  surfaces and  edges.   Let no one
object that the raspberry-like appearance assumed by the
globules inclosed  between two glasses depends on the fact of
their being altered by the compression; for, if we place a  drop
of blood entirely  deprived of fibrine between two glasses, we
never see  the globules become surrounded by granulations.
And if moreover  I have dilated in this place upon such a sub-
ject, it is in order to show, by this example chosen from many
others, how important it is to  investigate with  minuteness all
the  influences that can  take from the globules their normal
aspect, before considering these changes as the product of a
pathological influence.   What  beside more diversified than all
the  variations of form that the globules may take from  their
simple contact, or than the figures they may assume by their
agglomeration, without  our  being able to accuse  disease of
having given origin to such changes ?
   When we shall in  this way  have studied sufficiently all the
influences which, foreign to disease, may produce in the blood
changes in its physical properties, in its chemical composition,
and  in its microscopic constitution, it will become possible to
investigate the alterations that it may undergo, in these differ-
 ent respects, by the fact  even of disease.   It is of  this that I
 am about to treat in the following chapter. 
36             PATHOLOGICAL HEMATOLOGY.
                    CHAPTER II.

                 OF THE BLOOD IN DISEASES.

   T have pointed out in the preceding chapter, the methods
 which it  is most convenient to follow, and the  preliminary
 researches to which it is indispensable to attend, in order to
 study with advantage the alterations that the blood is suscep-
 tible of undergoing in diseases.
   The  alterations  that chemical  analysis  and  microscopic
 examination enable us to trace in the blood ought, it seems to
 me, to be divided into three great classes.
   In  a first class, I 'range the alterations of  the blood which
 result from  the fact that the principles which enter normally
 into the composition of that fluid do not exist there in the pro-
 portion compatible  with the physiological condition.
   The normal elements of the blood, in which the present state
 of our knowledge enables us to trace these changes of propor-
 tion, are the globules, the fibrine, the albumen of the serum,
 the different organic materials other than the albumen, which
 are found in the  serum,  (fatty matter  and others,) then  the
 inorganic  principles contained in the blood, and in particular
 the free  alkali which it contains,  its different salts, and its
 water.
  But this is not all; and here the idea presents itself of in-
 quiring  whether  disease, in some of its manifestations, may
 not have the power of rendering  more abundant, and conse-
 quently more appreciable by analysis, certain materials of the
 secretions  which  we  may suppose  to exist naturally, in  the
 blood, but in too  small quantity to  make it possible for us to
 discover them in its normal condition.  Disease would furnish
 then the means of recognizing them, by increasing their pro-
portion, as it sometimes makes more apparent also  certain
tissues, by causing them to emerge from their rudimentary state. 
OF THE BLOOD IN DISEASES.
37
  Microscopic researches should not often be employed in the
study of this first class of alterations; it is not indeed by such
means, as some persons have supposed, that we can even de-
termine an augmentation or diminution of the number of glo-
bules. .
  Without being changed in quantity, the normal principles of
the blood may become modified in relation to their size and
their physical properties.   The microscope  may, for example,
disclose differences in the volume or in the form of the globules,
etc.   Here we have a second class of alterations.
  Finally it may happen, that in the place of, or in connection
with the normal elements of the blood, there may be formed
new principles which have no analogues in the healthy condi-
tion, and which  may be compared in  that fluid to what  the
accidental formations are  in the solids.   Here then is  a third
class of alterations  of  the blood, for the discovery of which
should co-operate both chemical and microscopic researches.
It is the microscope, for example, which will reveal to us the
presence of pus in the blood, etc.
   I am as yet far from being able to trace a  history even in-
 correct, of all these alterations; but such is the circle which I
 have determined to pursue, by following out the modes of in-
 vestigation, whose  value  I  have  estimated in the preceding
 chapter.
   It was proper for me to commence with the  study of  the
 alterations comprised in the first class;  and in this class, the
 normal elements of the blood, whose changes of proportion in
 diseases I have sought to appreciate, are still only the globules,
 the fibrine, the solid matters* of the serum, and the water.  I
 am about to exhibit, in the following articles, the results that I
 have obtained, and I shall strive to show how, in each disease,
 the changes of proportion that the blood may have undergone

   • In the memoirs which I have already published, I had estimated in mass
 the quantity of these solid materials. More recently I have endeavoured to
 separate them one from the other, so that I might indicate with greater pre-
 cision for certain cases, the variations in proportion of the albumen properly
 so called, contained in the serum.
        4 
38
PATHOLOGICAL HEMATOLOGY.
in its physical properties are in relation to its changes of com-
position, and are explicable by them.
  Besides, the analysis of the blood in the diseased condition
reveals such great differences in  the composition of this fluid,
that it is  difficult not to admit  a priori that  changes so re-
markable  in the relative or absolute proportion of its consti-
tuent  principles must exercise a strong  influence upon  the
organism, and intervene as cause in the production of a more
or less considerable number of diseases.  When for example,
we see  in the morbid condition that the composition of the
blood, varies to such an extent that instead of a thousand parts,
there  may be only seventy-five of solids, or even only seventy,
we cannot understand that  so enormous a difference in the
quantity of the elements held  in suspension or in solution in
the water of the serum should not be taken into  serious con-
sideration in pathogenic theories.  This it is which I shall
endeavour to bring  out in what is about to follow.
  I shall begin by showing what are  the modifications  pro-
duced in  the composition of the blood by two states of the
organism, which, when to slight extent may still coincide with
health;  which, when to a greater extent, cease to belong to
the physiological condition, and which, in a  great number of
cases, complicate diseases and modify their symptoms.   These
two states are on the one hand plethora, and on  the  other
anaemia.
                        ARTICLE I.

                 Of the Blood in Plethora.

  True plethora  is more frequently constitutional than ac-
quired : we  cannot always create it at will  by the use of a
very substantial aliment.  It is not sufficient, in order to pro-
duce it, that an  individual shall  introduce daily into his di-
gestive organs, a large quantity of reparative material, and that 
OF THE BLOOD IN DISEASES.
39
he shall expend very little.  Plethora seems to depend often
upon a primordial constitution of the blood, which it is im-
possible for us  to produce so readily as we can produce anae-
mia, that is  to say, in  other  words, that it  is much more
in our power to impoverish the blood than to increase its rich-
ness.
  In plethora, as in anaemia, the peculiar state of the blood is
the appreciable cause  of the general modification which the
organism presents.   This is for us at least the primitive fact
beyond which we cannot go, and to which we  have  the right
to refer all the others.  Beyond a  doubt some forces have
been in action in the naturally plethoric or anaemic individual,
from the commencement of  the formation of the being, which
have impresssed upon  the blood a certain constitution that it is
ordained to preserve ; but this constitution, once produced, does
not the less remain the single demonstrable fact, the only one
that observation can seize upon, in order to make of it the ex-
perimental cause of the phenomena.
  But are the limits of the science  established when it has
been said in a general  manner that  the blood is abundant and
rich in plethora, that it  is thin and impoverished in anaemia ?—
This question  it is  important  to examine, and I proceed by
turns to occupy myself in resolving it for both of these condi-
tions.
  The most accredited opinion relative to the state of the blood
in plethora, is, that it  fills the vessels in very large quantity,
that its different organic elements have become more  abun-
dant, and that it is in particular richer in fibrine.
  Let  us examine one  after  another these different assertions.
  It is impossible to demonstrate the augmentation in  quan-
tity of the blood in plethora—how estimate in reality what
is in weight or in volume the mass of fluid contained  in the
vessels ?
  But if we cannot arrive at this valuation, and  if, in conse-
quence, we are compelled to acknowledge our ignorance as to
whether plethoric persons have in  their circulatory apparatus 
40
PATHOLOGICAL HEMATOLOGY.
more or less blood than other individuals, we can seek to deter-
mine whether the  blood of such persons has not  a peculiar
constitution.  Now, with respect  to this, here is what analy-
sis has taught me:
  It has shown me in the  first place that it is  not true that,
in plethora, the  blood contains very much  more fibrine than
in any other condition;  I have found, in reality, 2.7 of fibrine,
as the average of  this principle, in thirty-one  bleedings per-
formed upon  individuals in whom the plethora was fully cha-
racterized.  Some presented as  yet no marked symptoms : in
them the bleedings were simple  measures of precaution; in
the others, were observed vertigo, tinnitus aurium, palpitations
of the heart, excessive difficulty of respiration, an injection as
though'apoplectic of  the conjunctivae of the eyes, and of the
face, etc.  Thus, in these individuals, the fibrine did not even
quite equal the  physiological mean.  The symptoms of ple-
thora do  not  depend  then, as has often been repeated, upon
an augmentation of fibrine in the blood.   Consequently, in the
point of view of the  composition  of the blood, plethoric indi-
viduals should not be more  disposed than others  to contract
inflammations, and I do not fear to affirm that, if clinical facts
be interrogated as  to  this, they will  lead to the same conclu-
sion ; it is but a false  analogy of symptoms which  has caused
it to be said  that plethora disposed to the phlegmasiae.  The
results yielded by the  analysis of the blood  are  found here to
be in perfect  accordance with those to which clinical observa-
tion conducts.
  The fibrine does not  then  sensibly augment in plethora; it
remains within the limits of  its physiological state, and does
not even tend, in  the greater number of cases, to  mount to-
wards the higher limit of this state.
  The organic materials of the serum do not offer either, in
plethora, any remarkable change of proportions.
  The globules alone  remain, and it is effectively the great ele-
vation of their proportion which establishes  in the blood the
character of plethora; in the 31  bleedings to which I  have 
OF THE BLOOD IN DISEASES.              41
already referred, I found for the mea*n of the globules the cipher
141; for minimum, 131; and for  maximum, 154.
  The blood of plethoric persons then differs  from ordinary
blood  in the greater quantity of  globules and the much less
quantity of water that it contains.
  The physical properties of this blood may be  perfectly ex-
plained by the nature of the changes that it has undergone in
its composition.
  Thus, before coagulation, the blood of plethoric  people is
remarkable  for its  high coloration, which is in  relation with
the large proportion of globules it contains.
  When we examine  it after coagulation, we observe gene-
rally that the serum is more or less coloured,  that the clot is
large,  voluminous, of moderate firmness, and  that it retains a
large quantity of serum; we never find any buff upon its sur-
face ;  at most we may sometimes observe  there a thin and
transparent pellicle, or some scattered irisations, if the blood
has flowed very rapidly from the vein.
   The considerable volume of the clot  depends manifestly
upon the large number of globules, and its softness, as well as
the constant absence of the buff, depends upon the small pro-
portion of the fibrine relatively to that of the globules.
   The excess of globules in the blood of plethoric people coin-
cides in  them with a certain  modification of the physiological
state,  and also  with a certain number of  pathological facts
which seem to be a consequence of it.
   Thus, all the functions are usually more active, and there is
as  it were an exuberance of life : digestion proceeds  rapidly;
respiration is favoured by  the great development of the thora-
cic cavity ;  the circulation is rapid, the heart beats with force;
but it is an  error to admit, as has  been done, that in such cases,
its pulsations may  be  accompanied  by a  bellows-sound.  I
myself not long since put forth  this opinion; but a more at-
tentive and a longer observation  have convinced me that it is
not so, and that consequently, in  those cases where a  bellows-
sound had been heard in the heart  or arteries of plethoric
 patients, it is  because the diagnosis  had  been badly made 
42             PATHOLOGICAL HEMATOLOGY.

and  because there had been  some  other  disease with  the
plethora.
  While dwelling on all these modifications of functions which
coincide with the plethoric condition, I do not wish  to repeat
here what is everywhere  known; it was only necessary for
me to speak of them, in order to make evident their coinci-*
dence with the fundamental modification that the blood under-
goes in that condition, to wit, an augmentation of its globules:
however I will remark besides the peculiar disposition that the
brain then presents to become excited, the  facility and at the
same time the mobility of  the emotions, without  our observ-
ing at the same time those exaggerations or those aberrations
of sensibility,  and those  nervous predominances, which we
shall presently find to accompany almost necessarily an oppo-
site state of the blood, to wit, the anormal diminution of its
globules.
  The individuals whose blood contains an excess of globules
are subject  to some peculiar symptoms, of which no one has
perhaps up  to the present time given a very satisfactory ex-
planation ; thus, the vertigo, the dizziness, the tinnitus aurium,
the heat of head that they experience, have been accounted
for by congestions of blood towards the brain ;  but these con-
gestions have never  been, in like  conditions, anatomically
proved, and the mere passage  of  an excessive  quantity of
globules through the vessels of the brain appears to me a fact
sufficient to  account for them;  but, singular circumstance, if it
happens on  the contrary that too small a number of globules
traverse these  same vessels, analogous  symptoms will still
present themselves, so  that a quantity of globules either too
high or too low disturbs  in the same way certain cerebral
acts.
   An excess of  globules in the blood coincides also with the
more frequent and more  ready appearance of certain hemor-
rhages; I shall endeavour further on to give an explanation of
this.
   Finally, in these cases of excess of the globules,  it is not un-
common to see arise by intervals, a general  increase of excita- 
OF THE BLOOD IN DISEASES.
43
bility of the organism, carried to such a point that a true fever
may be the consequence.  Vainly should we seek, in order to
account for this, any alteration of the solids ; they do not pre-
sent any, and the fever ought then  to be considered as having
its point of departure in some state of the blood.  But, let us
take another case: suppose that coincidently with some inflam-
matory alteration of a solid, developed in an individual whose
blood contains too many globules, there arises fever; this will
then present a physiognomy altogether peculiar;  it will  be
remarkable by the symptoms of high reaction which shall ac-
company it; it will present that  type of fever called by Pinel
angeiotenic; and this type will depend less upon the seat and
nature of the local lesion, than on the  condition of  the blood
itself.  Venesection will certainly modify it, by acting on the
blood, whose globules it will infalliby diminish; but though
evidently useful  in this point of view, it will  have a much
less direct influence on  the  inflammatory alteration which
has produced the fever ;  for this alteration is connected with
another modification of the blood, upon which bleeding has
much  less direct and  immediate  influence, as we shall see
further on.
   The phenomena  of plethora, viewed in connection with the
composition of the  blood in  this condition, may enlighten us
on the part played by the globules of the blood in the organ-
ism.
                       ARTICLE II.

                Of the Blood in Jinsemia.

  I have  just pointed out what may result in the organism,
in the state of health  and of disease, from an excess of the
globular element of the blood.  But there  are cases also in
which this fluid comes  to present a character precisely inverse,
that is to say when its amount of globules falls much below
the physiological  mean, and  diminishing  more  and  more, 
44
PATHOLOGICAL hematology.
reaches a proportion so low that we can scarcely comprehend
how, with so few globules in the blood, life can still be main-
tained.
  This diminution, in  different degrees, of the globular ele-
ment of the blood is the fundamental character of anaemia, a
condition which, therefore, in regard to the composition of the
sanguine fluid, as well as  in relation to its symptoms, is the
opposite of plethora. According to the degree of the diminu-
tion of the  globules, this condition is still compatible with a
certain amount of health, or it becomes by itself a true morbid
state, which may exist  alone, or intervene as complication in
all  diseases.  Thus then,  independent of the solids, we find
one of the principles of the blood, becoming distinct from all
the others, exercising,  sometimes by its augmentation, and
sometimes by its spontaneous diminution, an influence such as
to become the point of departure and the sole appreciable ma-
terial element of a considerable number of diseases.
  I have found, as the  average of  the proportion of the glo-
bules, in 16 cases of commencing anaemia, the cipher 109, and
in 24 cases of confirmed anaemia, the cipher 65.   I have con-
structed these averages only from cases of  spontaneous anae-
mia occurring in the human  race;  I should have found a
lower average in the  sheep kind, which  are also exposed to
become anaemic, and which,  in this condition, may have a
blood so deficient in globules, that I have  seen one of them
which had but 15 of those corpuscles (see Memoir, etc.), whilst
in the  human race, the lowest proportion of globules that I
have ever met with in  spontaneous anaemia is 28.  It  is true
that man possesses normally in his blood more of the globules
than does the sheep species; whence it follows that, propor-
tionally to the physiological condition, the minimum 28 of glo-
bules, found in the spontaneous anaemia of man, is very nearly
equal to the minimum 15 found in anaemic sheep.
  Besides, it is necessary to distinguish several kinds of anae-
mia, according to the modifications of composition that they
produce in the blood.
  In spontaneous anaemia, whether strongly marked or not, 
OF THE BLOOD IN DISEASES.
45
the globules alone are diminished:  the fibrine and the  solid
matter of the serum have preserved their normal proportions;
thus in  16 cases of slight anaemia, I have found as the average
of fibrine the cipher 3.0; and in 24 cases of confirmed anaemia
the cipher 3.3.*
   In the anaemia which follows more or less  abundant losses
of blood, it may equally happen that we shall  find  the  glo-
bules alone diminished; that is indeed the first effect of every
hemorrhage; but if this  augments or is renewed, there soon
arrives a moment when the blood comes  to  lose  equally its
other principles, and we  see the albumen and  the fibrine of
the serum diminish with  the globules.  It is in  this way that
in a woman who had  suffered from  very abundant attacks of
metrorrhagia, the blood contained only 21 in globules, 1.8 in
fibrine,  and 61  of solid matter of the serum.   The water  had
risen to the enormous  proportion of 915.
   Anaemia may also be the result of certain appreciable modi-
fications of the organism which  exercise an  influence on the
blood. In this case, the composition of that fluid appears to be
the same  as in  spontaneous anaemia,  that is to  say the globules
alone are diminished, while the fibrine and  albumen of the
serum remain the same.  This is what  occurs in many preg-
nant women whose blood loses its globules without losing its
fibrine.   The average of the globules is the same in them as
we have found if in cases of slight anaemia.
   Why is it  that woman is more exposed than man to  this
singular alteration of  the blood in virtue  of which, without

  * The  state of  the blood of animals shows perfectly to what point the
fibrine and the globules may remain isolated in their increase or diminution;
thus, the dog whose blood contains much less fibrine than that of man and of
all other animals that I have examined, is precisely the animal whose blood
is most rich in globules.  On the contrary the horse, the sheep, the ox, whose
blood contains more fibrine than that of man,  and especially than that of the
dog, have in their  blood much less of globules than the two other beings.—
(See the Memoire sur la composition du sang de quelques animaux domestiques,
etc.)  Besides, in the same  species, those individuals who  possess in  their
blood the most globules are not those  whose proportion of fibrine necessarily
rises highest, and vice versa. 
46
PATHOLOGICAL HEMATOLOGY.
any evident cause, the globules of this fluid are  thus dimin-
ished in so  strong a proportion ?  Why is she particularly ex-
posed to it  at a certain epoch of her life ?
  Yet men also are sometimes attacked with spontaneous anae-
mia ; they  present in such a case all the symptoms which cha-
racterize the chlorosis of the  female, and I have proved that
their blood then suffers the same alteration of composition ; it
is with them equally  the globules alone which diminish; the
fibrine and the solid matter of the serum remain the same.  I
have met with examples of this spontaneous diminution of the
globules both in men still young, and in others aged from forty
to sixty years.
  When the influence of lead has acted  for a long time upon
the human constitution, there  may result from  it the produc-
tion  of a cachectic condition, very well  described by Doctor
Tanquerel; I have found that, in this condition, the globules
of the blood suffer as great a diminution  as in  spontaneous
anaemia, and, as in this latter, the fibrine and other elements
of the blood preserve their normal quantity.   This effect of the
saturnine intoxication repeated or prolonged is certainly very
remarkable.
  It would be very curious to know  whether the globules at
the same time that they are diminished in quantity in anaemia,
do not  become  altered  also  in  their structure, and tend  to
undergo a true destruction.  I announced in my course at the
Faculte in 1840-41, the results that some microscopic research-
es undertaken with this  view have  yielded me.  It  seemed
to me, in two cases of chlorosis, that the globules were become
smaller than we  generally see them, and  at the same time a
certain number had  no  longer their  accustomed form;  they
appeared in the field of the microscope, as though broken, and
disseminated,  like kinds of fragments.  A young girl  who
presented me  this singular condition of the globules, on the
6th of December, 1840, was perfectly cured two months later ;
her constitution had  even undergone such a metamorphosis,
that it had  gradually arrived  under our own observation at a
plethoric condition; the  14th  February 1841,1 was obliged  to 
OF THE BLOOD IN DISEASES.
47
bleed her, and  her blood then presented me very beautiful
globules, extremely different  from those that I had  observed
in December.
  These facts seem to me of so  much interest  and import-
ance as to make me feel the necessity of seeing  them again,
before accepting them definitely, and drawing deductions from
them.
  The physical properties of the blood in anaemia are very
well accounted  for by the nature of the changes that it has
undergone as to its composition.
  In  the most ordinary condition, the one in which the only
change undergone, consists in a diminution of its  globules, the
blood presents to the naked eye the following appearance:
  Supposing it to have flowed freely, we find in  the vessel
which has received it a small clot which swims  in the midst
of an abundant and  perfectly colourless serosity.  This clot,
far from being soft, as we might  have expected, is  on the
contrary remarkable  for its  density; its molecules retain  a
strong power of cohesion, and it is not at all uncommon to find
upon its surface a very characteristic buff;  one might  take  it
for pleuritic blood, or for that of an acute  articular rheuma-
tism.   This  density of the clot, and the buff which covers it,
are the more marked in proportion as the anaemia is more con-
siderable.  The existence  of cupped blood in anaemia is not a
new fact in  science.   Borsieri, ,amongst others,  had noticed
the presence of the buff in the blood of chlorotic patients, and
he had with good reason, drawn from this an argument against
those who pretended that this crust was  always the necessary
indication of a phlegmasia; and it is curious to find that Tom-
masini, who had also seen the coagulum of the blood of chlo-
rotic  patients become covered with a buffy  coat, would not
for that abandon the principle sustained  by him,  that there  is
no  buff in the blood without inflammation;  for, said he, chlo-
rosis is nothing more than a chronic angioitis.  Such an asser-
tion does not even require refutation.*

         * Tommasini sull' inflammazione, t. 11, p. 250 to 278. 
48
PATHOLOGICAL HEMATOLOGY.
  I regard as incontestable, the fact that the clot of the blood
of chlorotic patients is often  buffed, and like  Borsieri, I have
from this long since drawn the inference that the presence of
the buff is not always evidence of the existence of an inflam-
matory disease, for chlorosis  is certainly not of this character.
But why is the blood, in this disease, often cupped ?   It  is
because the blood of chlorotic patients  has retained  all its
fibrine,  and lost  some of its  globules; it is in  consequence
of this that there is really in this blood, as in that of inflamma-
tions, or as exists normally in the blood of some  animals,
excess of fibrine in proportion to the globules; now, whenever
this excess takes place, whether it be absolute or relative, and
whenever at the same time the coagulation of the fibrine is
not very much too rapid, this principle will be  seen to accu-
mulate alone on the surface of the clot, and the cup will appear.
This is the reason why the  blood of anaemic individuals may
be  buffed, and why that  of  plethoric  individuals  is  not; it is
the cause also why the coagulum of blood is firmer and more
dense in the first than in  the last.   It is also one of the circum-
stances which explains the  constant existence of the buff  in
the blood of the  horse.  We must add  to  this, in the latter
animal, the greater slowness of the coagulation of the fibrine.
   Thus, all those various functional  disorders which accom-
pany anaemia correspond to  an alteration of the blood which
is always the same, to wit, a diminution of the glob ules, and
the intensity of these disorders is so much the greater in pro-
portion as the globules  have themselves undergone a more
considerable diminution of their cipher.   If this diminution be
slight, it is compatible with  the persistence of a certain phy-
siological condition;  if it becomes  rather greater, the disease
commences.   Whatever  indeed  be the cause that may have
brought on diminution of the globules, the resulting symptoms
differ only in relation to their degree of development; but re-
main the same as to their  nature.  Whenever we  find the
diminution of the globules to coincide with that of the albu-
men, or with that of the  albumen of the  serum, we  shall ob-
serve peculiar symptoms appear, which I purpose mentioning 
OF THE BLOOD IN DISEASES.
49
further on; so that what I am about to say at present will
regard only the most common case of all, that in which the
anaemia  is the simple manifestation of a diminution of  the
globules alone.
   The blood  cannot be deprived of a certain  quantity of its
globules, without there resulting from it great prostration of
the muscular  system, very marked  general feebleness, grave
perturbations  of the nervous  system, which are betrayed by
different disorders of the intelligence, of sensation and of  mo-
tion ; and various disorders of the functions of digestion, res-
piration and  circulation.  Who  is  ignorant of the various
neuroses to which anaemic patients are subject, their dyspepsia,
their dyspnoea, their palpitations of the heart ?  Who has not
observed the  singular discoloration of their skin and exterior
mucous membranes, which is so naturally explained by the
small number of colouring globules which still  flow in their
vessels ?  But what  is less  generally known is, that it is not
uncommon to meet with individuals whose colour remains
natural, whose cheeks even  are  habitually injected to a re-
markable extent, and whose external aspect would easily
make us regard them as of a plethoric habit, but who neverthe-
 less have in  their blood, an  insufficient quantity of globules;
 this is because there exists in them a false appearance of ple-
 thora.   Observe in effect such individuals a little more closely,
 and you will  be struck with their feebleness; they will have,
 as in the most advanced anaemia, vertigo, dyspnoea, and pal-
 pitations, upon the  slightest  effort;  they will  bear with  diffi-
 culty any kind of exertion, and still worse venesection, which
 far from diminishing, will increase their symptoms.  All this
 shows that the diminution of the globules of the blood, before
 betraying itself by the  discoloration of the cutaneous tissue,
 may declare  its existence by the perturbation which it pro-
 duces in the different vital acts, and this perturbation is always
 nnuked by symptoms perfectly identical.
    There is a phenomenon  revealed  to us  by auscultation,
 which  constantly coincides with a  certain  diminution of the
 globules; this is the singular bellows-sound, heard in the heart,
         5 
50
PATHOLOGICAL HEMATOLOGY.
 and especially in the arteries, in all cases of anaemia however
 slight.  For its manifestation, it  is necessary that  the impove-
 rishment of the blood  should have fallen upon the globules;
 it is not present when the fibrine alone has been diminished; so
 that I have never met with it in scorbutic patients, unless they
 had reached  that period at which the  globules, at first  unaf-
 fected, yield in their turn.  Neither have I met with this  bruit
 de souffle, in the cases which will be detailed farther on, where
 the  impoverishment of the blood is owing particularly to a
 diminution of the albumen of the serum.  Remark in addition,
 what the analysis of 88 cases in which  this bruit existed in the
 carotid arteries,either continuously or intermittently, has taught
 me, in regard to the relation  to establish between the diminu-
 tion of the globules of the  blood, and the appearance of the
 bellows-sound  in the arteries.
  Of these 88  cases, there were 56 in which the souffle was
 continuous, and 32 in which it was intermittent.
  Of the 56 cases in which the bruit de souffle was continuous,
 and represented what  M. Bouillaud has called the bruit de
 diable, I found 28 in which the cipher  of the globules had not
 risen above  80, and had fallen even to 21; I found  13 in
 which the cipher varied between 80 and 100; 10 where it had
 risen from  100 to 115;  and 5 again where from 115 it had in-
 creased even up to 125.
  Of the 32 cases  in which the  bruit de souffle was  merely
 intermittent, there  were only 3 below 80 in globules (76, 77,
 77); 13, from 80 to 100 ; 8, from  100 to  115; 8  others  from
 115  to 126.
  We see then that the bruit de souffle of the arteries does
 not always show itself with the same degree of diminution of
 the cipher of the globules, in different individuals; there are
 nevertheless some rules to be established in regard to this, such
 as the following:
  1. When the  globules are so much diminished as to be
below the cipher 80, the bruit de souffle exists in  the arteries
as a constant condition.   I have  not found a single exception
to this law. 
OF THE BLOOD IN DISEASES.
51
  2. When the globules remain above this cipher 80, the bruit
de souffle may still  show itself, but it is  no longer  constant:
we continue to hear it  not unfrequently, while the cipher of
the globules oscillates between 80 and 100; it is still heard,
but much less frequently, in  proportion  as the cipher of the
globules  passes  100, and  finally is no  longer observed, at
least as dependent upon an alteration of  the blood, when the
cipher of the globules has risen above its physiological mean.
  Whatever  be  in  other respects the  nature  of  the disease
in which  the  diminution of the globules exist, the bruit de
souffle of the  carotids  does  not the less show itself; I  have
verified it in the most opposite cases, in putrid  fevers, in erup-
tive fevers, pneumonia, acute articular  rheumatism, and in a
great number of chronic  diseases.   But in all these cases it
occurred only in connection with the ciphers of the globules
above indicated.
  The bruit de souffle shows itself sufficiently often in preg-
nant women, which is in relation with the frequent diminution
that the globules undergo in them.
  The intensity of the bellows-sound, is commonly subordinate
to the degree of diminution of the cipher of the globules.
  Thus in 22  cases of chlorosis, I have found the  intermittent
souffle 8  times, the  cipher of the  globules oscillating between
117 and 77, and the continuous souffle 14 times, the cipher of
the globules varying from 113 to 28.
  1 have sought  to find as  to  what extent the diminution of
the globules exercised an influence upon the temperature of the
living body, but have arrived in this respect at results merely
negative.   1 have been not a little surprised to observe this
temperature remain normal, even in cases where the globules
had undergone  the most  considerable  diminution of  their
cipher.   It is thus that individuals who had in their blood no •
more than 50, 40, 30 and even 21 parts  in globules for 1,000
parts of blood, preserved nevertheless in the axilla a tempera-
ture which varied between 37 and 38° centigrade: is not this
the temperature  which belongs to the greater  part of men in
health ?  And not only does the temperature not  fall because 
52
PATHOLOGICAL HEMATOLOGY.
the globules diminish, but we see it even rise, notwithstanding
this diminution, as always happens, when anaemic persons are
attacked with fever; for they are exposed to this  like other
individuals.
  We must not then forget that at the commencement of every
disease, the blood may present two great modifications in its
globules, one of which  belongs  to  plethora, and the other to
anaemia.  It is upon a variation of increase or diminution in
the cipher of the globules that depend the peculiar symptoms
then observed, and which are  superadded  to  those  of the
disease.
                        ARTICLE III,

                Of the Blood in the Pyrexias.

   The pyrexiae form a large class of acute diseases which it
 has vainly been sought to  dismiss from nosological systems,
 in order to throw them all into the order of simple inflamma-
 tions.  Such pretensions however  cannot  be maintained:  the
 pyrexiae  exist as diseases apart;  the causes which often  de-
 velope them, the symptoms which characterize them, the spe-
 cial nature of the alterations that  they produce in the solids,
 the epoch of development of these alterations often  posterior
 to that of the febrile movement, here are already enough of
 grave reasons for not confounding the pyrexiae and the phleg-
 masiae; but the analysis of the blood comes still more to estab-
 lish a very remarkable difference between the one and the other
 class; the results furnished by this analysis have something so
 marked, that they seem to me to fix in a  definite manner the
•distinction, vainly combated, between the pyrexiae and  the
 phlegmasiae ;  this is what I  am about to endeavour to prove.
   Whilst, in the phlegmasiae, there  are always two constant
 alterations which march together, that of a solid, and that of
 the blood, it is no longer the same in the pyrexiae; in these
 diseases in reality, the only phenomenon which never fails, is 
OF THE BLOOD IN DISEASES.
53
the fever itself; the various alterations of which the solids are
the seat, may be entirely wanting, nor do the changes of com-
position that analysis has discovered in the blood appear in all
cases;  so that, in the present condition of our knowledge, the
character of the pyrexiae still  remains a negative one ; that is
to say, that, until  more fully inquired into, the fever, which
accompanies the pyrexiae, recognizes neither in the solids, nor
in the  blood, any constant alteration that  can account for it.
Nevertheless, we can more or less frequently, find alterations
in the blood and in the solids ; yet these are but the effects of
a  more hidden cause which  governs the  constitution, effects
however which it is important to study thoroughly, since in
their turn they themselves become causes of a certain number
of symptoms, and because by their seat and  by their nature,
they serve to classify and denominate the pyrexiae.
   In my first memoir upon the alterations of the blood, I have
proved that, the fibrine never augments in the  pyrexiae, sup-
posing them divested of all phlegmasial complication; that it
often remains in normal quantity, and that sometimes it di-
minishes to a point at which we do not  find it in any other
acute disease.  I have shown that the pustules of variola, and
the  dothinenteric plaques of  typhoid fever, do not have the
power of increasing the cipher of the fibrine; and  finally I
have shown that with all the possible proportions of the glo-
bules,  whether they were  very abundant, or  whether they
have become very rare, a pyrexia could equally arise with all
its varieties of form and gravity.
   But is it indifferently, and as it were by chance,  that the
fibrine shows itself, in the pyrexiae, either  in normal quantity,
or in a proportion infinitely rnore feeble than  in the  physiolo-
gical condition ?  No, without doubt, and  with regard to this,
very clear general principles may be laid down.
   At every period of clinical observation,  and upon whatever
theoretical point of view, the observer was placed, it has been re-
cognized that amongst the pyrexiae, there were some unattended
by any grave symptoms, which marched naturally towards a
favourable termination; while there  were  others which, either
                            5* 
54
PATHOLOGICAL HEMATOLOGY.
at their commencement, or during  their course, were  accom-
panied by accidents of such a nature, that it seemed as though
the forces which rule the organism were either vanquished, or
profoundly disordered to such an extent that the extinction of
life must be the consequence; and at the same  time it was
found  that in  such cases the blood presented  an altogether
peculiar appearance ; it was observed  that, become less con-
sistent, it seemed to tend towards a sort, of dissolution.   Ad-
mitted at all periods, but differently explained according to the
prevailing  theories, this condition which may develope  itself
in any pyrexia, and towards which several seem to tend natu-
rally, has  been called turn  by turn  putrid, adynamic  and
typhoid state:  it has its greatest development in the typhus
fevers properly so called; it is in some  sort inherent in them;
it is as it were their essence.  The pyrexia now called typhoid
fever, presents it  in a slight degree from the invasion and the
grave cases of this disease are its marked representation.  It
does not ordinarily exist  in  the  eruptive  fevers,  but it  often
complicates them, and constitutes one of their dangers. Finally,
in addition to  the pyrexiae with well marked characters, and
which have a  fully determined place  in nosological systems,
there are others to which no name has been given, which may
yet present in  a high degree the different symptoms to which
the ancients attached the idea of the putrid state.   This  is
because there  may exist in effect, in all the pyrexiae, a com-
mon alteration of which the blood is the seat, and whose exist-
ence  constantly coincides with the  appearance of those  phe-
nomena always the same, attributed by vitalism to adynamia,
by solidism to relaxation of the fibre, and by humorism to
putridity of the humours.  This alteration of the blood consists
of a diminution of its fibrine ; it is consequently an alteration
the inverse of that which betrays in the blood the  phlegmasial
condition.
   This diminution of fibrine, every time  that it  takes place,
produces remarkable modifications in the physical qualities of
the blood.  Whatever be the pyrexia  in which  it  exists, blood
drawn from a vein presents the following condition:
\ 
OF THE BLOOD IN DISEASES.
55
  The serum and the clot are imperfectly separated from each
other, whence it follows that there seems to be but little serum
in proportion to the clot.
  The clot is voluminous, it often fills  the whole  breadth of
the vessel in which the blood has been received; it is never
elevated upon its borders, as is so commonly the case with the
clot of the phlegmasiae.  Its consistence is always slight, it is
torn and broken with the greatest facility, and there are some
cases even where, by the slightest pressure, it may be reduced
to a true condition of difnuence ; it ceases then to form a single
mass, and is divided into a number of grumous portions which
mix with the serum, and colour it of a more or less deep red.
This is the  condition of dissolution of the blood so  well de-
scribed by the ancients, and which  ought to  be regarded as
the necessary consequence of  the diminution that the  sponta-
neously coagulable matter of this fluid has undergone.  Then,
in effect, the net-work, which maintained the globules  pressed
one against the other, and which by its power of contraction
squeezed out  the serum, no longer exists but imperfectly;
thence also  arises  the great size of the clot, which  is found to
be in  an inverse proportion to its density, and which  is not a
certain index of the quantity of solid material that it contains.
Let us add however that the cause of the large size of the clot,
is really also  the large proportion of globules that it contains,
especially in the  early stages of the disease ;  for these do not
 diminish in  such  cases, like the fibrine; far from that, they
 may  become  remarkable  by  their abundance.   Very  fre-
 quently, indeed, I have  been struck by the great elevation of
 the cipher of the  globules in individuals with grave  typhoid
 fever; and  in my first memoir upon the alterations of the
 blood, I was even inclined to  suppose that this superabundant
 quantity of globules was one  of the characters of that  fluid in
 the pyrexiae ; but this was because I had not then sufficiently
 studied the condition of the blood in the plethoric; since then
 I have convinced myself, that if, in typhoid fever, we  often
 find this predominance of the globular element of the blood, it
 depends on the fact that typhoid fever most frequently attacks 
56
PATHOLOGICAL HEMATOLOGY.
 individuals, who by their age and constitution, are in a con-
 dition of plethora more or less marked; but the superabund-
 ance of the globules depends so little upon the typhoid fever
 itself, that  this disease, as I have myself seen, may occur in
 chlorotic girls,  whose blood  is  so  poor in  globules.  But
 whether these be abundant or not, the influence of the disease
 upon the fibrine remains always the same.
   There is another quite negative  character of the blood in
 the pyrexiae, which  is of importance and which serves still
 more to distinguish the sanguine fluid of these diseases from
 that of the  phlegmasiae.  This character is the absence of the
 buff.  I may affirm here  that I have never met with it, unless
 there was some phlegmasial complication, either in inflamma-
 tory fever,  in slight or severe typhoid fever, in measles, in scar-
 latina, or in variola.
   Nevertheless, we may  find the buff upon the surface of the
 clot, in this latter pyrexia, when the eruption is very confluent,
 and especially when collections of pus  exist  beneath the skin,
 or in some organ; but this buff always appeared to me to
 have a peculiar aspect;  far from being firm  and consistent,
 like the ordinary crust of the phlegmasiae", it is very soft, and
 gelatinous as it were, and however thick it may at first  appear,
 may be rapidly changed into  quite a thin pellicle, by expel-
 ling by means of compression, the large quantity of serosity
 which infiltrates it.
  If, as I have already proved, the indispensable condition for
the formation of the inflammatory crust, is a certain excess of
 fibrine in proportion to the globules, we can understand why
this should  not exist in the pyrexiae, since, in  these diseases,
supposing  them  always  without phlegmasial complication,
two cases only can occur, one in which the fibrine has retained
its normal  proportion, and the other in which it  has dimin-
ished.
  Since the diminution of the fibrine does not exist necessarily
in any pyrexia, it is perfectly clear that, it is not in this altera-
tion of the blood, that we should  place the point of departure
of this class of diseases.   But what seems to me incontestable, 
OF THE BLOOD IN DISEASES.
57
is, that the specific cause which gives them birth, acts upon
the blood in such a way, that it tends to destroy its spontanc
ously coa^ulable matter, while the cause which produces the
phlegmasiae, tends on the contrary to create in that fluid  a
fresh proportion of that matter.  If this cause act  with  slight
energy, or if the economy resist it, the destruction of the fibrine
is not accomplished; if  on  the contrary the cause  continue to
act with all  its intensity, and  the forces of the organism  be in
fault, the destruction of the fibrine will commence  either at
the very beginning of the disease, which is very rare, or  a cer-
tain period  after  its commencement:  all this  applies itself
equally well both to  typhoid fever, and to the eruptive fevers.
For me there is, in all these cases, a true intoxication; if it be
slight, its effect must to  be sure always exist, but it is not ap-
preciable ; if the intoxication be stronger, the  effect which  it
has produced upon the  blood  becomes visible, and is marked
jn that fluid, by a diminution of the fibrine.
   Whilst then we establish, in certain forms of typhoid  fever
or scarlatina, that alteration of the blood which consists in a
tendency to the  destruction  of  its  spontaneously  coagulable
matter, we no more attain by this means the true cause of the
disease, than we do, by studying the alterations of which  the
tegumentary membranes are the seat.  But, as these altera-
tions of the  mucous membrane or of the skin, once produced,
bear their part in the production  of the symptoms, just so does
the peculiar alteration of the blood, which  may  then  arise,
bear its part.
   Amongst  the phenomena which seem to me to have a  direct
connection with the diminution of the fibrine, I believe I  ought
to place in the first rank the hemorrhages that are so common
in all the pyrexiae in which the adynamic or  putrid type pre-
dominates, that is to say those in which it has been proved by
analysis that the blood had lost some of its fibrine.   In variola,
when the pustules are  filled with blood, in  scarlatina,  when
there are abundant losses of blood from all parts, in  individuals
attacked  with acute purpura hemorrhagica, as well  as in ty-
phoid fevers accompanied with  epistaxis and buccal hemor- 
58
PATHOLOGICAL HEMATOLOGY.
rhages which increase with the debility, I have shown that
the blood was effectively very poor in fibrine, and 1 shall essay
to prove further on that we cannot in such cases accuse the
hemorrhage of having diminished  the fibrine.   It would seem
that in this condition a certain diminution of the spontaneously
coagulable matter of the blood has for effect to permit the glo-
bules to abandon more  readily  the vessels which contain
them.
   How again fail to remark the  coincidence, so frequent in
the pyrexiae, of the diminution of the  fibrine of the blood, and
of the facility of production of  those  congestions or  sanguine
states which have so often been confounded with true inflam-
mations ?  wherefore this coincidence ?  Deprived of the ordi-
nary quantity of fibrine borne along with them in the torrent
of the circulation, are the globules  at  the same  time  deprived
of a means of regularization for their movements, and do they
come in this way to accumulate and stagnate in the capillary
rete ?  I know not; but it must  be  that there is some con-
nection  of cause  and effect  between the diminution of the
fibrine of the blood and the  production of these congestions,
since these latter follow so constantly the former.*
   There is  a peculiar congestion  which rarely presents  itself
except when there exists a typhoid condition, whatever be in
other respects the disease in the course of which this condition
may have arisen.  This congestion has its seat in the  spleen,
which becomes remarkable at the  same time  by its great size,
and by the extreme diminution of consistence of the material
which fills its cellules.   The softening of the spleen, noted in
these cases by all observers, does not  depend on an alteration
of its own tissue: for it is found  quite untouched, when, by
washing, it has been emptied of all  the material that it con-
tains; it is evidently this latter which has lost its usual con-

  • I am happy to say that all the facts, that I have just reviewed in this arti-
cle, are in perfect harmony with the  principles emitted, since 1837, by M.
Magendie on this subject.  While employing different experimental methods,
we have each arrived at similar results. 
OF THE BLOOD IN DISEASES.
59
 sistence.  But, what is  this material ? it is nothing more than
 blood retained and coagulated, I know not by what influence,
 in the innumerable cellules or areolae of which the splenic tis-
 sue  is composed; but this blood ought  to possess the same
 qualities as any other blood  poor in fibrine, that is  to say it
 ought to  coagulate imperfectly; whence will result, in the
 spleen as  elsewhere, a marked softness and at the same time a
 large amount of clot.  It is always the same cause which pro-
 duces a similar kind of modification, whether in the blood that
 we extract from  the veins during life, in that we collect from
 the heart  and vessels after death, and in that again contained
 in the splenic  cellules.   Thus then, the augmentation in size
 of the spleen  and  its softening, which certainly accompany
 every well marked typhoid condition, may be regarded as the
 effect of a diminution of the fibrine  of  the blood, and this
 change is one  of its manifestations.  Let no one say moreover
 that it is inconsequence of the greater rapidity imparted to the
 circulation that the spleen comes to present the changes that I
 have just  described: for, in the acute phlegmasiae with fever,
 it presents nothing of the kind.
  I  have already said  that,  however poor the blood might
 have become in globules, this did not prevent the temperature
 proper to  the human body from persisting in its normal con-
 dition, and even elevating itself if there were occasion.  The
 same is true in cases where the blood has lost a great portion
 of its fibrine:  not only does not the temperature of the body
 fall in consequence, but it may even augment several degrees,
just as in any other circumstance.   Thus I have  found it  at
 40° c. in cases of typhoid fever when the blood did not offer
 more than TT5Lq in fibrine.  Yet this is likewise the most ordi-
 nary temperature that we find in individuals who have fever
 symptomatic of an acute phlegmasia, even  when the fibrine has
 doubled or tripled in quantity.   Consequently  the greater  or
 less elevation of the temperature of the body in diseases, is not
dependent upon the quantity of fibrine that the  blood may
contain.   This  temperature attains  its maximum (42° c.)  in
intermittent fevers in which, as 1 have assured myself, the 
  GO            PATHOLOGICAL HEMATOLOGY.

  fibrine of the blood remains in normal quantity;* and the ave-
  rage  even shows itself somewhat  more elevated in typhoid
  fever or in scarlatina than in the acute phlegmasiae.


                         ARTICLE IV.

               Of the Blood in the Phlegmasia.

    I have now shown  that  there  is a large class of febrile
  diseases in which the  fibrine is never increased, but is often
  normal, and often  diminished.  There are others, again, in
^  which there is constantly an increase of this principle, diseases
  which are  symptomatic of that sort of alteration of the solids,
(  which from time immemorial has been  called inflammation.
'  This  is not the place  to criticise the vagueness  and insiiffi-
  ciency of such an expression;  but it is  my  duty here to set
  forth  prominently that remarkable coincidence, in certain dis-
  eases, between the  increased quantity of  the  spontaneously
  coagulable matter of the blood, and the development of various
  lesions of the solids, which although differing in many respects,
  yet resemble one another so strongly in others, that in all ages
  they have been classed together by nosologists, as forming a
  single group of diseases.  And yet it must be admitted that
|  the organic changes are much more uniform in the blood, than
  in the solids; amidst the diverse lesions of the latter, the blood
  exhibits, by the identity of the alterations which it undergoes,
  a  disease uniformly of the  same  nature.  Not  long since,
  Meckel defined inflammation to be, congestion with a  ten-
  dency to new production.  The study of the  blood shows the
justness of this definition.  For  what else  than a new pro-
 duction  is this excess of fibrine which suddenly appears in the
 blood of a person attacked with pneumonia  or erysipelas, with
 an inflammation of the tonsils, of the tongue, of the bronchia,
 or of  the peritoneum ?   A  new and redundant production of

   * See in our first memoir, the results which a certain number of analyses
 of the blood in intermittent fevers, have given to M. Gavarret and myself. 
OF THE BLOOD IN DISEASES.
61
fibrine in the blood is, then, the least variable sign of a certain'
number of diseases which present further analogies in the na-
ture of the general symptoms accompanying them, and in the
uniformity of the treatment  they require.   In my preceding
essays, moreover, 1 have shown, that in these diseases, the other
organic constituents of the blood, and particularly the globules,
do not increase with the fibrine.
  In the phlegmasiae, then, there is an excess of fibrine rela-
tively  to the globules, that is to say the reverse of what takes
place in typhus.  Hence may be explained  the physical pro-
perties of the blood drawn from a  vein, in these diseases.
While in the pyrexiae, generally, the clot is bulky, flabby, and
imperfectly separated from the serum, here,  on the contrary it
is smaller, more dense, and of superior consistence ;  besides
which, if  the blood has been properly drawn, the clot will be
covered with a buffy coat of variable thickness.
  I have  already explained myself in regard to the value of
the indications to be derived from  the buffy coat.   Except'
when it occurs in cases of anaemia, this production uniformly
denotes a state of inflammation.  I can cite in support of this \
assertion a summary of nearly eighteen hundred bleedings, in
which the blood, examined by myself, never presented a buffy
coat except in one or the other of two series of cases, those of
anaemic patients on the one hand, and those of persons attacked
with various acute or subacute phlegmasiae, on the other.  In
the former, the buffy coat, which, indeed, is of moderate thick-
ness, results from the great diminution of the globules, for the
fibrine although in its usual quantity, is nevertheless in excess,
relatively to the globules.  But in the phlegmasiae the globules
are neither increased nor diminished, while the fibrine having
become redundant,  the  law which governs the formation of
the  buffy coat reaches its full development.  Moreover, the
fibrine of the new product entering  into the composition of
the buffy  coat coagulates more slowly than the old, which is
another cause favourable to the appearance of the buffy coat,
since the gradual coagulation of the fibrine allows the globules
to sink to the bottom of the vessel, leaving the fibrine above
       6 
62
PATHOLOGICAL HEMATOLOGY.
them, still dissolved, or suspended, in  the  serum.   Besides, if
an analysis be made for the purpose of determining the quantity
of fibrine in the buffy coat, or underneath it, some indeed will
be found in the latter  situation, but very little compared with
what can be extracted from the buffy coat itself.*
   There is a striking contrast between the usually great firm-
ness of the buffy coat, and the extreme softness of that portion
of the clot which retains  its colour; this softness is always
great in proportion  to the density of  the  buffy coat, and the
brownish red mass which the latter surmounts, bears the great-
est resemblance to imperfect and half liquid currant-jelly.   On
examining this  mass through a microscope, an  accumulation
of globules is found in it, while  none, or very few, can be

  * With reference to this subject I have studied the clot in  three cases of
pneumonia, and in two of acute articular rheumatism.  In  these five cases
the fibrine of the clot was apportioned in the following manner:
  First case of pneumonia.
         Fibrine of buffy coat.....8.1
         Fibrine of rest of clot......1.1

                                    Total fibrine    9.2
  Second case of pneumonia.
         Fibrine of buffy coat   -   -   -    -    -   5.8
         Fibrine of rest of clot......3.2

                                    Total fibrine    9.0
  Third case of pneumonia.
         Fibrine of buffy coat.....4.8
         Fibrine of rest of clot -    -    -    -    -     - 2.5

                                    Total fibrine    7.3
  First case of articular rheumatism.
         Fibrine of buffy coat    .....   7.0
         Fibrine of rest of clot -    -    -    -    -     - 1.6

                                    Total fibrine    8.6
  Second case of articular rheumatism.
         Fibrine of buffy coat.....7.5
         Fibrine pf rest of clot......1.7

                                    Total fibrine    9.2 
OF THE BLOOD IN DISEASES.
63
detected  in  that portion of the clot which  forms  the  buffy
coat.
  On examining the latter in the earliest periods of its separa-
tion, and before the coagulation is visible to the naked eye, or
just as it is commencing, certain phenomena may be witnessed;
such I have verified with M. Gavarret, and which I will now
describe..
  We received in a glass vessel 80 grammes (about 2\ ounces)
of the blood of a person suffering from acute pneumonia ;  the
coagulation took place as usual, and a buffy coat soon  made
its appearance upon the surface of the clot.  Hardly had  the
yellowish and opaline liquid which constitutes its first rudi-
ments appeared above the mass of globules, when we placed
a drop of it under the microscope ; then, in addition to some
red globules, the field of the instrument  appeared to us filled
with  those grain-like corpuscles whose nature I have  already
endeavoured to determine.  The opaline liquid became every
moment more consistent;  when it assumed the appearance of
a tremulous jelly  denoting its approaching solidification, we
again examined it under the microscope, and saw forming
before our  eyes numerous very fine fibres, resembling long
and very delicate threads, crossing one another in various di-
rections, so  as to  leave intervals between them of variable
extent, and giving to the whole the appearance of a net-work.
These fibres, at first, few in  number, and scarcely visible, be-
came more  numerous  and more  distinct, until they occupied
the whole  field of vision; and, as they increased, formed
superposed planes at certain points, where  the net-work was
succeeded by an appearance like felt.   The fundamental form,
however, continued to be reticular.   As  the solidification of
the buffy coat proceeded, this appearance of interwoven fibres
disappeared, and  there only remained visible a confused and
amorphous mass.
   I have repeated this experiment several  times, and always
with  the same result.  I have also examined with a  micro-
scope the sero-fibrinous liquid which may be separated from
the globules, as already stated, by subjecting the blood to the 
64
PATHOLOGICAL HEMATOLOGY.
 action of sulphate of soda, and then, upon examining the flakes
 which quickly appear in the liquid, I have found these same
 reticulated fibres.  I shall avail myself hereafter of this micro-
 scopical sign afforded by the fibrine of the  blood, to prove the
 identity of this principle with other spontaneously coagulable
 matters, which, in  certain cases, are  found mixed with the
 serosity.
   Here, then, is the necessary, the indisputable  modification
 offered by the blood in every inflammation acute  enough to
 be accompanied with fever, the creation in that fluid of a new
 quantity of fibrine.  Here we have an explanation of the phy-
 sical properties of the blood in the phlegmasiae, so different
 from what they are in the pyrexiae: here too the cause of the
 formation of the buffy  coat, whose fibrinous nature is thus
 demonstrated as well by microscopical examination, as by
 chemical analysis.
   This spontaneous production of an excess of fibrine in  the
 blood  is,  moreover, independent of the various  conditions in
 which the system of the individual attacked with inflamma-
 tion may happen to be.  For, remarkably enough, it does not
 fail to take place even when a  phlegmasia occurs during the
 course of  typhoid fever, the influence of which is to create, at
 least, a tendency to lessen the quantity of fibrine in the blood.
 The real increase of the  fibrine in such a case is not, however,
 very great, for I have never found its maximum to exceed 5£,
 which number corresponds to one of the lowest degrees of the
 inflammatory state, and  in other cases the amount of fibrine
 was even  less, its increment was only relative.   Does it not,
 then, seem as if the fibrine were controlled by two forces, one
 of which,  represented  by  the intercurrent  phlegmasia,  urges
 its increase, and the other represented by the typhoid fever,
 acts in the opposite direction, and reduces to its minimum the
 influence  of the phlegmasia ?   In this way we  may under-
stand  how the  fibrine,  although exceeding its physiological
quantity in cases of typhoid fever complicated by  intercur-
rent inflammation, is yet developed in a less degree than if its 
OF THE BLOOD IN DISEASES.
65
increase were regulated only by the laws of the inflammatory
state.
  Although the constitution  may be  exhausted by a chronic
disease, or a more or less complete state of anaemia be estab-
lished, the fibrine will nevertheless  be augmented under the
influence of whatever inflammation may supervene.  Nor is
there any thing surprising in this; for, in the supposed circum-
stances, the globules diminish, while the fibrine  remains nor-
mal, so that its increase, through the intervention of the inflam-
matory state, is less singular than in the case of typhoid fever.
In the  above mentioned conditions of the economy I have seen
it increase much more  than  in  typhoid fever.  In  chlorotic
patients, for instance, who had been attacked with acute arti-
cular rheumatism, capillary bronchitis, pneumonia, or erysipe-
las, I have found the blood to contain 6, 7, and even 8 parts of
fibrine.  While,  therefore, clinical observation demonstrates
the frequent coincidence of anaemia and inflammation, chemi-
cal  analysis discloses to us in the composition of the  blood,
circumstances which far from opposing this coincidence, should
rather  be held capable  of favouring its development.  For
since in  all cases of general debility  the globules are dimi-
nished, and the fibrine relatively increased, it  follows that in
the spontaneous anaemia occurring towards the close of many
chronic diseases, the proportions of the several constituents of
the blood  to one  another are such that the  state of this fluid
approximates more  nearly to the change of composition effect-
ed by  inflammation, than under any other circumstances, so
that the blood may  be said to have then a sort of predisposi-
tion to the inflammatory state.
  I have  not observed that, apart from the disease itself, the
differences of constitution or  temperament, of  age or sex,
modified in  any notable  degree the quantity of fibrine in the
blood.   Whether the individuals attacked with acute inflam-
mation were strong  or feeble, of a sanguine or  lymphatic tem-
perament, the increase of the fibrine was neither more nor less
considerable, following only,  amidst these various conditions
of the organism, the variable intensity of the inflammation.
                            6* 
66
PATHOLOGICAL HEMATOLOGY.
  I was much struck by a fact observed in some experiments
which I  undertook with  M. Gavarret in order to  settle the
composition of the blood in animals deprived of food.  This fact
was a remarkable increase of fibrine; but my surprise was at
an end when, upon the dissection of these animals, I discovered
in their stomachs lesions of the most clearly  inflammatory
nature, such as bright  redness, softening, and numerous ulcer-
ations of the  mucous  membrane.  From that time, I have
seen in those experiments only a confirmation of the principle
I have just now laid down, to wit, the possibility of an inflam-
mation developing itself in spite of the general debility of the
system, and the simultaneous increase of the  fibrine of the
blood in spite of the  general impoverishment of that liquid.
The following are some details of those experiments.
  We bled three healthy and well kept  dogs.   Their  blood
contained fibrine represented by 2.3; 2.2; and 1.6  respect-
ively.  These  variations  are ordinary and physiological in
canine blood, as I have elsewhere shown.*   After having thus
determined the composition of their blood, these three animals
were  made to fast, more or less rigorously, until they died.
  From the first both food and drink were withheld from De-
cember 21st 1841 to January Hth 1842, when he died.  Dur-
ing this period he was twice bled, on December 28th and
January 4th.   The quantity of fibrine in his blood rose from
2.3 to 3.9 and 4.5.
  The second dog was not allowed to eat from December 21st
to January 8th, the day of his death;  but all this time he was
permitted to drink water.   He was bled December 28th, Jan-
uary 4th and 8th, and  the fibrine of his blood had risen from
2.2 to 2.9 and 4.0.
  The third dog  was not  starved so absolutely: from Decem-
ber 21st to January 16th  he  received every morning a small
ration of soup.  He was first bled December 28th, and again
January 4th, but there was no considerable increase of fibrine,
although it was far from diminished, being represented by 1.8
* Mem. cit. 
OF THE BLOOD IN DISEASES.
K7
instead of 1.6.   Such was  not the case, however, on January
12th, four days before the animal's death, and when the influ-
ence of insufficient food had been longer felt by the organism.
In this third bleeding the increase of fibrine was very marked ;
it had  reached 3.3.  The proportion was indeed less than in
the other cases; but it is worthy of remark that this third dog
had not been entirely deprived of food, and was the only one
whose stomach was not ulcerated; the redness of his gastric
mucous membrane was also less general and less vivid.
   Need I  here recall the fact, that independently of the interest
which belongs to these experiments in relation to the subject in
hand, they entirely confirm the opinions which, ever since the
time of Hunter, have prevailed in our science respecting the
morbid and excessive excitement, and the  inflammatory dis-
organization, which may affect the stomach when, for a certain
period, it  has either received too little food, or none at all ?
   No matter, then, what  may be the state of  the  system, the
supervention of an acute phlegmasia involves necessarily, and
in every case,  the increase of the fibrine of the blood beyond
its normal quantity.   This law,  too, prevails amongst animals,
as well as amongst  men, as I have become well  assured by
analyzing the blood of dogs, horses, neat-cattle, and sheep, at-
tacked  with various inflammations which had been discovered
during life, and after death.
   In man, when an acute  inflammation is well established, the
fibrine varies in quantity between 6 and S;  in a smaller num-
ber of cases it rises as high as between 8 and 9; and, more
rarely still, exceeds the latter number, and reaches by degrees
 IO5, which is the highest number I have yet found represent-
ing the fibrine in phlegmasiae attacking the human race, though
in a neat  affected with pneumonia I found it as high as 13. It
must be remarked here, that since the physiological number
representing the fibrine in animals is not the same as that for
man, the  increment in the former  must not be judged of by
the standards of the latter, but must be referred to the average
obtained for each particular class of animals.   Thus the phy-
siological mean of the fibrine in dog's blood being only 2.1, 
68
PATHOLOGICAL HEMATOLOGY.
the numbers  3, 4, and 5 obtained when this  animal was  at-
tacked with inflammation, would, in the case of man, indicate
a development of fibrine to be represented by much higher
numbers.   On the other hand, the  physiological mean of the
fibrine in  the blood of horses and neat-cattle being  greater
than that of man, the number 13  indicating the quantity of
fibrine in the  blood of one of these animals, would, in the case
of man, represent a much inferior quantity.   These corrections
are indispensable, if  we desire profitably to apply to  human
pathology the results obtained from studying the pathology of
other species.
  In regard to the cases in which  the fibrine falls below 5,
they are either acute and slight inflammations, and which can
hardly be said to have commenced, or whose  activity and ex-
tent are inconsiderable : in them it may happen that the fibrine
falls from  5  to4§,and  sometimes  even to 4; but this last
number represents the lowest possible, and, as it were, excep-
tional limit, of the quantity of fibrine in the acute or subacute
inflammatory state.
  To demonstrate  the  sudden change of composition which
takes place in the blood of persons attacked with acute phleg-
masiae, I might cite  several cases in which the same person
having been bled, some days before the outset of the phlegma-
sia, and again during the course thereof, his blood, which con-
tained  the normal quantity of fibrine at the first depletion, was
much more abundantly provided with it  at  the subsequent
ones.
  The two diseases  in which I have  noticed the greatest de-
velopment of fibrine, are pneumonia, and acute articular rheu-
matism ; they are the only ones in which this augmentation
reached the number  10.
  I will now pass in review all those diseases, different indeed
in seat, but not in nature, in which  I have found, as an inva-
riable characteristic, an increase in the spontaneously coagula-
ble matter of  the blood.*

  •  For further  details respecting the state of the blood in these various  dis-
eases, see the two memoirs already cited, and which are published in  the 
OF THE BLOOD IN DISEASES.
69
  And first, since inflammation of the cellular tissue is  re-
garded as the type of all inflammation, I will notice a case of
phlegmon of the leg, of moderate extent, which terminated in
abscess, and which was accompanied by a very slight febrile
reaction.  The first bleeding gave 4.7 of fibrine, the second 5.
  In another case of phlegmon of the breast which terminated
in resolution, the blood furnished 4.5  of  fibrine during  the
course of the affection, and only 3.7 at its close.
  Out of 84 bleedings performed in the course of well marked
cases  of pneumonia, there were seven only in which the fibrine
varied in quantity between  4 and 5; in the 77 others it  ex-
ceeded the latter number, was eleven  times between 5 and 6,
nineteen times between 6 and 7, fifteen times between 7 and
8, seventeen times between 8 and 9, nine times between 9 and
10, and six times at, or a little above, 10.
  In inflammations of the mucous membrane, the quantity of
fibrine is found  to  remain normal, if the  inflammations  are
slight, limited, and without fever ; but do they acquire ever so
little of a certain degree of intensity, and  manifest a febrile
reaction, so surely does the fibrine of the blood augment.
  Thus I have seen it reach 6, 7, and 9 in  cases of bronchitis
of great extent and  acuteness.  I refer to my first memoir  for
the details of  these  cases, contrasted with others of chronic
bronchitis in which there was no increase of the fibrine.   In-
flammations of the intestinal mucous membrane present  the
same phenomena.
  I may here  be  permitted to cite, somewhat less briefly, four
cases of acute mercurial stomatitis which seem to me to possess
some interest  due, on  the one hand, to the cause producing
them, and, on the other, to the exact ratio which existed, in
all  these cases, between the intensity of the affection of  the
solid, and  the quantity of fibrine in the blood.   These four
cases have, moreover, never been published.
  In the first a slight stomatitis occurred after a dose of twelve
Annates de chimie et de physique, vol. lxxv of the 2d series, and vol. v of the
3d.  I shall here only notice at any length the facts not published in these
two memoirs. 
70
PATHOLOGICAL HEMATOLOGY.
decigrammes (18.5 grains)  of calomel; there were a  few
pseudo-membranous films scattered over the lining membrane
of the mouth; the salivation was copious;  the pulse 80; the
temperature of the skin 37.50.*  The blood contained 4.5 of
fibrine.
  In  the second  case a  dose of  only six  decigrammes  (9.5
grains) of calomel had given rise to a rather more  acute in-
flammation of the mouth; and there was more fever.  Pulse
100;  temperature 39.   The blood contained 5 parts of fibrine.
  In the third case, the  affection followed  the use of mercu-
rial frictions simultaneously with calomel given internally;  it
was more violent than the two preceding  cases.  Numerous
and thick false membranes  invested the gums, the  lips, and
the cheeks.  The degree of fever was about the same  as in the
second case, (pulse 96, temperature  38.50,) we found  8.4 of
fibrine in the blood.
  In the fourth and last case, the stomatitis, produced as in the
last case, was more considerable, for the whole  mouth  was
enormously swollen,  and encrusted with  false membranes.
The pulse was  120,  the temperature  39.  In this  case the
fibrine rose to 6.6, and its increase was clearly due to the in-
flammation ; for the patient had, a few days before, been bled
for a slight cerebral haemorrhage, and  at that time his blood
contained only 3.5 of  fibrine.  In the other three cases, there
was no other affection before the mercurial  sore-mouth, which
could have produced any modification in the amount of fibrine
in the blood.
   Mercurial stomatitis, therefore, notwithstanding its specific
nature, does not differ from ordinary inflammations in its influ-
ence on the blood; and yet it has been asserted again and
again, that one of the effects of mercury introduced  into the
system is to bring about a  state of dissolution of the  blood,
which is incompatible with an increase of fibrine.   It is possi-
ble that this may take place  after a prolonged use  of the medi-
cine,  but assuredly such is  not the case soon after its  first
  • Probably centigrade: but the author does not mention what thermometer
was used by him.  Tr. 
OF THE BLOOD IN* DISEASES.
71
exhibition.  Consequently, when  it is administered to combat
certain acute phlegmasiae, such  as peritonitis, it is  not right to
assume that its antiphlogistic action consists in its producing
in the blood a condition opposed to that which belongs to the
inflammatory state.  Nor do I find that this dissolving hiflu-
ence upon the blood which  is claimed for mercury, has ever
been demonstrated, in any alleged case, by a rigorous exami-
nation of that fluid.  It appears to me that the opinion rests
chiefly on a fancied analogy between the effects of mercury,
and those of scurvy, upon the mouth.
   But this is a deceptive resemblance: in  the affection of the
mouth following the administration of mercury, are to be ob-
served all  the marks of a true inflammation, which, if some-
what intense, is accompanied with active fever.   But the case
is not the same in scurvy: the symptoms which then show
themselves in the  mucous membrane of the mouth are only
amongst the phases of those haemorrhagic congestions which
are ready to take place in nearly  all the tissues.
   Proceeding with the exposition of our analyses of the blood
 in various cases of inflamed intestinal  mucous  membrane, I
 find it to be uniformly the fact, that a notable increase of the
 fibrine takes  place  whenever  any portion of this membrane,
 from the fauces to the end of the colon, inclusive, is attacked
 with inflammation acute enough  to excite fever: in these cases
 the quantity of fibrine has  reached 5,  6, and 7, but never a
 higher  degree.  We  have  already  shown that  this increase
 does not occur, when the inflammation, seated in the follicles,
 exists only as one of the elements of a general disease, i. e. of
 a typhoid fever.
    The great  distinctive traits  separating  cholera from proper
 inflammatory affections of the  intestinal canal,  might have
 found confirmation, if need were, in a recent examination I
 had occasion to make  of the blood, in a perfectly sporadic case
 of this disease.   The patient was a robust man, in middle life,
 who entered the hospital of La Charite with all the symptoms
 of a pretty severe attack of cholera: (copious vomiting  and
 purging, colourless stools resembling rice water, cramps, apho- 
72
PATHOLOGICAL HEMATOLOGY.
nia, suppression of urine, cold skin, but a pulse of natural ful-
ness, and moderate  frequency.)  The blood of this  patient
gave only 3.3 of fibrine, and contained only 118 parts of glo-
bules, and S8 of the solid constituents of the serum.
  Finally, to close this review of the state of the blood in in-
flammations of the  mucous membranes, let  me  remark, that
the increase of the  fibrine has not failed to occur, either in
various cases of acute cystitis,  whether accompanied or not
with nephritis, or in recent, painful, and intense inflammations
of the  utero-vaginal mucous membrane.  In these different
cases, which were  all accompanied with fever, the  fibrine
oscillated between 4, 5,  and 7.   I may mention  that one of
these cases was complicated with  Bright's disease of an indo-
lent and apyrectic form, to combat which I directed a bleeding
which gave 3.6 of fibrine.  Three or four days afterwards an
acute pain  attacked the right side of the  lumbar  region, and
fever set in.  The patient was again bled, and  this time his
blood,  suddenly changed  in its composition, contained  5 of
fibrine.
  Inflammations of the skin, as well as of the mucous mem-
branes, bring with them an increase of the fibrine of the blood.
This I have ascertained  in a person who had been severely
burned; while, on the other hand, there was no increase in
another, whose burn was slighter, and less extensive.
  It appears  to  me  peculiarly interesting to  determine,
whether, in cases of burn, the  blood  becomes charged  With
fibrine, because in such cases, evidently, the  disease begins in
a solid, and the alteration of the blood can  therefore only be
regarded as consecutive.   Further on I shall revert  to this
subject.
  The  course of erysipelas, when acute and febrile, is like that
of a burn, and shows an increase of fibrine represented by the
numbers 6 and 7.  The pustules of variola, and the exanthema
of measles and scarlatina, like the follicular affection in dothi-
nenteritis, exert less influence  upon the blood,  than simple
erysipelas.
  I have likewise established this invariable law of augmen- 
OF THE BLOOD IN DISEASES.
73
  I have likewise established this invariable law, of augmen-
tation in the fibrine of the blood, in regard to every acute in-
flammation of the  serous  membranes.  It was, for instance,
very marked in a case of cerebro-spinal meningitis, in which,
after death, I found the spinal marrow surrounded, in its whole
extent, by a sort of purulent sheath, the pus having infiltrated
the pia mater.
  In pleurisy, peritonitis, and pericarditis, I have also found in
the blood this same excess of spontaneously coagulable matter.
These various cases, 24  in  number, are divisible into two
series.  The first comprises those in which the disease, whether
acute or chronic, was accompanied with fever, and continually
grew worse; which suggests the probability that the primary
cause of the disease  was not exhausted, but  maintained its
action.   In  the  cases belonging  to this series, I imiformly
found an excess of fibrine in the blood, its minimum being 4,
its maximum  8.4.
   In the second series, other facts  present themselves.  The
inflammation  seemed to be suspended; the  pulse  lost its fre-
quency ; and  the  only remains of the disease were a greater
or  less effusion  into a serous cavity.   The blood  then ceased
to contain an excess of fibrine.  It may even happen, as I once
saw, that this principle, although excessive at the  commence-
ment of the  disease, may return  to its normal  proportion,
while yet the fever persists, but only after the prolonged dura-
tion of the malady has caused extreme emaciation.
   The case referred to is that of a woman attacked with peri-
tonitis;  during  the earlier stages  I had her bled twice;  the
 blood gave 5.3  and 5.4 of fibrine.  The peritonitis lost its in-
 tensity after this depletion, but was not cured, and gradually
 passed into a chronic state.  The  patient was already much
 emaciated, when  I  endeavoured,  by another  bleeding, to di-
 minish the fever, which had never for a moment ceased. This
 time the blood contained only 3.5 of fibrine.  After this bleed-
 ing, there was no improvement, and the patient sunk speedily.
 The intestinal  convolutions were  united by  organized false
 membranes, and the pelvis was filled with pus.   The tempe-
        7 
74
PATHOLOGICAL HEMATOLOGY.
 rature of the skin, even to the last day, remained at 40° cent.,
 and the blood did not then contain more than 68 parts of glo-
 bules.
   In addition  to  these 24  cases of serous inflammations, I
 should cite another, in which the fibrine was so small in quan-
 tity as to contrast with all the other acute and recent cases.
 The form of the disease was, moreover, quite peculiar.  It was
 seated in the pleura ;  indeed commenced like a simple pleuro-
 dynia; and  then  without any initial  chill, or frequency  of
 pulse, a considerable  effusion  took  place rapidly on one side
 of the chest.  In this singular case of pleuritic effusion without
 fever, the fibrine  in the blood preserved its normal quantity,
 (3.5).  It may be doubted whether there was, in this instance,
 a real inflammatory  process.   Was it  not simply  hydrotho-
 rax?*
  There is a disease which, in many respects, seems to differ
 from ordinary inflammations, but which, like  them, obeys the
 law relative to the fibrine of the blood.   I allude to articular
 rheumatism.  If acute, the fibrine augments uniformly, as has
 been proved  to me by an analysis of 43  bleedings, in which
 the fibrine was once  represented by 4, six times by 5, fifteen
 times by 6, thirteen times by 7, three times  by S, three times
 by  9, and twice by 10.
  But if the  articular rheumatism  be only subacute, there is
less fibrine, although it  generally  exceeds the physiological
 quantity.  In six cases of the sort it varied between 4 and 5.
  If, finally, the articular rheumatism be decidedly chronic, the
fibrine returns to its normal standard.
  To bring this long catalogue to an end, I have yet to point
 out the modifications of the fibrine in certain inflammations of
the parenchymatous tissues, regretting, at the same time, that I
 am unable to furnish more cases in point.   But, thus far, I have
not had the opportunity of collecting them.
  In  two cases of acute  inflammation of the lymphatic gan-
glia of the  neck, with fever, I  have seen the fibrine reach 4.2

  *  The details of this case may be found in my first memoir upon the alte-
rations of the blood, p. 74. 
                 OF THE BLOOD IN DISEASES.              75

 and 5;  one of these cases is  the more conclusive, because the
 blood of the patient, who was bled for another reason, two days
 before the attack of ganglionitis, gave only 2 parts of fibrine.
   In a case, proved by the autopsy to be acute nephritis, this
 element reached the number 7.
   In conclusion, I give  another illustration of the state of the
 fibrine  in  a case of softening of the  brain.  A woman was
 brought to the hospital labouring under a recent attack of apo-
 plexy. Her limbs were paralyzed and rigidly flexed. I had her
 bled, and was struck with finding a larger quantity of fibrine in
 her blood (4.5) than is usually found in simple hemorrhages.
 She soon died, and the autopsy disclosed,  in the right corpus
 striatum, and  around a clot, a red softening of the cerebral sub-
 stance, of small extent, but very distinct.  Inflammation had,
 then, existed around the apoplectic centre; the contraction of
 the paralyzed extremities had indicated it during life, and the
 excess of fibrine in the blood had  added to  the value of that
 sign.   It should also be remarked here, that if the excess of
 fibrine was small,  the inflammatory complication was also
 very limited.
   Since  the commencement of my inquiries, I have  not met
 with a single case of acute hepatitis, a disease known to be rare
 in our climate.  I have several times analyzed the  blood of
 persons affected with jaundice, but found no increase of fibrine
 in any of them; nor yet in a simple case of hepatic cirrhosis.
   The increase of fibrine in  the blood takes place from the
 very  commencement of the  inflammatory state.   I have fre-
 quently had the same individual bled twice ;  the first time, on
 the day previous to the inflammatory attack, and the second
 time, a few hours after its  distinctly marked invasion.   The
 first time, the  fibrine of the blood was normal, the second, in
 excess.   I have, thus far, vainly striven to determine whether
 or not the composition of the blood was modified, before the
 change denoting inflammation appeared in the solids; 1 have
not succeeded, and  my analyses have proved to me  nothing
more than  the simultaneous origin of these two  phenomena.
This serious question does not yet,  however, appear to me to 
76
PATHOLOGICAL HEMATOLOGY.
 be set at  rest; a question, by the  ultimate solution of which
 we must decide, whether in the great phenomena of inflam-
 mation, the source of disease is in  the solids, or in the blood,
 or whether the alteration of the one is not so essential to that
 of the other, as that both must necessarily begin to exist at the
 same moment.  Remark, too, what a variety of beginnings
 belong to  the diseases  ranked as inflammations:  at one time
 there is no interval between a state of perfect heaJth, and the
 invasion of the disease; at another, there is a general uneasi-
 ness, and that slight disturbance of all the functions which we
 call  the "prodrome" of diseases; at another, a well marked
 fever sets in,  from one to three days before the appearance of
 symptoms  denoting a  phlegmasia of some  one of the solids.
 But even where the disease comes on without any " prodrome,"
 it may do  so in one of three  ways: either there is pain, a
 purely local symptom, to open the attack, while the rest of the
 economy seems  unaffected by the local  disorder; or before
 this latter is felt, there may be a violent chill as the only appre-
 ciable morbid phenomenon, and which may last for half an
 hour, for an hour, or even longer;  or else the local symptom
 and the chill may appear simultaneously.  I ought to add that
 this last case  is more common than the two others.  We may
 well inquire whether, when its earliest symptoms are so dif-
 ferent, the starting point of inflammation is  always the same.
 That which  takes place in the case of a burn  proves very
 clearlyt hat,  under the  circumstances, the blood  is modified
 in its composition subsequently to  the alteration of the solid,
 and, inferentially, we may suppose that  it must be so in all
 other inflammations.  The analyses of the blood hitherto made
 would tend to confirm this view, for they have never revealed
 an excess of  fibrine in  the  blood, before the occurrence of in-
flammatory symptoms in the solids.   On the other hand, there
are certainly cases  in which the sensible  alterations of the lat-
ter are so inconsiderable, so variable, and sometimes so ephe-
meral, that it is  difficult to understand how they can be the
cause of such intimate  and enduring changes as have then
taken place in the blood.  Is it not often so in articular rheu- 
OF THE BLOOD IN DISEASES.
77
matism, and is it not remarkable that this is one of the diseases
remarkable for increase of fibrine ?  In all this there are un-
known quantities to determine : there is yet to be discovered
that mysterious  link, whose necessity  is proved by its con-
stancy, and which, in the phlegmasiae, unites the alteration of
the solids with that of the blood. '  Yet, from the simultaneous
character of these alterations, the deduction may still be made,
that what we call  inflammation  is not a disease seated in the
solids merely, that it does not influence the rest of the economy
only by pretended sympathetic radiations, and, that in all these
things, the changes which are then taking place in the blood,
play an important part. An inflammation, then, is not a purely
local disease.  Does the fever which accompanies every acute
phlegmasia of some intensity depend upon the excess of fibrine
contained in  the blood ?*  Observe that there is still an almost
constant and reciprocal relation -to be studied, between these
two facts; for, as  the  fever begins,  the fibrine increases, and
as the fever ceases, the fibrine returns to its normal condition,
yet  the  local lesion may still persist with considerable acti-
vity.  How  many times, for instance, have  I not continued
to find,  by  auscultation, the most  perfectly  distinct signs of
pulmonary hepatization, when, for several days  before, all
fever, and every appearance of reaction between the lung and
the system, had completely disappeared; so completely, that
but for auscultation, one might have  believed the disease at
an end.   And indeed it was so, in this sense, that the lesion of
the lung was only the result, and almost an unimportant one,
of a morbid action that had ceased; thenceforth the fever also
ceased, and  the production of new fibrine, the index of this
process in the blood, no longer took place.  The disease had
once more become entirely local, if indeed such a condition of
the lung deserves the name of disease.   It would  be said, in
the language of some of the schools, that the diathesis no longer

   • At any rate we should be able to explain only the symptomatic fever of
acute phlegmasia^ in this way; for in the pyrexiae the fever is long, and in-
tense, without there being an excess of fibrine in the blood.
                             7* 
78
PATHOLOGICAL HEMATOLOGY.
existed.  But what is meant by this expression?  To point
out the existence of a  general condition of the system  of
the same  nature as the local lesion, and which  causes the
whole  organism to share the suffering of one of its parts.
There  is not, says  Tommasini, an  inflammation, properly  so
called,  without the production of a diathesis; a local irritation
caused by a thorn run into the finger, does not, according  to
this author, become an inflammation, unless, in consequence
of this very circumscribed lesion, the sthenic diathesis should
be established; and it is established, he adds, by the diffusion
of the phlogosis of the vessels around the injured point, to those
of the rest of the body.   This theory is nothing more than the
emphatic announcement of the important fact that the whole
organism  participates in the morbid  operations which seem
confined to a single one of its points.  Who does not see, that
in other words, and in another aspect, it is this same fact upon
which  is founded the law requiring the production of new
fibrine  in the blood, as soon as any solid  becomes the seat  of
an inflammation intense enough to give  rise to  more than
what Tommasini calls a simple irritation?  Is not the excess
of fibrine then produced, the material representative, as it were,
of what Tommasini terms the diffusion of phlogosis ?   Thu£
it is that we reach the same conclusion, in spite of the sugges-
tions of different theories, and of opposite methods of observa-
tion.
   The  formation, then, of an  excess of fibrine in the blood is
uniformly the accompaniment of inflammations of a grade
high enough to  give rise to  fever; but this  fact acquires a
greater importance both as a diagnostic sign, and as an element
of the  doctrine which relates to the production of disease, if
we reflect that it never takes place  unless an inflammation
exists somewhere.  An excess of fibrine in the blood becomes,
therefore, a pathognomonic sign of  such inflammation.
   There is,  however, a circumstance, occurring even during
health  both  in man and the lower animals, which has the
power of augmenting the proportion of fibrine contained in the
blood; I allude to gestation.   But this augmentation, which is 
OF THE BLOOD IN DISEASES.
79
found only at certain epochs of pregnancy, is rather a high
physiological maximum, than even  the  ordinary degree of
pathological increase.   The following are  the results obtained
by M. Gavarret and myself from analyzing the blood of 34
pregnant woman.
  From the first to the end of the sixth month, the blood con-
tained less than its average physiological proportion of fibrine ;
the mean of the fibrine during the first six months being only
2.5; its minimum 1.9 ; and its maximum only 2.9.
  On the other hand, during the last  three months of preg-
nancy,  the  mean of  the  fibrine exceeded the  physiological
mean; it reached 4, and the maximum rose to 4.8.
   And, further, it was found that the increase of the fibrine
had become greatest in the  last month of pregnancy; at this
 period its mean was 4.3 ;  its maximum was not reached until
 the access of labour, and  it may be presumed that this maxi-
 mum was  maintained, if not exceeded,  for some time after
 delivery.  It seems to me that this presumption is supported
 by the results which I  obtained  with  MM.  Gavarret and
 Delafond, by analyzing the blood of sheep  and cows during
 their gestation, and  again  after they had brought  forth;  at
 which latter time these animals furnished more  fibrine than
 before.   (See  the Memoir upon the composition of the blood
 in certain domestic animals.)
    It is then demonstrated that in women, at particular periods
 of gestation,  and in  cows  and sheep,  after parturition, the
 blood  contains  a certain excess of fibrine.  The blood, on
 these occasions, shows a remarkable tendency to assume the
  character of inflammatory blood; and, assuredly  there is mat-
  ter for reflection in  the relation which may exist  between the
  modification then effected in the blood,  and the  development
  of those peculiar attacks, generally of an inflammatory aspect,
  to which women in childbed are so liable. But ought the slight
  excess of fibrine in their blood, at that time, to be regarded as
  a predisposing cause of these  attacks?   If so, this would  be
  such a case as I recently sought, (and observation has not yet
  furnished me with any other) in which  the proper mflamma- 
80
PATHOLOGICAL HEMATOLOGY.
 lory alteration of the blood precedes the signs of inflammation
 in the solids.
   If in the later periods of pregnancy the blood contains rather
 more fibrine than in other states of health, we may understand
 how it happens,  that when blood is drawn from a certain pro-
 portion of pregnant women, its clot should be covered with a
 buffy coat; and  this should occur-the more readily in them,
 because the amount of globules  in their blood often  falls more
 or less below the  normal standard.   Thus, of 34 pregnant
 women whose  blood we examined, in one only  who  had
 reached the end  of her second  month, did the globules, (145)
 exceed the physiological average; this woman was  plethoric,
 and the quantity of her fibrine was only 2.8.  In another case
 of pregnancy of from one to two months, the globules reached
 exactly the normal average, 127.  But  in the 32 others, they
 fell below this point, varying in six cases from 125 to 120, and
 in the 26 other cases from 120 to 95 ; whence it follows that
 there was a commencement of anaemia in all  these women.
 This state of  the blood, is also perfectly in keeping with the
 remarkable pallor, and the degree of puffiness of the face, which
many women exhibit, as soon as they have conceived.  Preg-
nancy, then, which has often been looked upon as a cure for
chlorosis, rather disposes  some women  to the affection while
 that state lasts.
  But enough about  this subject, upon which I have entered
 here only that. I might render  prominent the curious analogy
that exists between the blood of pregnant women, and that of
persons attacked  with acute inflammations.
  Before concluding our notice of the state of the blood in in-
flammation, I wish to direct the attention, for a few minutes, to
the nature of those  alterations which may occur in the solids.
 These products are either the natural secretion of the inflamed
 part, modified both in quality and quantity, or else pus, or some
 of the elements of the blood itself.  I shall, in this place, allude
only to the third form.
  The two principal elements of the blood which are the most
frequently separated from it, in inflammation, are albumen and 
OF THE BLOOD IN DISEASES.
81
fibrine.  But although the albumen of the serum may be given
up by the blood in  many conditions of disease which have no
connection with inflammation, such is not the case with the
fibrine, which does not  leave the blood, in disease, except to
be deposited in the tissue, or upon  the  surface, of organs
whose texture has been altered by inflammation.
   The serum contained in an inflamed solid, moreover, as well
as that which is separated from the blood under any other cir-
cumstances, never exactly resembles the serum of the blood,
in the proportion of albumen it contains.  It may be laid down
as a general principle that  morbid secretions of serum, what-
ever be their origin, are rarely as rich in albumen, as the serum
of the blood;  but, other things being equal, those which most
closely resemble the  serum of the blood  in the  quantity of
albumen they contain, sometimes even equalling  the propor-
tion contained in that  fluid, are such as are exhaled from in-
flamed surfaces. I  shall  demonstrate this in a  subsequent
article upon the state of the blood in dropsies.
   I have  also endeavoured to discover how much albumen
was contained in  another variety of serum, that of a conges-
tive  abscess, and which had suspended in it a large quantity of
pus-globules.  To the  naked eye this  liquid appeared turbid,
and  of a milky hue; but  by filtering, we  easily deprived it of
the globules that diminished its transparency, and then we ob-
tained a liquid  so perfectly resembling pure serum  in all its
physical properties, as not to be distinguishable from it.   This
liquid, thus deprived of the matters suspended in it, we sub-
jected to the ordinary processes, and found  that it contained a
proportion of  albumen nearly equal  to  what exists in the
healthy blood;  a result confirmatory of the principle just now
laid down.
   We learn, besides, from this experiment, that a portion of
the liquid furnished by an inflamed solid is nothing more  than
the serum of the blood, with which is mixed a greater or less
number of those singular  bodies called pus-globules.
  Thus, one effect of the  morbid process, called inflammation,
is to  deprive the blood of a certain portion of its  serum; the 
82
PATHOLOGICAL HEMATOLOGY.
latter, as may be conceived, is not then altered in its essential
nature, but undergoes a change of aspect dependent upon the
admixture  with it of two  new bodies; a principle (fibrine)
which, like the  serum itself, is an emanation of the blood, and
of a matter (pus) which, as  regards its physical properties,
at least, has nothing like it in the blood.
   This process, then, whose nature is wholly unknown, and
which cannot  be  accomplished  without the blood is  over-
charged with fibrine, determines, whenever it takes place, the
elimination of a certain quantity of fibrine.   But this elimina-
tion is not always distinct; it is especially observed, and in the
most evident manner, either  in  the serum formed upon the
skin by the action of cantharides, or  in that which fills the
cavities of inflamed serous membranes.
   It is not only at this day that the spontaneously coagulable
matter found in these liquids  has been considered  fibrinous;
but there was no ground  for its being so called, other than its
property of becoming solid.  To demonstrate  that this  sub-
stance was really fibrine,  I adopted another method of investi-
gation :  I examined, under the microscope, the flakes which the
serum holds suspended, and also the yet soft false membranes
lining the free  surface of inflamed serous membranes, and
found, in both instances,  a net-work precisely similar to that
presented by the fibrine of the blood, and which has already
been described.  Thenceforth I no longer doubted that the
flake-like matter which swims in the liquid produced by blis-
ters, and the false membranes of serous tissues, were really
composed of a substance  perfectly analogous to the fibrine of
the blood.
   I have not yet had an  opportunity of determining whether
or not this net-work, which is so characteristic of the presence
of fibrine, is to be found in the pseudo-membranous layers
which, in certain cases, cover the  mucous membranes.   To
the naked  eye, these concretions are far from resembling the
serous false membranes, and it may be, that under the influ-
ence of  some pathological action, other principles, besides the
fibrine, acquire the property of coagulability.  Who knows 
OF THE BLOOD IN DISEASES.
83
how far the habitual acidity of the mucous membranes, and
of the skin, may favour this coagulation of the albuminous
principles which  are thrown upon the free surface of these
organs, either accidentally, or in consequence of disease ?
  But what is  the  nature of pus, and the mode of its forma-
tion ?  It  is very difficult to resolve  these questions in the
present state of science.  I cannot admit, as has been main-
tained by some, that the globules of pus  are a transformation
of those of the blood ;  there is such a difference in their very
nature, that if  a little ammonia be added  to a mixture of pus
and blood placed in the field of a microscope, the globules of
the blood are seen to disappear, while the globules of pus are
in no wise changed. Nor is the pus formed at the expense of
the serum, the albumen of which is found unchanged, the
pus being merely suspended in, without being, the least in the
world, confused  with  it.   If a mass  of pus be  treated  with
nitric acid or alcohol, granite-like plates are seen, by the micro-
scope, to form, just  as  in all serum treated in  the same way,
but the pus-globules undergo  no change.   May not, then, the
pus-globules be nothing more than a modification of fibrine,
which, instead of reaching the net-work form, has remained in
the serum in that state of granular corpuscles, whose origin
and nature I have already pointed out ?  May not these cor-
puscles, grouping themselves together with a certain regularity,
produce the globules of pus ?   Shall  I say, in favour of this
view, that on  examining with the microscope the sero-fibri-
nous liquid separated from the blood-globules by means of sul-
phate of soda, I happened, more than  once, to see the corpus-
cles that were swimming in the liquid, arrange themselves in
little masses which appeared to me to have the  most perfect
resemblance to  pus-globules?   It would have been quite im-
possible to show any difference between them.   And further,
in the  microscopic examinations of pus, not only are volumi-
nous and  regular globules observed, but  alongside of them is
seen a large number of little  molecules  precisely like  those
which swim in the serum of the blood, and which evidently
approach one another, unite together, and at last become ag- 
84
PATHOLOGICAL HEMATOLOGY.
gregated in rounded masses.   If finally, we examine atten-
tively a well formed globule of pus, it appears to be made up
of a collection of globules placed in juxtaposition, rather than
blended.  It is not, certainly, a body formed in a single piece,
and constituting a perfectly homogeneous whole, like the glo-
bules of the blood.
  Thus two substances  are revealed by the microscope, the
one globular, the other reticular, which characterize the pre-
sence of the morbid process, termed  inflammation,  in  the
solids.   The reticular substance is nothing more than  fibrine
identical with that of the blood; the globular substance is per-
haps this  same fibrine, but altered in its nature, and arrested
in its coagulation.   These two matters  have, moreover, very
different destinies.  One  of them, the reticular, is capable of
assuming organization; vessels may be seen to ramify in it;
it may become a tissue; this  it is which  forms adhesions, or
which, under the name of coagulable lymph, places  itself be-
tween the lips of wounds and  becomes the medium of their
union;  far from causing injury by its presence, it is, then, in
certain cases, the means of reparation to the tissues, and to that
end it lives with their life, and ends by identifying itself wholly
with them.  But such is  not the case with the  globular mat-
ter.  Whether or not it have a common origin with that last
mentioned, certain it is, that it constitutes a product which can-
not remain within the solids without affecting, more or less, the
whole economy ; it is incapable of organization, and reveals
no trace of vitality.   While the organism tends, in some sort,
to assimilate to its own proper use the reticular substance, and
employs it to repair the mischief it originally caused, it strives,
on the contrary, to expel the globular matter, whose presence
is pernicious; so long as it  is  not eliminated the disease per-
sists, and this elimination itself is not always effected without
serious accidents.  But  can the globular matter, instead of
being merely expelled, and after having been conducted more
or less rapidly to those surfaces in  direct communication with
the exterior of the  body, disappear from the  place where it
was formed, and enter  directly into  the  circulatory torrent ? 
OF THE BLOOD IN DISEASES.
85
It is not easy to understand how such large globules as those
of pus can penetrate in mass, by a sort of endosmosis, through
the coats of the vessels; at the most, they could traverse them
only in fragments, and, as it were, in ruins.  But once received
into the blood could they again unite, and re-form new glo-
bules ?  I do not wish to exhaust this question;  and indeed
I do not think it can be resolved  by the facts we at present
possess.  Still,  I  will say that the presence of pus-globules
in the circulating fluid, appears to me, after what I have
seen,  a fact  that can in no wise be contested.  I  have found,
more than once, in the midst of blood-globules taken from the
vessels of dead bodies, globules of pus, well formed, and so
distinctly characterized that they could not possibly be taken
for any thing else.   They were, certainly, neither altered glo-
bules of blood either jagged  or granulated, nor  those white
globules which are found mixed with the ordinary red ones,
and which, besides, could.not  be confounded with globules of
pus.  The following cases are those in which I met with them.
   The first is that  of a person who was brought, dying, into
the hospital of La  Charite, and in a very marked ataxo-ady-
namic state.  At the dissection I found very numerous ab-
scesses  in the  brain, the lungs, the kidneys, and the spleen.
The  blood was everywhere either quite liquid,  or grumous
and like  thin currant-jelly.   I collected a small quantity of
blood from  the crural vein for examination  by the micro-
scope ;  in  the  midst of a great many disfigured and granu-
lated globules of blood, (for such is their ordinary condition in
the dead body,) a considerable number of pus-globules could
be very distinctly made out.   There was nowhere the  least
trace of phlebitis.  This is one of the cases which  the older
writers would have  designated under the  name of purulent
diathesis.   Collections of pus in several of the solid organs,
and  pus in the blood,  were in reality,  the  only lesions  that
 could be detected.
   In another case I found pus in the blood under the following
 circumstances.   A labourer had  been wounded by a violent
 blow on the leg.  He survived this accident but three days,
        8 
86
PATHOLOGICAL HEMATOLOGY.
and died after an intense fever, with delirium, to which suc-
ceeded great prostration, and  coma.  The veins in the neigh-
bourhood of the  wound offered nothing worthy of remark;
but the crural vein was  filled with coagulated blood, without,
however, its parietes presenting any notable alteration.  Ex-
amined by the microscope, this blood showed very small glo-
bules,  and yet, among them could  be discerned, here and
there, globules of pus as perfect as could have been found in
an abscess.  In the other portions of the vascular system, the
blood offered no peculiarities, either to the naked eye, or to the
microscope.   The inguinal glands upon the injured side were
swelled and suppurating.
  I will  cite still  another case, that of a woman who died at
La Charit6 in consequence of a vast psoas abscess.  Indepen-
dently of this, I discovered the following lesions: numerous
purulent collections, like those called metastatic, were in both
lungs: the coats of the  right crural vein were uncommonly
thick, carnified, as it were, and their internal surface rugose
and  uneven.   The blood filling this vein  resembled sanies,
and  the microscope revealed in it a large quantity of pus-glo-
bules.  But, in addition, these globules existed in the blood of
the  heart; a great number  of  them was found in the fluid
blood of the right ventricle,  and  they were again met with,
but in much smaller number, in the blood of the left ventricle,
which was also fluid.   A very small fibrinous concretion was
entangled in the columnae carneae of this ventricle; in those of
the right ventricle a membraniform web was interwoven, such
as is found in the heart after all varieties of diseases, and deaths,
and which is nothing more than a deposit of fibrine spread out
like a membrane, as it is sometimes upon the surface of con-
cretions.   If I speak of it here, it is for the purpose of showing
what degree of coagulability this pus-infected blood retained,
and because I examined this sort of false membrane with the
microscope, and found it constituted, like all fibrinous produc-
tions, by a very beautiful net-work, in whose meshes were
imprisoned globules of blood  and  of pus, as perfectly distinct
from one another, there, as elsewhere.  In this case, too, where 
OF THE BLOOD IN DISEASES.
87
blood and pus were mixed together at such different points of
the circulatory system, I did not find the globules of blood dif-
fering either in number or general aspect, in form or size, from
what they usually are in dead bodies.
   These three cases prove clearly that pus, in the form of glo-
bules, can circulate with  the blood in the vessels, and even
pass through the lungs from the right to the left  side of the
heart.   It seems to me very evident that it was so  in  the last
case : the greater part of the globules, urged from  the venous
system  into the pulmonary artery, stopped in the  ultimate
ramifications of this artery; whence the numerous abscesses
that existed in the lungs; but some of them were able to enter
the  pulmonary  veins, and  reach  the  left side  of the  heart
where I detected them.
   In these various cases, the globules of pus appeared to me
to remain as distinct from those of the blood, as they are when
artificially mixed together in a vessel.  I have often tried this
experiment, and can give my assurance, that unless  too little
pus be  mingled with the blood, the pus, on examination with
the microscope, will be found to exist in it, under  the form of
well preserved  globules: these  even seem, in most cases, to
unite together under the influence of a sort of attraction, so  as
to form little groups apart from the blood-globules, which do
not appear to be in the least altered by the admixture.   I have
also determined by experiment, that on mingling directly pus
with blood,  the latter suffers no  change appreciable by the
naked eye, or by the microscope, nor any in the amount of its
fibrine, so long  as the pus is fresh.  But  such is not the case
when pus, long separated from the body and partially decom-
posed, is mingled with blood; then the blood undergoes re-
markable modifications,  both  in its appearance, and in its
intimate structure, as the following experiment shows.
   I left to itself, from June 6th 1842, to  the 12th of  the same
month, some grumous pus furnished by a cold abscess.  It re-
mained for six days, in the sun, exposed to a high temperature.
At the end of this time it diffused a putrid odour, and had black-
ened the diachylum which covered the vessel containing it. 
88
PATHOLOGICAL HEMATOLOGY.
  I then had bled a patient suffering from acute articular rheu-
matism, and  divided the blood into three  equal portions.   I
mixed with the first its tenth part of the pus which had been
kept for six days, and the whole was beaten together to extract
the fibrine.
  The second portion was left to itself, for twenty-four hours,
without admixture of pus.  At the end of this time it pre-
sented a well formed coagulum covered with a thick buffy
coat, and surrounded by colourless serum.  From the first and
second portions I extracted the same  quantity of fibrine, viz.
two'  The solid part was even a little greater in the first, on
account of the pus which had been added to it.
  Finally the third portion of blood was, like the  first, mixed
with its tenth part of the  same pus, and then left alone.  An
hour after this admixture I found a well formed coagulum, but
without buffy coat, and surrounded with  transparent serum.
The pus, putrid  as it was, seemed, then, to have had no pecu-
liar action on the blood, (unless indeed it prevented the forma-
tion of a buffy coat,) it had not diminished its consistence.
  But at the  expiration of twenty-four hours, the condition of
things had changed: the vessel was filled with a reddish liquid
matter, like that  obtained by adding ammonia to blood.  There
was no solid substance  in this blood, except some fragments at
the bottom of the  vessel, and which  together were  hardly
equal to a twentieth of the original clot.  When subjected to
the microscope,  this liquid mass showed no traces of blood-
globules ;  but a  large number of pus-globules was found  in
it, so that putrefaction had not destroyed these latter.   In the
fragments forming  the debris of the clot, pus-globules were
also discovered, together with some remnants of blood-globules
irregular in form, and of diminutive size.  In these remains of
the clot, the fundamental character of the fibrine was  not lost,
for the microscope  revealed in it a net-work of fibres.
  It is now proper that I should add, that having in other ex-
periments, mingled with blood a tenth part of recent pus, taken
from abscesses one or two hours before, and distinctly alkaline,
in twenty-four hours I found the blood entirely coagulated, 
OF THE BLOOD IN DISEASES.
89
and in no apparent manner differing  from another portion of
the same blood simply left  to itself during twenty-four hours.
These two portions of  blood furnished me the same quantity
of fibrine.
   It is a clear deduction from these experiments, that the in-
fluence of pus upon the blood is far from being the same when
the pus is fresh, as when it has been long enough withdrawn
from the living body, to have become putrid.  Fresh pus has
no appreciable action upon the blood; putrefied pus acts like
ammonia upon the blood, destroying at the same time both
globules and fibrine.   But it is remarkable that this destruction
does not take place immediately.   The contact must have
lasted several hours before the blood begins to present any
traces of alteration.
   These results should incline us to believe, that in  cases of
disease  where pus  happens  to  circulate  in  the blood, the
changes which the latter may experience in its constitution will
vary according to the  qualities of the pus which may chance
to mix with  it: if recent, the pus will leave the blood un-
harmed ; if already old, and altered itself, it may become so
potent a cause of disturbance to the blood, as  to extinguish
life suddenly and inevitably.  But it is very remarkable that
even in the second case, it is not the  globules  of pus which
appear to affect the blood injuriously; I am much more dis-
posed to believe that what then destroys both the globules of
the  blood and the fibrine, is something which is no longer pus,
but the ammoniacal product formed at the expense of the pus
itself.*  And if, as can hardly be  doubted, this ammoniacal
product is that which  remains upon a bistoury that has been
 thrust into a putrid  subject, if it forms the basis of those dele-
 terious emanations which  escape from animal  bodies, either
 dead, or  in dense crowds while alive, we  may understand
 how, in these cases apparently so dissimilar, the blood must
 undergo alterations, identical in their  nature, and  variable
 only in degree; and understand, also, how symptoms of the

   •  The excellent thesis lately presented to the Faculty of Medicine by M.
 D'Arcet may be profitably  consulted in regard to this subject.
                             8* 
90
PATHOLOGICAL HEMATOLOGY.
same order  should  result  from causes which appear so dif-
ferent.  And thus it is that mflammation, the essence of which
is to make the blood more consistent, by increasing its fibrine,
may bring about, remotely, the liquefaction of the blood by
the destruction of its fibrine.  This is what happens, if the pus
created by the inflammation becomes mingled with the blood,
after undergoing a preliminary alteration  and decomposition
within, or without, the  place where it was formed.   But the
disease has then changed its nature, and the inflammatory state
is replaced, or at least, overpowered, by the typhoid state; that
is  to  say, instead  of there  being  more, there  is really less
fibrine in the blood, than natural.   The study of the altera-
tions of the blood comes, then, to confirm one of the most im-
portant principles of pathology, namely, that in proportion as
a disease passes through its  several phases, it is  modified, not
only in its symptoms, but in its essence.   Clinical and thera-
peutic facts,  no less than those furnished by an analysis of the
blood, do not permit our acceptance of the dogma maintained
by Tommasini, that a disease, commenced with one diathesis,
cannot change it during its course; that if sthenic in the begin-
ning, it will  remain so to  the  end, and  that consequently its
treatment should continue  to  be  uniform from beginning to
end.
  I am unwilling to leave this subject, without  saying a few
words touching the  influence of the ordinary  antiphlogistic
treatment upon the blood.
  Amongst the various forms of this treatment depletion holds
the first rank.  I have then naturally to inquire, how far bleed-
ing, repeated  more or less frequently, has the  power of re-
moving the excess of fibrine in the blood, rapidly or gradually.
Now it is found that however repeated or abundant the bleed-
ings, the fibrine increases none the  less, if these  bleedings are
performed in the early stages of an inflammation of some in-
tensity, or, in other words, at the period of the ordinary in-
crease of the disease; on the other hand the inflammation does
not prevent there being found, after each bleeding, a progres-
sive diminution of the globules.  It seems, then, that when 
OF THE BLOOD IN DISEASES.
91
once the blood has set about producing an excess of fibrine,
no matter what is done, a certain time must elapse before this
disposition is exhausted.  Besides, this resistance of the fibrine
to the action of depletions, and the development it acquires in
spite of them, are  perfectly in keeping with what takes place
in the inflamed solid itself, and in the  rest of the organism.
The most copious loss of blood does not effect the immediate
removal of the lesions of the solid; a certain space of time is
always necessary for accomplishing this, and for the extinction
of the fever.  So that the fibrine, the quantity of which in the
blood represents the degree of inflammation, obeys the same
law which makes  the  latter continue for a certain time, and
pass through certain stages.  Let it not, however, be thought
that I deny the utility of blood-letting, when properly em-
ployed, in this class of diseases.   Experience has taught me,
that without removing them suddenly, it often abridges their
duration,  and conspires to bring about a favourable issue.   I
even admit  that if blood be drawn at the very  outset of the
inflammation, while yet there is nothing more than congestion
in the solid, and the fibrine  of the blood hardly above its nor-
mal standard, depletion may stop the progress of the disease,
and, in certain cases at least, render it really abortive.  But if
the  disease be  a  little farther advanced, this will not be the
case:  it is not in the power of art to prevent a well formed
pneumonia from lasting seven or eight days at least, although it
may prevent its being prolonged for a fortnight.   You cannot
arrest a well marked case of acute articular rheumatism within
eight, twelve, and oftener, fifteen or twenty days; but by the
use of blood-letting will more frequently see it arrested within
the last named period, than if depletion had not been used.   I
will add a few words upon  the modus operandi of the agents
called revulsives.
   I do not deny that this term often expresses a real action, by
virtue of which the movement they attract  towards the skin,
or  the digestive mucous membrane, may put an end to that
which disease has developed at another point: I even believe
that one or  more  fluxionary movements may be established 
92             PATHOLOGICAL HEMATOLOGY.

towards  these membranes, which will diminish the activity
with which the fluids tend to the part originally irritated and
congested.   But another influence of these revulsive agents,
and one that has been less noticed, is that which they may
have upon the composition of the blood,  which they must
modify by means of the materials which they extract from it.
Thus a large blister takes from the blood a certain quantity of
its serum ; but, in addition, fibrine is deposited upon  the raw
surface produced by the  action of  the cantharides.  If the
blood should contain  a superabundance of fibrine, would that
be a means of diminishing its excess ?  Or, on the contrary, if
the blister were  large enough, if the resulting  inflammation
were very intense, if, above all, it increased the already exist-
ing fever, would there not result a new cause for the forma-
tipn of an excess of fibrine in the blood, and would not this
cutaneous inflammation, thus  artificially created to diminish
the intensity of another inflammation, and by the sort of influ-
ence it would  have on the blood, augment the morbid condi-
tion which represents the inflammatory state in  the blood,
and is the measure of its intensity ?  As to purgatives, which
are also employed as revulsives, it may be asked what is the
nature of their influence on the blood, according to whether
they chiefly excite the flow of perspiration, of mucus, or of bile,
and what changes of composition  they may occasion in the
blood.  This is undoubtedly an interesting subject for investi-
gation.
                       ARTICLE V.

              Of the Blood in Hemorrhages.

  I do  not intend, in  this article, to treat of the influence
which profuse losses of blood may have upon the composition
of that fluid; I have already spoken of this subject, and have
stated that every hemorrhage certainly lessens the quantity of
the globules, while, on the other hand, it must be very pro- 
OF THE BLOOD IN DISEASES.
93
longed or very copious, to diminish in any appreciable degree
the amount of fibrine.  I propose, at present, to inquire how
far all hemorrhages  are due, originally, to some modification
of the composition of the blood.
   From the examinations I have made of this subject, I be-
lieve  I may conclude that there is a certain number of hemor-
rhages whose cause  cannot be traced  to  any primitive lesion
of the solids, and which are the results of a  change in the
composition of the  blood, consisting in a relative  or  absolute
diminution of its fibrine.
   And let us remember, at the outset, that the ancients ranked
dissolution of the blood amongst the causes of hemorrhage.
But what else is  this dissolution, than a state of the blood in
which it contains less fibrine than usual ?
   Let us also remember  that hemorrhages are  common in
diseases where the  blood contains but little fibrine, such as
typhus  fever and scurvy; that, on the other hand, they are rare
in diseases where there is an excess of fibrine, either positively,
as in  the phlegmasiae,* or relatively as in chlorosis.
   In  the diminution of the fibrine relatively to the globules,
we must recognize the grand condition of the blood favourable
to the  production of hemorrhages; the relation of these two
facts is  so constant, that it seems to me impossible not to regard
the one as the cause of the other.  Let it not be said that the
hemorrhage induces the diminution of the fibrine in the blood;
for, as  I have already stated, the loss of blood must be very
copious to produce that effect, and I have seen the fibrine di-
minish  where the amount of the  hemorrhage  could certainly
not explain that occurrence.  Finally, I may add, as an argu-
ment that appears to me unanswerable, that if the hemorrhage
produced a change of the blood, in the  cases under considera-
tion, the globules should, unquestionably, be found diminished

  * It may be objected that the sputa of pneumonia are almost always
tinged with blood; but I reply that that is not an ordinary hemorrhage.  The
blood,  which, in this disease, is mixed with the expectorated  matter, is lite-
rally the  result of its forcible expression through the parietes of the ultimate
bronchial ramifications. 
94
PATHOLOGICAL HEMATOLOGY.
in a larger proportion, even, than the fibrine;  but this is not
the case, and so far from it, that the globules are most fre-
quently in excess relatively to the fibrine.
  Two very different conditions of the blood, in which the
law of the diminution of the fibrine relatively to the globules
persists, may predispose to hemorrhage.
  The first of these is that in which the amount of globules
has reached the highest limit of the physiological state, or has
exceeded it, the fibrine meanwhile preserving its normal pro-
portion, and standing at least as often below, as above, its
average.  This is what  takes place in plethora, and common
observation teaches us that plethoric persons are disposed to
hemorrhage.   Who is not familiar with their frequent epis-
taxes, and with the relief afforded by them ?   This is because
these hemorrhages infallibly diminish the amount of globules
of the blood, without affecting its fibrine; the equilibrium be-
tween these two elements is thus spontaneously re-established
in these persons, and hemorrhages with symptoms of plethora
are not renewed until an excess of globules is once more repro-
duced along with the blood.
  But  a second condition of  the blood which is  much more
favourable than the preceding to the production of repeated
and profuse hemorrhages, is that  in which the  quantity of
fibrine is really under the standard, while that of the globules
is natural.   I have observed this in scurvy.
  This disease resembles chlorosis, in some respects, and both
have symptoms  in common.  In both  may be remarked the
same feebleness, the same dizziness, the same aberrations of
sensibility, the same dyspnoea, the same palpitations, the same
dyspepsia.   But that which distinguishes scurvy from chlo-
rosis is the readiness  with which hemorrhage occurs in the
former affection, so as to constitute  one of its characteristic
symptoms.  And why  do hemorrhages so constantly take
place in scurvy, so rarely in chlorosis?  Because in the former
there is an alteration of the blood quite different from  that in
the latter.  In scurvy the globules are not  diminished as in
chlorosis; on  the contrary the  fibrine  decreases as we  have 
OF THE BLOOD IN DISEASES.
95
seen it do in typhoid fever of an adynamic or putrid type; a
disease, which not less from its symptoms, than from the alter-
ations it  caused in the blood, had been very correctly styled
acute scurvy, by Bordeu.
  Well marked scorbutic cases are so rare in Paris, that for a
long  time I had to rest contented with mere conjecture con-
cerning the state of the blood in scurvy, and had admitted, as
very probable, that it must contain less fibrine  than natural.
1 have at length been able, by observing the following case, to
satisfy myself that my supposition was correct.
   In the course of April, 1841, a  labourer, forty-one years of
age,  entered my wards at the hospital of La  Charite.  For
three years he had been wearing himself out by the daily toil
of turning a crank in a dark and wet place,  leaning against a
wall from which the moisture was incessantly dripping. About
once in every three weeks he indulged in wine to intoxication.
He slept with seven comrades in a small, badly-lighted, and
worse ventilated, chamber.
   At the  commencement of March, 1841,  he  suffered from
 vertigo, and a continual weariness that he could not account
 for; he felt sore and broken down, and soon was attacked
 with bleeding at the nose, which  recurred every morning.  A
 little later, red spots (as he called  them) began to appear all
 over his body;  these spots became more numerous, and larger,
 and, at the same time, his feebleness made such progress, that
 he was obliged to quit his woik.
    When this patient came under my notice, his trunk, limbs,
 and face, were covered with numerous petechiae, and large
 ecchymoses, which might have been mistaken for bruises; but
 so far from there being such, on the  succeeding days we saw
 others like them forming before our eyes.   The  gums were
 soft, swollen, and bleeding; the epistaxes continued, but spar-
 ingly.  The patient complained of  a general numbness, a
 heaviness of the head, and vertigo; he  begged to be bled to
 put an end to these  symptoms. The powers of digestion were
 still unchanged; there were some palpitations of the heart;
  but no bruit de souffle in the carotids. The pulse was 60, 
96
PATHOLOGICAL HEMATOLOGY.
the respiration  20, the temperature of the  skin  in  the axilla
37.60.  The great predominance of cerebral symptoms, and
the idea that they might be caused by a  sort of congestion,
induced me to  have the patient bled, and  indeed he strongly
desired  it.   I found in  the blood, globules 119;  solid con-
stituents of the serum 86 ; and fibrine only  1.6.
   After five weeks of rest, and substantial food,  and under all
good hygienic influences, this man  regained his  strength, and
the symptoms of which I have spoken had, at least, much im-
proved ; yet a considerable number of petechiae remained upon
his skin, and his gums were still inclined to bleed.  In this con-
dition he went  out on the 18th May.
   The 23d May, he was again attacked with violent vertigo;
his  appetite was lost;  he had a profuse epistaxis, and he
returned to the  hospital on the 2d of June.   He was then ex-
tremely feeble; extensive  ecchymoses covered  his skin, and
the conjunctivae were so infiltrated with blood, that  they pro-
truded beyond  the cornea, and surrounded it like a pad: the
case might have been taken for one of double chemosis.  Blood
exuded from the gums and mingled with the  expectorated
mucus.  I again examined the blood; it contained the same
quantity of fibrine as at first; the globules had fallen to 111;
the  solid constituents of the serum remained at 86, of which
70 were albumen, and 9 of other organic matters.  After some
time the patient became much better, and  went out.*

  . * Nothing is more difficult than the complete and ultimate cure of those
diseases in which the blood is gradually and spontaneously despoiled, either of
its globules or its fibrine. It is well known how easily chlorotic girls relapse,
and how long it is  before their symptoms disappear  entirely.  In older per-
sons, who become  anaemic spontaneously, the reproduction of the blood-glo-
bules is obtained  with greater difficulty.  As regards scurvy, that variety
which arises under the influence of external causes,  generally yields with as
much ease, as soon as  those causes  cease to operate, as  the other variety
which arises spontaneously, often resists every means that may be brought
against it. I have, it is true, seen some scorbutic patients recover, but I have
seen a greater number whose disease, although  at intervals appearing to
improve, never totally ceased, and sooner or later became so aggravated as
 to induce a fatal termination. 
OF THE BLOOD IN DISEASES.
97
  Here then is a disease, in some sort, of the same type with
all those in which more or less frequent and spontaneous hemor-
rhages arise in the same manner, and a remarkable alteration
of the blood accompanies it, to wit, a diminution of fibrine.  I
have found the same kind of alteration of the blood in a case of
scarlatina which terminated fatally on the second day of the
eruption.   In this  case there were petechiae all over the skin,
a bloody exsudation within the mouth, and, at the autopsy, I
found in the respiratory apparatus the anatomical signs of an
extensive pulmonary apoplexy.  The blood contained,  fibrine
2, globules 133,  solid constituents of the serum 81, of which
66 were albumen, and 6, other organic substances.  I  do not
doubt that the fibrine of the blood would be found below its
normal standard in all distinct  cases  of purpura haemorrha-
gica: I can at least declare, that in a case of purpura  whose
symptoms resembled those of  the severest typhus, I found the
blood in that state of fluidity  and dissolution which is the ex-
pression of its loss of fibrine.
   But it is not only in these cases of repeated hemorrhage, or,
if the term be preferred, of hemorrhagic  diathesis, that I have
seen the blood thus impoverished in fibrine.  I have elsewhere
cited cases of cerebral hemorrhage, where also the attack had
 been preceded by a diminution of the fibrine in the  blood ;*
Hence, whether the blood escape from several tissues at the
same time, or whether it find exit through a single  one of
them, facts lead us to admit, in  the second case as in the first,
that some hemorrhages take place because the blood, deprived
 of its natural proportion of fibrine, has, on that account, lost a
 portion of its plasticity.   And thus we are led  to find, in an
 alteration of the blood, the starting point  of certain  morbid
 phenomena, the cause of which is usually referred  to a lesion
 of the solids.   The cases in which the  fibrine is only dimi-
 nished relatively to the globules in excess, belong, by virtue of
 their symptoms, to the class of hemorrhages called active, and
 the cases in which the fibrine is  really diminished belong to

          • First Memoir upon the alterations of the blood, &c.
        9 
98
PATHOLOGICAL HEMATOLOGY.
that of hemorrhages called passive.  A somewhat minute  in-
vestigation of the alterations of the blood lends a new support
to this ancient classification, which though inadmissible into
certain theories, is not the less essential, both in therapeutics,
and in clinical instruction.  In spite  of  every effort, it will
never be possible to attribute identity of cause and nature, to
the hemorrhage of a plethoric, and that of a scorbutic indi-
vidual.
   I have  abundantly demonstrated,  that the most usual im-
poverishment of the blood, that which results from the mere
diminution of the globules, is not a  direct cause of hemor-
rhage : yet it happens, from time to time, that hemorrhage is
observed  to come on, and to recur with disastrous obstinacy,
in persons who have suffered from  excessive loss of blood;
but this fluid is then so far exhausted, that after having lost a
great part of its globules, it  has also  parted with  much of its
fibrine.   When this latter condition exists,  hemorrhages may
take place; so that their occurrence is connected with the last
degree of impoverishmentof the blood, not because the globules
are then greatly diminished, but because the fibrine has, in its
turn, given way.   Besides, when blood enough is taken from
an animal to  destroy it, and this blood is divided  into several
portions for separate analysis, the fibrine is found less abun-
dantly in  the portions last drawn, than in the first.  Profuse
hemorrhages may, then, exhaust the blood  of its  fibrine, and
this explains  how it may happen, that towards the  end of a
very considerable  hemorrhage, the blood  may escape-  from
other outlets  than those from which it at first issued.   I  re-
member, for instance, having seen a young man whose whole
cutaneous surface was covered with petechiae, during the con-
tinuance of a copious epistaxis which could not be arrested;
although, until that time, he had never had such symptoms.
These facts being known, we can conceive how a hemorrhage,
which has exhausted the system by its copiousness, and by its
frequent  returns, may find a cause of persistence and relapse
in the new condition of the blood which it has created. Hence,
one of the dangers resulting from large depletion resorted to 
OF THE BLOOD IN DISEASES.
99
for the arrestation or prevention of hemorrhages;  it may, from
its excess, have the effect of perpetuating them or of bringing
them back.
  Hemorrhagic blood, as  regards its physical properties, does
not differ from that of the  pyrexiae.   It never presents  any
buffy coat, without inflammatory complication.   The  clot is
generally large, and never small,  except  in  those cases of  ex-
treme poverty of  the blood of which 1 spoke last.  It is more
commonly remarkable for considerable softness, and when the
hemorrhage depends on a very great diminution of fibrine, the
blood may be so little coagulable  as hardly to form a veritable
clot; or it may happen that, instead of this  latter, there is no-
thing in the vessel containing  the blood, except some discon-
nected lumps suspended in reddish serum.  This is that state
of dissolution of the blood of which  I have already spoken
under the head of the pyrexiae, and which exists, more or less,
in all the  diseases characterized by a general disposition to
hemorrhage.
   I have already  had occasion, in several places in this work,
to insist upon the relation which may be shown between the
dissolved state of  the blood, and  certain morbid phenomena ;
this  is one of the most important  facts in medicine, a fact very
carefully studied by the observers of preceding ages, and from
which the exclusive  solidist doctrines of our day had entirely
diverted the attention.*   I have  shown  that  this state of  dis-
solution of the blood uniformly coincided with a diminution of
the quantity of fibrine.  But is this the ultimate alteration we
are permitted to arrive at ?  Before the  fibrine decreases, has
there not been some other change of composition in the blood,

  * Let me here be allowed to remind my readers, that in a work published
in 1823 (Clinique Medicale, t. I.) I had admitted and  described this state of
dissolution of the blood in certain cases  of low fever,  and that I had pointed
it out as capable of playing a part in the production of several of the symp-
toms of these diseases, and especially of the hemorrhages which so often ac-
company  them.  The investigations of  M. Magendie have, more recently,
thrown light on  this important question of etiology.  (See his Legons sur les
phenomenes physiques  de la vie, 1837.) 
100
PATHOLOGICAL HEMATOLOGY.
 of which the depression of the fibrine below its normal ave-
 rage is itself only the consequence ?  Upon this subject some
 facts may be cited.   It may be remembered that on throwing
 into the veins of living  animals, as M. Magendie has also re-
 cently done,* a concentrated solution of subcarbonate of soda,
 an almost fluid blood was found in the  bodies of these ani-
 mals when  dead, and that, during life, their symptoms were
 analogous to those  observed in diseases, in which the older
 writers  admitted a state of dissolution of the blood.   It may
 also be remembered that some authors declare, that they have
 found an excess of alkaline matters in the imperfectly coagu-
 lated  blood of persons who died of low fevers or scurvy.
 I may also  state  that in the investigations which I am now
 pursuing in regard to the variations in the proportions of the
 inorganic constituents of the blood,  I have  found,  amongst
 other things, that the blood most highly charged with free
 alkali belonged to the scorbutic patient whose history I have,
 a little while ago, related.  This is a result analogous to that
 announced by M. Fr6my, several years ago.
  The different virulent and miasmatic substances which, on
 being introduced into the blood, diminish its coagulability,
 may, then, act  upon  the fibrine like the alkaline substances
just alluded to.   Thus, too, the venom of the viper may act,
 which, according to Fontana, produces  a dissolution of  the
 blood.
  It has been said that extreme agitation of  the nervous sys-
 tem may deprive the blood of its power to coagulate.   Accord-
 ing to  several observers, a similar effect may be produced
 by a strong  moral emotion, a concussion of the brain, the de-
struction of a certain portion of the spinal marrow, or a violent
blow upon  the pit of  the stomach affecting the nervous plex-
uses of that  region.   If facts of this class were  appropriately
verified, they would, doubtless, be of the highest importance:
for they would show that the nervous system  exerts a power-
ful influence on the constitution of the blood, and that, conse-
• Magendie, t. II, p. 316. 
OF THE BLOOD IN DISEASES.
101
 quently, a lesion of innervation may deteriorate the blood, just
 as an alteration of the blood may modify the nervous action.
 For the very reason that such facts may have extensive bear-
 ings, we are unwilling to receive them at present, and we wait
 until new facts have stamped  them with their proper value.
 Professor Dupuy of Alfort announced  that by dividing the
 pneumogastric nerves in horses, the blood of these animals
 lost its property of coagulating.  But, as it seems to be the fate
 of  our science that it shall appropriate no truth that has not
 been, as it were, purified, by the test of contrary facts, the
 value of these experiments has been lessened by others of Dr.
 Mayer, in which,  this savant, having tied the pneumogas-
 tric nerves in living animals, found that, uniformly, the blood
 had coagulated  throughout the whole pulmonary circulation.
 These facts require a new examination.  Nor shall we receive,
 without additional  proof, certain  other  allegations, already
 old, from which it would result that the blood is found in a
 state of dissolution  in animals  killed immediately after being
 violently driven.
    Whatever may be the truth  regarding  the number and the
 nature of the causes which render the blood less coagulable, it
 is not the less certain that there are some diseases  in which
 the blood shows a  strong tendency to dissolution, while there
 are others in which the blood  becomes more coagulable.  A
 learned Italian physician,* Bufalini, even regarded these two
 states of the blood of such importance, as to make use of them
 for dividing all diseases into two great classes:  to one of these
 he assigns as cause what he terms the phlogistic process, and
, to the other an  opposite state of the  system which he desig-
 nates by the term process of dissolution (processo dissolutivo).
 This division is  equivalent to that which I have admitted, into
 diseases with an excess of fibrine in the blood, and those with
 less than the normal quantity of this principle ; for in the latter
 there is evidently a cause whose effect is, necessarily, to make
 the blood less coagulable.

   * Bufalini, Fondamenti di patologia analitica, Pesaro 1830, vol. ii, p. 327.
                             9* 
102
PATHOLOGICAL HEMATOLOGY.
   I cannot here refrain from a short discussion of a historical
question, long  ago proposed by Grant.*   This author, who
practised medicine, and wrote towards the close of the last
century, suggested the inquiry whether the peculiar hygienic
condition of the people of Europe before  the eighteenth cen-
tury,  must not have caused  them to be frequently attacked
with  diseases, one of whose principal elements, if not their
starting point, was a state of dissolution  of the blood.  It is
certainly very remarkable that the observers of preceding ages,
constantly speak of dissolved and incoagulable blood, in their
histories of epidemics.   I readily admit that the theories then
prevalent may have contributed to make this state of the blood
appear more  common than it really was.   I know very well
that there is more than one cause of error to be avoided in this
case; that, during life, blood may seem less disposed to coagu-
late, merely because it has not run well from the vein, or been
received in a proper vessel.   I also  know that  blood which
has coagulated, as usual, soon after the extinction of life, will
subsequently become  fluid, and that  more or less speedily ac-
cording to the temperature, after some degree of putrefaction
has commenced in the body;  I admit that these circumstances,
and  several  others, may  have  been overlooked more than
once, and that blood has been regarded as dissolved by disease,
when it was so only from some accidental cause.   Neverthe-
less, all the circumstances just enumerated were as well known
by the ancients, as by ourselves; and if they have sometimes
taken no account of them, it appears to me difficult to suppose
that they should always have overlooked  them.  Besides, in
some histories of epidemics, they are very careful to say that
the blood had not the same aspect in the different stages of the
disease, and that, for example, it formed a distinct clot  at the
commencement, while, at a later period, it hardly coagulated
at all.   This  record of the changes experienced by the blood,
in proportion to the progress of the malady, gives a great value
to these descriptions.  At  an epoch nearer to our own  times,

  * Grant, Recherches sur Usfievrts, LefSbure's translation, vol. I, p. 276. 
OF THE BLOOD IN DISEASES.
103
  Sarcone,* in his history of the epidemic of Naples, has spoken
  of the difference between the blood drawn at the commence-
  ment, and that drawn towards the termination of the disease.
    " The blood," says this author, "was tenacious and buffy
  during the first week, and the first days of the second; at the
  end of the second week, its aspect changed, and it appeared
  to be more distinctly altered ; the clot could be easily divided ;
• a slight pressure was sufficient to break it up. . . .; lastly, these
  alterations still increased in the course of the third week, and
  especially that tendency  to dissolution which appeared at the
  close of the  second week.  The blood, drawn from a vein,
  was converted into  a thin, black coagulum, swimming in a
  dirty and bloody serosity."t
    The  disease in which Sarcone observed this alteration of
  the blood, is one of the last remnants of those great epidemics,
  which continually prevailed in Europe during the middle ages,
  and whose incessant re-appearance seemed attributable to the
  bad ventilation and food peculiar to those times.   In those
  epidemics, which, indeed, often  become endemics, nothing was
  more common  than to observe gangrene, hemorrhage  from
  various parts, extensive ecchymoses, or thousands of petechiae
  covering the skin, while  the general symptoms of our typhoid
  fever developed themselves with a high  degree of intensity,
  and the greatest rapidity.:}:   These pyrexiae, with their assem-
  blage of dangerous symptoms, and especially their hemorrha-

    *  Sarcone, Systematic account of the diseases observed at Naples during
  the year 1764, translated [into  French] by Bellay, vol. 1.
    -f- Huxham (treatise on fevers) has, in his narrative of the epidemic fever
  of Plymouth, described a much more complete dissolution of the blood than
  that mentioned by Sarcone.  The blood of the  patients, seen by Huxham,
  did not even present a distinct coagulum; the vessel appeared to contain
  nothing but a brown liquid, at the bottom of which was deposited a sort of
  reddish powder, formed by the separate particles of what should have been
  the clot.
    +  This is not the place to enter into detail as to the nature of the hygienic
  influences, which even at a period not very far distant, gave birth to and
  maintained in Europe those general diseases in which the alteration of the
  blood seems to play so important a part. Even men unfamiliar with the 
104
PATHOLOGICAL HEMATOLOGY.
gic form, rarely appear in these  times, and, when  observed,
only as sporadic cases.  Scurvy, as  an endemic  disease, has
also disappeared, and now a few cases of it only are seen.   This
disease, the cases of which were formerly so numerous in Paris,
can hardly be said to exist there at present, except by the
traces it has left.   But these different affections are, as it were,
the external  manifestation of the internal condition of the
blood; we must therefore  admit, that  in  consequence of the •
change in the nature of the influences which necessarily act
upon men, the blood, which receives before the solids, the im-
pression of the greater part of these influences, must  present
changes in its constitution proportioned to those undergone by
the agents  which operate  upon it.  It would appear,  then,
that there must have been a time when a very peculiar consti-
tution of the blood engendered maladies, which, in  certain
respects,  may have differed from those now observed, and
may not have required the same treatment.   And thus it is,
that at different periods of the existence of our race, and
through the diversity of influences to  which  it may be  sub-
jected, diseases of very different types may  arise, and undergo
changes in  their essential nature which  are revealed to us by
the specific character  of  their symptoms.   This  too, is one
amongst  many reasons,  why,  according to the  times, some
theories may be received with peculiar favour, and explains

practice of  medicine were, themselves, struck by it.  Erasmus, the philoso-
pher, who  flourished towards the close  of the sixteenth century,  wrote
that, in his day, the inhabitants of London were every year, from spring
to harvest, attacked by a malignant fever, which committed the greatest
ravages in  that city, and especially  amongst the poorer classes. I have
been struck with the following details given by Erasmus of the causes to
which he attributes this fever.   " The supply of water," he says, " fails the
inhabitants; they have to seek it at a great distance from the  city; the river
water is carried upon their backs, and is so dear that the poor cannot pro-
cure enough of it to wash themselves, and keep their houses clean.  These
houses are  of wood, and very cold in winter, which makes it necessary to fill
the  rooms with straw.  But as  this cannot  be  often renewed, it becomes
spoiled, and very injurious."  I find this passage in Grant, who quotes it,
(vol. i, p. 288, op. cit) 
OF THE BLOOD IN DISEASES.
105
 how the development of these theories may be favoured  by
 the very nature of the facts observed.
   The dissolution of the blood has been regarded, at other
 epochs of our science, as connected with another state, which
 was held to be very common during the empire of the old
 humoral doctrines, I mean putridity;  and as, in our day, this
 term has been revived by some persons, it is well to ascertain
 its meaning.
   As long as the blood circulates in the living vessels,  it js  in-
 admissible to suppose that it can undergo a real putrefaction.
 Yet there is a certain number of diseases in which, after death,
 every part of the body, but especially the blood, much more
 speedily presents the signs of putrefaction, than in others, and
 these diseases are precisely those in which the blood has lost
 its coagulability during life.   Independently of this common
 character, they have all a peculiar aspect; their ordinary phe-
 nomena being rapid prostration, fcetor of the  excretions, and
 a tendency to hemorrhage, and gangrene.   These the ancients
 considered  as signs of the putrid state; but they are nothing
 more than signs of the diseases in  which  the spontaneously
 coagulable  matter of the blood is  more  or  less diminished.
 The rapidity with which putrefaction after death is observed
 to take place, in these cases, simply depends, perhaps, on the
 tissues being more  promptly impregnated with blood,  on ac-
 count of its fluidity, which  allows it to transude through the
 coats of the vessels very soon after "the cessation of  life.  Let
 us also remark that, in the language of Boerhaave and Hux-
 ham, the  phrases dissolved state and putrid state were sy-
 nonymous.   So that, in their numerous treatises upon diseases
 which they  called putrid, the older  writers have  done no
 more than transmit  to us their observations and  their hypo-
 theses touching  that extensive class of maladies, in which the
 blood does not  contain  its normal  quantity of fibrine,*  and

  • Schwenck thus  describes the qualities of the blood in putrid diseases:
" In morbis putridis, dissolutio cruoris advertitur, et a vena emissus  sanguis
non coagulatur." (Schwenck, Hxmatologia, p. 129.) 
106
PATHOLOGICAL HEMATOLOGY.
these, moreover,  they set in opposition to  inflammatory dis-
eases,  just- as our  modern  investigations  authorize  us  still
to do.

  Long before Schwenck, Fernel had also  noticed the absence of coagula-
tion in the blood as  one of the fundamental characters of putrid diseases.
Upon this subject he expresses himself thus:
  "Sanguis, qui per  febres putridas detrahitur, saepe  animadvertitur putri-
dus, adeo ut nee sibi  cohaerere, nee concrescere queat, omnibus scilicet ejus
fibris nutredine consumptis." (Fernel, Defebribus, cap. v.)
  In a very remarkable  work of  Huxham, entitled " An essay on fevers, and
on the different kinds of fevers which depend on the constitution  of the blood,"
there  is a  chapter whose title is, " On the dissolved and putrid state of the
blood,-" and there Huxham has recorded a very interesting case, which ap-
pears to me eminently fitted to show the identity of nature of those diseases
formerly called putrid, and those in which the blood has  been proved, by
analysis, to be spontaneously deprived of a certain quantity of its fibrine.
  The subject of this case was a surgeon, who in October 1741 was  seized,
without known cause, with alternate rigors and flushes of heat, a weak pulse,
loss of strength  and  appetite; and heavy respiration; he continued at his
business in spite of the fatigue he experienced.  Four or five days after his
seizure, Huxham met him at a patient's house, and observed that his breath
was foetid.  Two days after, he being at  another patient's house, suddenly
fainted.   When  he came to himself several livid and violet-coloured spots
were observed on his hands and neck.  On the way home, he fainted several
times.  The disorder increased every moment; he had extreme languor, and
great oppression, with continual sighing; his breath was now insupportably
foetid, blood leaked from his gums, and a great many livid, violet, and  black
spots appeared all over his body,  on the trunk, as well as the limbs.
  Huxham continues the narrative as follows:
  " He was bled  to about 3xii from his arm, but this gave him no manner of
relief, the  oppression, sighing, fainting, and anxiety continuing as bad as
ever, nay rather increasing;—a violent hemorrhage also broke forth from his
nose;  which continuing from both nostrils, he was bled again to 3x about
twelve hours after the former bleeding:—neither did this give him any relief,
but increased his weakness considerably, and he continued as anxious, rest-
less, and oppressed as ever, without even  the  least sleep.   The blood now
not only issued  from his gums and nose, but.....in a surprising manner
likewise dropped, though slowly, from the  caruncle of  one of his eyes; and
several livid pustules on  his tongue, and within side his lips, broke, and dis-
charged a bloody, thin matter very copiously.
  " The hemorrhage being somewhat restrained, a bloody dysentery came on
with severe gripes, and excessive faintness, and he was still exceeding rest-
less and very feverish: his  pulse now intermitted every sixth or eighth pul- 
OF THE BLOOD IN DISEASES.
107
                           ARTICLE VI.

                   Of the Blood in Dropsies.

   It is at present, generally acknowledged that,  while some
 forms of dropsy depend upon certain alterations of the solids,
 there are others again whose point of departure must be sought
 for in an alteration of the blood.  It has been asserted also in
 rather a vague way that  serous effusions might be the conse-
 quence of an  impoverishment of the blood,  or of what  has
 been called hydroaemia.  This  opinion, I  am  now about to
 examine.
   And in the first place, we  may understand  by the expres-
 sion, impoverishment of the blood, very different conditions of
 that  fluid.   The blood  may really have lost  somewhat of its
 accustomed  richness, from  its containing either  less  fibrine,
 fewer globules, or less  albumen than usual.   In  these three

 sation, and then fluttered on  again vastly quick;  he had likewise a constant
 tremor and subsultus.  The  hemorrhage all this while continued  from one
 part or other, and when stopped at one place forthwith burst out at another;
 so that his urine now seemed tinged with blood.... Soon after he  was bled
 the second time, I was sent  for, and  hastened to him. I found him in the
 manner described, under an inexpressible anxiety, yet quite free from a de-
 lirium, though he had  no manner  of sleep for several days and nights: his
 tongue was vastly black, and his breath and stools insufferably stinking.
  "I found that neither of the portions of the blood that had been drawn (not
 even the first) had separated into crassamentum and serum as usual, though
 the former had  stood so many hours; but continued as it were half coagu-
 lated,  and of a bluish livid colour on the top:—it was most easily divided by
 the slightest touch, and seemed a purulent sanies rather than blood, with a
 kind of sooty powder at bottom.  His hemorrhage still continued, especially
 from  the tongue, lips, and gums, with a perpetual dripping of bloody ichor
 from  the nose; with never  ceasing tremblings, subsultus tendinum, and al-
 most  continual faintings."—[An Essay on fevers, &c, by John Huxham,
 M.D.,  3d edition, London, 1757.]
  Huxham put this patient on the use of small and repeated doses of Peruvian
bark, and various aromatic and astringent substances; he endeavoured to
nourish him moderately, and succeeded in gradually restoring him to health. 
108
PATHOLOGICAL HEMATOLOGY.
cases, it should be equally regarded as impoverished; do they
all then give rise to dropsy ?
  Diminution  of  the  fibrine,  to  whatever  extent  it  may
have gone, does not certainly  produce, as one of its conse-
quences, the formation of this disease.  In those morbid con-
ditions in which the blood has lost no other principles than its
spontaneously coagulable matter, we do not see effusions into
the areolae of the cellular tissue, any more than into the serous
membranes, occur as  an  ordinary phenomenon.  If these
effusions are produced  in that condition, it is the exception;
and it becomes necessary,  consequently, to seek some other
cause for them than  the  diminution of  the cipher of the
fibrine.
  Is the diminution of the  globules, which, however slight,
brings with it as a necessary result, the hydroaemic condition,
a cause of the production of dropsy any more than the pre-
ceding ?  It is generally thought to be, and yet it seems to me
that a somewhat rigorous observation  does not permit us to
adopt this opinion.
  Were it true that dropsy was  the ordinary consequence of a
diminution of the globules of the blood, it ought to follow from
this that the  greater number of chlorotic  patients, especially
those  who  have  the disease in  a marked manner, should
sooner or later become  dropsical.   But, this  certainly is not
the case.  I have never seen the  serous cavities filled with
fluid in cases of simple chlorosis, nor have I ever  observed a
true anasarca; at most we may find in some chlorotic patients
slight oedema around the malleoli,  or  slight  puffiness of the
eyelids, and that is all!
  Neither have I observed  dropsy to occur in men attacked
with spontaneous anaemia, who, like chlorotic girls, had but a
very feeble proportion of globules in their blood.  I have said
elsewhere that  there is  a kind of cachexia produced by the
prolonged operation of saturnine emanations, a cachexia also
characterized by  a  great diminution  of the  globules of the
blood.   I have treated  many patients of this kind at La Cha-
rite, and have  never observed dropsy in any of them. 
OF THE BLOOD IN DISEASES.              109
  Phthisical persons, in whom there generally exists a rather
low cipher of globules, do not  become dropsical, unless the
pulmonary tubercles coincide with some other affection, whose
effect is to give rise to serous effusions, as for example, disease
of the heart, liver, or kidneys.
  With the exception of chlorosis, I have rarely seen the glo-
bules descend to so low  a cipher, and  the  anaemia become so
marked  as in individuals exhausted by some chronic organic
disease of the stomach.   In such cases there existed, in conse-
quence of this considerable diminution of the globules, a well
marked hydroaemia, and yet they presented me no trace of
dropsy.   In women labouring under cancer of the uterus, the
blood comes  insensibly to contain but very few globules, in
consequence of the hemorrhages which many of these persons
suffer from almost constantly; yet, we do not find dropsy super-
vening in  these cases, any more than in the preceding;  there
was, for example, no trace of it  in one of these women, whose
case I have elsewhere cited, and whose blood contained only
21 in globules.*
   Here then are many  different cases in which, however im-
poverished the blood may have  become in consequence of the


  *  I am not ignorant of the fact that, in some women who have cancer of
the uterus, we find not unfrequently asdema of the lower extremities, or serous
effusion into the abdomen;  some  have  anasarca  even.  But, on the one
hand, these various dropsies are not in such cases in proportion to the abun-
dance or frequency of the uterine hemorrhages; and on the other hand,
whenever I have met with them, I have been able  to account for their pre-
sence by the existence of different alterations of the solids.  Thus the oedema
of the lower extremities was explained to me  by tumours  developed in the
pelvic excavation, which compressed the crural veins, or by coagula  formed
in those veins during life.  Cancerous  masses, deposited in front of the
vertebral column, a  disease of Ihe liver,  a chronic peritonitis, tumours ob-
structing the circulation in the superior vena cava, or in the axillary veins,
accounted to me for the occurrence whether of ascites, or of serous infiltration
into one or both of the superior extremities.  In the same way when  cancer
of the stomach is accompanied by ascites, we may affirm that the disease is
 not simple; and, if cancerous tumours do not exist in the peritoneum, we
may be almost certain that the liver has participated in the degeneration of
 the stomach.
        10 
110
PATHOLOGICAL HEMATOLOGY.
 diminution of its  globules,  dropsy does not result.   But, in
 all these cases, the blood has been slowly and gradually de-
 prived of its globules.   I have  now to examine another con-
 dition, that in which the  diminution of the globules  has oc-
 curred rapidly and almost instantaneously: thus it happens
 in persons who lose  suddenly a very large quantity of blood.
 Do we see dropsy  establish itself more readily in such  a case ?
 I do not fear to affirm  that, even in this case, serous effusions
 occur only as an  exceptional condition;  they are observed
 much less frequently than has been asserted after even very
 abundant bleedings; let us  remark however that this cause
 produces them somewhat less rarely in children than in adults
 Neither  do excessive  spontaneous hemorrhages necessarily
 give rise to dropsies: I will cite as proof of this the case of  a
 young woman who, a  few days before her entrance  into La
 Charite, and in good health up to that time, had  had, in conse-
 quence  of an abortion, a metrorrhagia so profuse that she
 resembled when I saw her, a  chlorotic person in the most
 advanced stage; a very strong bruit de souffle could be heard
 in the heart  and two  carotids.   This woman  was so feeble
 and exhausted that it seemed as though she would expire in
 some of  the continual  syncopes which  she fell  into.  During
 the following days, her strength  improved somewhat; she
 retained  however the paleness of death, and could  not as yet
 make a movement without being threatened with fainting.   It
 was necessary for two months to elapse before she could begin
 to leave  her  bed, and  yet at  the end of this time she still re-
 tained a  bruit de souffle in  the heart and carotids.  During
 these two months,  and  afterwards,  I sought with care  for the
 slightest traces of dropsy in her case, but discerned  none; the
pressure  of the finger  produced not the slightest mark upon
the malleoli.   She  had  merely, as some chlorotic patients have,
a slight swelling of the  face, which is not oedema, for the skin
in such conditions does not retain the impression of the finger.
  I have seen so many cases like the preceding  that I do not
hesitate to assert that dropsy does not generally result, when
the impoverishment of the blood depends simply  upon the 
OF THE BLOOD IN DISEASES.
Ill
diminution of its globules.   Consequently, when it does occur,
we should  reasonably infer that the blood must, at the same
time that it has lost some of its globules, have  become im-
poverished in some other  mode; and  as it is not the diminu-
tion of its fibrine which can bring on this result,  we may ask
ourselves whether  it be not owing to  a diminution that shall
have taken place in the albumen of the  serum.   Let us see
what facts will reveal to us on this point.
   There is a disease which, at the same time that it  adds to
the ordinary principles  of  the urine a certain amount of albu-
men, lessens more decidedly than any other the cipher of the
albumen of the blood.  Now, in this  disease, which has the
kidney for its seat, one  constant phenomenon appears  sooner
or later; this is dropsy, which, at first  partial and slight, ends
by becoming general  and very considerable.  This dropsy
augments in  proportion as there escapes from the kidneys a
larger quantity of albumen, and as we find less of it in the
blood.   Hence there are three facts which co-exist, disease of
the renal parenchyma, diminution  of albumen in the  blood
and dropsy.  Is it the  disease of the kidneys which produces
the dropsy directly, as does an affection of the heart or liver ?
This cannot be  admitted,  for it is  manifest  that the kidneys
exercise  an influence upon  the formation of the dropsy but
indirectly, and in so much  only as the change that has occurred
in its texture allows it carry off from  the blood  its albumen.
It is then the diminution of this latter, in the serum  of the blood,
which  must be  regarded  as the  true cause of  the  dropsy.
Whatever then  be  the cause which makes this  albumen di-
minish, dropsy will result.   And moreover, it is not necessary,
in order  that this effect be produced, for the globules to  di-
minish at the same  time with the albumen.  In Blight's dis-
ease, there is at  first diminution of the cipher of the albumen
alone, and the globules do not  begin  to decrease until later,
when dropsy already exists.
   Diminution of the albumen of the blood has, up to the pre
sent  period, been met with in man  only in cases where this
fluid has first lost a portion of its albumen through  the kidneys 
112
PATHOLOGICAL HEMATOLOGY.
I have shown in another work,* that, in animals of the sheep
kind, the diminution of albumen may occur, independently of
the preliminary discharge of this principle by the urine ; serous
infiltrations also result from it occasionally in these animals,
which  helps to prove that their production is not in  imme-
diate dependence upon the disease of the renal parenchyma;
but sheep in this case always have entozoa  in  the  biliary
duct.   Is this  then, a cause of the loss of albumen from the
blood of those animals ?  We do not then as yet possess any
well established case proving that the  albumen, like the glo-
bules and fibrine, may spontaneously diminish in the blood, to
an extent sufficient to produce disease.   Nevertheless we have
a right to affirm that there is but one kind of change of com-
position of the blood which results necessarily in the produc-
tion of dropsy, and this  alteration is the  diminution of the
albumen; consequently, whenever we  see  dropsy arise from
what we suppose to be some modification experienced  by the
blood, we ought naturally to seek whether  this fluid has not
lost a portion of its albumen.  Besides, it is not only from an
excess of watery particles in the  blood, that ser6us effusions
are formed; for, if this were true, as I have before said, every
chlorotic person should  become  dropsical, whereas, we see
dropsy on the contrary, depending on another kind of altera-
tion of composition of the blood, one in which it does not con-
tain a great superabundance of water.
  The dropsy which occurs towards the end of certain cases
of scarlatina,  seems to me equally to recognize  as exciting
cause a diminution of the albumen of the  blood; for  in this
species of dropsy I have always found  that the urine had be-
come  albuminous.
  We  sometimes see individuals who, having been exposed
to some sudden! cause of  cold, are attacked  a few hours  after
with anasarca.   This  accident, somewhat rare in our climates,
is common on the contrary in equatorial regions.   Upon what

  * Memoire sur la composition du sang chez quelques animaux domes-
tiques. 
OF THE BLOOD IN DISEASES.
113
depends this kind of dropsy ?   I long accounted for it by sup-
posing that the sudden suppression of the cutaneous function
of transpiration rapidly produced a superabundant exhalation
of serum  into the areolae of the cellular tissue  and the serous'
cavities.   But a fact that I have recently observed permits me
to explain otherwise  the formation  of this kind of dropsy.
This fact is the following:
  A young man, previously in  good  health and strongly con-
stituted, enters the hospital of La Charite with considerable
anasarca  and commencing ascites.   He relates to me that, a
few days  before,  being abed and asleep, some of his comrades
poured upon him a pot of cold urine, while he was in a state
of perspiration.  He  got up  naked  in order to pursue them,
and was very much chilled;  he remained, said he, as though
frozen.  From the day following this occurrence, he began to
perceive a slight  degree of swelling, which rapidly augmented.
I examined the urine of this patient,  and found it albuminous.
I concluded from this that the blood had been deprived by the
kidneys of a certain  amount of its albumen, and in this way
accounted to myself for the formation of the dropsy.  It is then
upon the  kidneys that the action of the cold had fallen.  This
dropsy was not, moreover, of long duration ;  at  the end of a
fortnight, the cure was complete.
   Cases of dropsy following insufficient alimentation have been
cited, and Dr. Gaspard has even reported a true epidemic of
this kind, that prevailed in 1816, through several departments
 of the interior of France, as the result of a great scarcity which
 had afflicted those districts.*  The  inhabitants had been re-
 duced to seek their  food  among the  roots and  herbs of the
 fields, which they cooked, etc.  A large number of them be-
 came'dropsical.  History informs us that the same thing has
 occurred  at other epochs under the influence of the same cir-
 cumstances.  It is probable that, in  these singular  epidemics,
 the insufficiency of alimentation must have modified the com-
 position of the blood; that there was the point of departure of

     •  Journal de Physiologie experimentale, par M. Magendie, tome ii.
                            10* 
114
PATHOLOGICAL HEMATOLOGY.
the dropsy, and, after what I have said in the preceding pages,
it is allowable to conjecture that  the blood, under the empire
of this influence, experiences a diminution of its albumen.
What may still add some weight to this  conjecture, is what
takes place in sheep, when they have fed, for some time, in
humid places, in pasturage of quality insufficient to furnish a
good reparative material for their blood; in them also, the
blood loses a portion of its albumen, and they become drop-
sical.
   I shall not seek to discuss the question why blood, which
has become poor in albumen, brings on readily the formation
of serous effusions, and wherefore diminution of globules in the
same blood does not produce a similar result.  Is it the change
effected in the  physical qualities of the serum, by the loss of
albumen which assists the passage of the former through the
vascular parietes ?  Is this then a case of exosmosis favoured by
the diminution  in density of the fluid, or is it that the  water of
the blood flows with more  difficulty in the capillary rete, be-
cause, being less charged with fibrine, it has become less unc-
tuous, and slides perhaps less readily over the internal surface
of the vessels?   If it be so, the diminution of albumen in the
serum of the blood would, as one of its effects, render more diffi-
cult the passage of this fluid through the small vessels, and con-
sequently as to the immediate cause,there would not be so great
a difference between dropsy following an organic disease of
the heart or liver, and that  which follows  the diminished pro-
portion of albumen in the blood.
   Let no one believe however that, in cases of dropsy, there
occurs only a separation of serum such  as it existed in the
blood; it is not so in any case of simple dropsy, for the con-
stant rule  is, that  the serosity which has  been  effused, even
while remaining composed of the same materials as the serum
of the blood, contains proportionally more water than this,
and much less of the organic principles, particularly albumen.
Thus, in sixteen analyses  that  I have made of the fluids of
different dropsies, I found  for the maximum of albumen the
cipher 48, and for  minimum the cipher 4.  In no case, there- 
OF THE BLOOD IN DISEASES.
115
fore, was the quantity of albumen even equal to that which
the serum of the blood contains.  We may see moreover, by
these extremes, how much the  proportion of albumen con-
tained in the fluid of dropsies may differ.   In the sixteen ana-
lyses, I found the proportion of albumen in one thousand parts,
represented  by the  ciphers, 48, 47, 41, 40, 30, 28, 19, 15, 14,
12, 12, 11, 10, 8, 6, 4.  In six other analyses of serosity taken
by puncture from the  tunica vaginalis of  the testis (cases  of
hydrocele), I found the albumen generally more abundant than
in other effusions of serosity: thus, in  these six cases, there
was in albumen 59, 55, in two 51, 49, 35.  The highest cipher
in these six  cases is far from  equalling the mean of albumen
in the serum of the  blood.  I have not observed in these dif-
ferent cases that the seat of the dropsy,  any more  than  its
cause, exercised an  influence upon the greater or less elevation
of the cipher of albumen; but it was different as to the more
or less complete state of integrity of the constitution:  in pro-
portion as this remained stronger and more entire, so  in gene-
ral did the  serosity effused contain more  albumen.   Here is
very probably the reason why the fluid which came from the
tunica vaginalis was usually richer in albumen than that of
any other dropsy; because, in all these cases of hydrocele, the
individuals  operated upon were still full of health and vigour.
In cases, on the contrary, where I have had occasion to exa-
mine the serosity taken from the abdomen of the same indi-
viduals by several successive tappings, I have constantly ob-
served, that the more  frequently the operation was repeated,
the less abundant was the quantity of albumen contained in
the serosity, which  fact appeared to me to depend upon the
progressively increasing debility of the constitution.
   As to the water,  I found it in all these specimens of serosity
much more abundant than in the serum of the blood;  its high-
est cipher was 986, and  its lowest 930: consequently the ef-
fused serosity which had the minimum of water, still contained
more than  the serum of blood most highly charged with this
principle :  in this serum, in fact, we have found the maximum
of the water for man  915; the minimum 725, and the mean 
116
PATHOLOGICAL HEMATOLOGY.
790.  Besides it is in the serosity taken from cases of hydro-
cele that we have  met with the least amount of water;  it was
in one of these cases that  our  minimum  930 existed, whilst
the maximum of water for these  same cases, was 947.   On
the contrary, in the sixteen other cases relative to serous effu-
sions whether of the cellular tissue, of the pericardium, of the
pleura,  or of the  peritoneum,  this maximum  947  becomes
almost the minimum;  in  all these cases, save two, we  find
more than 950 in water, 4 times from 950 to 960, and 10 times
from 960 to 986.
  Moreover, all these  samples of serosity  presented us,  like
the serum of the blood, fatty and extractive organic matters,
an alkali, and alkaline and calcareous salts.  The quantity of
the saline matter appeared to us nearly similar to that of the
same matter in the serum of the blood.
  With the exception of our six analyses of the fluid of hydro-
cele, all the others  are relative to cases where the dropsy was
the result of some obstacle to the free return of the venous
blood towards the heart; I much regret that none had any
connection with  Bright's disease.  In these cases  then, as in
those of hydrocele, there  is separated from the blood propor-
tionally more of water than of albumen.
  I have already said that the proportion of albumen separated
from the blood, becomes  more  considerable when  it is  an in-
flammatory process which has provoked the effusion of sero-
sity.  This may be proved by an analysis of the fluid of vesi-
catories.
  Cases, on the other hand, may present themselves where a
fluid, similar to serum in its aspect, and like it alkaline, fails
to show by re-agents any trace of albumen.   This  I have ob-
served in the liquid, clear and limpid as rock-water, which is
contained in  hydatids of the  liver.   This fluid, slightly alka-
line, was  not sensibly clouded either by heat, by alcohol, or
by  nitric  acid.   It contained some  alkaline chlorides, some
sulphates, and much fatty matter.*   Did the albumen  which

  *  The fatty matter, which we find in serosity has  at times a nature dif- 
OF THE BLOOD IN DISEASES.
117
was absent from this fluid exist in the parietes of the living sac
which contained it?
  It is worthy of remark that, in a case where, in the  same
individual, there exists simultaneously several serous effusions
in different parts, the fluids which constitute  them may differ
considerably from each other, as to the quantity of albumen
which they contain.   Thus, in a female attacked with an or-
ganic disease of  the heart, there were 30 parts of albumen in
the serosity of the pericardium, while  there were but 4 in the
serosity of the cellular tissue of the inferior extremities.
                         ARTICLE VII.

 Of the Blood in certain diseases commonly called Organic.

   I have studied the composition of the blood in five cases of
 hypertrophy of the heart; in all of them the amount of glo-
 bules was natural, as was, also, the albumen  of the serum.
 Once only the fibrine showed a slight elevation, represented
 by 4.  In the four other cases  it preserved its physiological
 quantity,  being represented by the numbers 2.6; 2.7; 3.0;
 and 3.7, respectively.  These differences in the  proportion of
 fibrine, bore a strict relation to  those observed in the symp-
 toms themselves.  For, in  the cases  which  gave 2.6, 2.7,
 and 3.0 of fibrine, the affection of the heart was chronic, and
 the pulse not accelerated.  In the case which gave 4 of fibrine,
 the  disease, on the  contrary,  presented a  totally different
 aspect.   The symptoms of the heart disease were only of two

 ferent from that of the same  matter ordinarily existing in  the serum of the
 blood. It is thus that while  examining with the microscope the fluid of a
 hydrocele obtained by tapping, I found in it crystals of cholesterine assuming
 the form of the purest parallelogram.  To the naked eye the fluid psesented
 us, at the moment of its escape from the tunica vaginalis, a clouded appear-
 ance due to an infinity of little micaceous spangles which it held in sus-
pension, and a great part of which were precipitated upon the bottom of the
vessel by repose. 
118
PATHOLOGICAL HEMATOLOGY.
months' standing.   They came  on acutely during the course
of an attack of articular rheumatism, and survived it.  In ad-
dition to  the  signs of hypertrophy, a very distinet  bruit de
souffle might be heard at every  contraction of the ventricles.
   In the  case  where 3.7 of fibrine was found in the blood,
that is to say, one of the highest maxima of the  physiological
state, the bleeding was performed under  peculiar  circum-
stances.   There was no articular rheumatism, but a sudden
exacerbation of the disease of the heart; the movements of
this organ were excessively agitated,  a very strong bruit de
frottement was heard  during both systole  and diastole;  the
dyspnoea was extreme; the pulse beat 108 in a minute.  The
depletion  was followed by great  improvement, and, after a
few days, the  rubbing  sounds had  become  much feebler.
These facts teach us that  the  alteration of nutrition, which
produces hypertrophy of the  heart, does not affect the fibrine
of the blood, when free from all  complication;  and that the
increase of the fibrine takes place only under peculiar circum-
stances, and accompanied with symptoms which recall those
of the inflammatory affections.
   The mere deposit, within  the tissues,  of the morbid sub-
stances known as tuberculous, scirrhous, and encephaloid, and
the development of hydatids, do not augment the fibrine.  It
may however, happen that at certain periods of the existence
of these several productions, an excess of fibrine may be found
in the blood, but that is because some other morbid condition
has supervened.  The  following rules  may be laid down in
regard to  this matter.
   So long as tubercle  and cancer preserve the character of
hard masses, without any  inflammation  around them, an
analysis of the blood uniformly gives the normal quantity of
fibrine.  But, as the softening of these hard masses advances,
and a process of elimination,  analogous to  that of inflamma-
tion, is set up around them, the blood becomes more and more
charged with fibrine; so that the excessive formation of this
principle is not due to  the development of the accidental pro-
duction, but wholly to  the inflammation excited by the latter 
OF THE BLOOD IN DISEASES.
119
at certain stages of its existence.   This is a new proof to be
added to the many others which show that the process engen-
dering the different accidental productions, such as tubercle,
cancer,  melanosis, hydatid, &c, is not of an inflammatory
nature.
  In order to justify the principles  I have just laid  down, I
will first cite a very remarkable case, in which tubercles de-
veloped in the pia-mater simulated acute meningitis ; but the
qualities of the blood, even before the autopsy, excited doubts
regarding the existence of the latter disease.
  A sempstress, 24 years of age, entered the  hospital of La
Charite, May 27th 1841, complaining of having had a cough,
and shortness of breath, for some time; she stated that she
suffered  from continual  head-ache; on  May 18th she met
with a serious disappointment, and, a few days afterwards, her
headache increased; from  that epoch she experienced creeping
chills.   From May 23d she grew more seriously ill; on that
day her headache  was unusually  severe,  and,  at the same
time, she had humming noises in her ears, intolerance of light,
and bilious vomiting.   From the 27th to the 30th of May, the
symptoms of an acute cerebral affection grew more and more
distinct.   From May 30th to the day of her death, which hap-
pened June 5th,  she  uttered piercing  cries  like those  called
hydrocephalic; there were delirium, strabismus, rigid flexure
of the limbs; distressing  moans  and convulsive movements
whenever the skin of the trunk or limbs, which seemed to have
its sensibility greatly exalted, was at all rudely touched; and,
towards the close, tetanic rigidity of the neck.
  At the autopsy,  the pia-mater was  found thickly studded
with tuberculous granulations, which were collected most nu-
merously about  the  fissures of Sylvius.   In no other part,
either  of the brain or its membranes, was any  appreciable
alteration detected.   Tuberculous granulations similar to those
which filled  the  pia-mater, were also found  in  the  pleurae
of both  sides, and in the peritoneum, both of which mem-
branes were covered with  them;  both lungs were filled with
miliary tubercles. 
120
PATHOLOGICAL HEMATOLOGY.
   In this case,  then, the only lesion revealed by dissection
 was the equal development in all the great serous membranes,
 and in the lungs, of small and hard tubercles, with no signs of
 inflammation around  them.  The anatomical characters of
 meningitis were completely wanting.
   Let us  look now at the analysis of the blood in this case.
 At the first bleeding we found 3.0 of fibrine, and at the second
 3.4; so that  the quantity of this principle did not exceed its
 physiological limits.  While the patients lived, we were  as-
 tonished at this result;  it seemed strange that in a disease
 which appeared to us to be acute meningitis, the amount of
 fibrine  should not  be  increased; the  autopsy explained this
 anomaly, or rather showed  us that the  anomaly  was only
 apparent.  What evidence could be stronger than this, that
 whatever may be the extent or the rapidity of the formation
 of tubercles, it does not, in the beginning, augment the fibrine
 in the blood ? An  examination of the blood, in cases of pul-
 monary consumption, had  already led  me to lay  down this
 proposition, in the first memoir I published with M. Gavarret.
 Since the publication of that memoir, we have collected ad-
 ditional, and confirmatory cases, of which  the following is  an
 abstract.
  We weighed the fibrine obtained from  the blood of thirty
 tuberculous patients, drawn at thirty-three  different bleedings.
 In seven of these patients the tubercles were still crude; in
 nine others they were softening, and in the remaining fourteen,
 there were cavities  in the lungs.
  The six patients of the first series were bled, altogether, nine
 times.   Seven times the fibrine was found  to be normal, vary-
 ing between 2.7 and 3.5.   Twice, however, the fibrine ex-
ceeded its physiological quantity, and gave the numbers 4.8
 and 5.1.  But, in each of these two cases, there was an  in-
 flammatory complication;  in one a sub-acute  entero-colitis,
and, in  the other, a bronchitis of much greater intensity than
 is usual in the first stage of phthisis.
  In ten bleedings performed on the nine patients of the second
series, we already come to different results.  Nine  times out 
OF THE BLOOD IN DISEASES.
121
of ten the  fibrine was  in excess, sometimes very slightly,
hardly reaching 4, and sometimes varying between 4 and 5.
In the tenth case, there were only 3 parts of fibrine.
  In fourteen bleedings performed on  the  fourteen patients of
the third  series, the fibrine was in excess twelve times, but
much more so than in the second series.  The minimum found
was 4.0, and that once only.  In three other cases, the fibrine
varied between 4.4 and 4.6 ; in all the others it was between
5.0 and 5.9.
  The only two cases of the third series which did not follow
the rule of the increase of fibrine, must be regarded  as excep-
tional ; the subjects of them were far gone in marasmus, when
we attempted, by a small bleeding, to diminish the state of
half asphyxia which  they presented;  and, indeed, they were
momentarily relieved by it.   In one of them the fibrine was
at its physiological mean, in the other it had fallen to 2.0.
  In the third stage of phthisis, therefore, although the fibrine
is generally in excess, there are yet some cases, in which the
exhaustion, consequent on the softening of the tubercles,  is
indicated by an opposite  modification in the amount of fibrine;
it augments during the  process of elimination,  and then di-
minishes,  so as to fall even below the lowest limit of its phy-
siological  state.
  Let us now examine how far the quantity of globules in the
blood is affected  by pulmonary consumption.   This investi-
gation will lead us to results worthy of some attention.
  From the very commencement of pulmonary tubercaliza-
tion, and when even auscultation can hardly detect its exist-
ence,  the globules are already diminished.  I have never seen
them  reach even their physiological average, 127, in  any case
of the kind.   Their highest representative was 122, their low-
est  99,* and they usually varied between 120 and 100, ap-
proaching the latter number oftener  than the  former.  The
blood of persons,  then, whose lungs are beginning to be tuber-

  *  This minimum was found in the patient spoken of a little while ago, and
whose serous membranes and lungs were thickly studded with tubercles.
       11 
122
PATHOLOGICAL HEMATOLOGY.
culous, offers that particular modification which belongs to
feeble constitutions; they are, truly, in a state of commencing
anaemia, and their blood is like that of patients who have been
bled several times.  This condition of the blood which accom-
panies the first stage of phthisis, and which, to all appearance,
precedes it, is the same general condition found in every case,
where, from  any cause, the powers  of life  have lost  their
energy.   What need  is there of saying that these results of
analysis agree perfectly with clinical observation?   Who is
not familiar with that  shrunken, pale, and  feeble look, which
belongs to most consumptives, even in the first stages of their
malady ?   There are young girls, who, when consumption is
imminent, become so  frail  and  pallid,  and yet  have so few
invocal symptoms, that it sometimes happens that the nature of
their disease is  misunderstood, and that they are supposed to
be chlorotic.  On the other hand, there are cases of chlorosis,
which, owing to the complication of  a bronchitis, or  of a
merely nervous cough, have thrown the most  accomplished
observers  into doubt, and made them  apprehend a develop-
ment of tubercles.
  In all commencing phthisis, there is, then, a certain degree
of anaemia; but is that equivalent to saying that the impover-
ishment of the blood is the sole efficient cause of tubercles?
Certainly not; for, in  such  case, a  greater number of persons
affected with phthisis would be found among chlorotic females
than are so found, and I do not believe  that girls with chloro-
sis become tuberculous oftener than others.  The decrease of
globules, from the outset of consumption, is not, then, a cause
of the formation of tubercles, but we must regard it as a certain
sign that  this disease  arises during a  marked impairment of
the constitution, and, by adding  it to those signs furnished by
the clinical observation of all ages, it helps to enlighten us in
the choice and application of modes of treatment.
  As the tubercles of the lungs advance, however, the diminu-
tion of the globules grows  more and more considerable, and,
at last, reaches  its minimum when the  lungs are filled with
cavities.  Yet, this minimum is not always what theory might 
OF THE BLOOD IN DISEASES.
123
lead us to suppose it.   It would seem, indeed, that in a disease
in which the essential organ of haematosis is so  seriously in-
volved, and has become'so unfit to fulfil its functions, the glo-
bules  ought to diminish nearly as much as in chlorosis.  But
this is far from being the fact.   In the second and third stages
of phthisis, I  have not'yet seen more than a single case, in
which the globules had fallen below  80; in it they were at
72, and the fibrine at  5.5.  In all other instances they varied
from 80 to 100.  Is it not strange that in chlorosis, without any
appreciable alteration of the lungs, or other solid, the globules
should fall even lower than 30, while their minimum is at 72
in a disease in which it should seem that  the state of the lung
could hardly permit the formation of the  blood, at all ?   And
yet not only do the globules not diminish as much as might
be  expected, but, when even  a large  part of the lung'is de-
stroyed, the fibrine increases, and the temperature of the body
may  rise, just as in  typhoid  fever, or acute pneumonia.  I
have  seen the  temperature rise to  39° and 40° in the hectic
fever which usually accompanies the last  stage  of phthisis.
   I heard a bruit de souffle in the carotids of one only of the
phthisical patients whose blood I analyzed, the same in whose
blood the globules were at 72.   This patient was a man about
thirty years of age.   The occurrence of the carotid souffle in
him was well explained by the extreme poverty of his blood
in globules; and its existence, in this single case, goes  to cor-
roborate the principles we  have already laid down in  regard
to the connection of this sound with a certain decrease in the
globules of the blood.
   The appearance of the blood in the several stages of phthi-
sis is  well explained by the changes occurring  in its composi-
tion.
   In  the earlier periods of the  disease the blood offers no pecu-
liarity, except that its clot is generally rather small and dense,
which may be explained by the moderate quantity Of its glo-
bules, and its preservation of a normal  proportion of fibrine.
   But with the  progress of the disease,  the softening of the
tubercles,  and the formation of cavities, the  clot becoming 
124
PATHOLOGICAL HEMATOLOGY.
smaller and smaller, is  covered with a buffy coat, the more
perfectly formed in proportion to the degree of disorganization
of the lung.  Two circumstances evidently contribute to pro-
duce this buffy coat; the increase of fibrine which takes place
so frequently in  the  last stage of phthisis, and  at  the same
time, the progressive decrease of the  globules; so that, there
are two causes of an excess of fibrine relatively to the globules,
and, if the blood flow in a proper manner, a buffy coat must
necessarily be formed.   This, indeed, is what happens, and a
buffy coat upon the surface of the clot, is nearly as constant in
the advanced stages of phthisis, as  in  pneumonia, or acute
articular rheumatism.   Considered in relation to the causes
which  govern its formation, it holds a middle place between
the chlorotic, and the inflammatory, buffy coat.
  Let us now examine the characters of the blood in cases of
cancer.  It may be inferred from the cases  I have collected,
upon this subject, that in cancer, as  in tubercle, the fibrine of
the blood does not increase until the scirrhous or encephaloid
matter is advancing to, or has already reached, its stage of
softening and destruction.  Yet, if the cancer,  owing to its
situation, interfere with the  functions of an organ, which  is
subservient to the reparation of the blood, this fluid may show
a diminished quantity of fibrine.  But that is a peculiar case.
  In four cases of cancer of the stomach, we found the normal
quantity of fibrine three times, in the fourth case it was less
than this, being only 1.9.
  In two cases of -cancer of the liver, we found, on the other
hand, a certain excess of fibrine in the blood; in  one case 3.7,
and in the other 5.0.
  In the first case, the tumour of the right hypochondrium
seemed to be in a state of transition between immaturity and
softening: although usually indolent, it sometimes grew pain-
ful, and then a temporary fever was excited.
  The symptoms of the other case were totally different; a
patient had, in the region of the liver, a  large,  very painful
and indistinctly fluctuating tumour, which had become rapidly
developed, and was accompanied with continual fever.  The 
OF THE BLOOD IN DISEASES.
125
liver, in its whole  extent, and beyond  the place occupied by
the tumour, was very much enlarged.  The patient presented
all the signs of an inflammatory affection so distinctly, that we
conjectured the existence of a hepatic abscess.  He sank rapidly,
without our having, a few hours before  his unlookedfor death,
seen any thing to  indicate  so  sudden a termination.  It was
explained by our  finding, on dissection, an immense effusion
of blood in the peritoneal cavity.  The source of this blood
was  a spongy cancerous projection, completely softened and
ulcerated, and which occupied the free edge of the liver.  Nu-
merous encephaloid masses,  reduced to a sort of  detritus,
filled the parenchyma of the liver, as well as several branches
of the vena-porta.
  In a case of cancer, ascertained by dissection to be ovarian,
and  which was accompanied with fever, and acute pains, the
fibrine rose to 4.5.   The cancerous mass was partially softened,
and  innumerable vessels traversed it in every direction.  There
were some traces of a slight peritonitis around it.
  Finally, in two cases of cancer of the womb, we found that
very different numbers expressed the quantities of fibrine; viz.
5.6 and 1.8.   But the progress of  the first case indicated a
state of pretty  intense  phlogosis;  the  whole  hypogastrium
was  tense and painful, and there was constant fever.  In the
second case there was  complete apyrexia; the patient was
thoroughly exhausted  by repeated  hemorrhage  from  the
uterus.  This was the remarkable  instance of which  I have
already had occasion  to speak, in which the blood contained
only 21 parts of globules.
  I have not, yet, had an opportunity of analyzing the blood
of persons  affected with hydatids, but, in sheep, I have often
made this examination, and have always found the quantity
of fibrine normal, where  no other  affection complicated the
hydatids; but augmented, whenever an inflammatory  process
had  been established around them.*

  * Researches into the composition of the blood of certain domestic ani-
mals, &c.
                           11* 
126
PATHOLOGICAL HEMATOLOGY.
  In the several cases of cancerous disease I have just re-
viewed, the globules of the blood offered nothing remarkable,
except the progressive diminution  they undergo, whenever
the organism is subjected to any cause whatever of exhaustion.
The  profuse hemorrhages which  accompany some forms of
cancer, the defective  nutrition which must  result from  the
greater number of cancers of the stomach, explain why, in
many diseases of this nature, the blood is found sparingly sup-
plied with globules.   But this deficiency does not appear to
take place in cancer, as in tubercles, at the commencement of
the disease; it comes on late, and quite accidentally, from the
causes just enumerated.  The  predisposition of the organism
to form cancer, is not,  then, like its tendency to form tubercles,
expressed from the outset, by an impoverishment of the blood.
It should be  remarked, too, that,  while  from the very origin
of his disease, and even before it is susceptible of demonstra-
tion, the tuberculous patient is always remarkable for his de-
bility and paleness,  such is not the case with one who  has
cancer.   The  latter may, before  the commencement of his
disease, and during its first stages, present  every variety of
constitution and temperament.   What is more common than
to see a cancerous affection in persons of a sanguine tempera-
ment, and who have the appearance of plethora ?  And what
more rare, on the other hand, than the development of tuber-
cles  in such conditions of the  system ?  Doubtless, there  are
not  a few cases of  young persons  becoming  tuberculous,
amongst those who are fleshy, and have a ruddy complexion,
with a certain appearance of strength: but the plethora of these
individuals is deceitful, they have, in reality a lymphatic tem-
perament, and if their blood be analyzed, its globules are found
at, or even a little below, the lowest physiological limit.
   There is ground for the question, whether, when once the
cancerous cachexia  is well established, there may not be an
absorption of the cancerous detritus, and whether some traces
of it may not be detected in the blood.  To ascertain this, M.
Gavarret and I have, several times, examined with a  mi-
croscope, blood taken from the  bodies  of persons who had 
OF THE BLOOD IN DISEASES.
127
died of various cancerous affections, and, in some  instances,
we found well formed globules of pus in the blood.   These
globules were not, indeed, portions of cancerous matter; they
were merely a product of the inflammatory process, which, at
a certain stage of the disease, is developed in the tissue where
the cancer originates.  Nevertheless, this is a fact in the his-
tory of cancer, important to be known,  since it proves the pos-
sibility of a  purulent infection of the blood, in this disease.   In
a case of osteo-sarcoma, with consecutive production of a large
cancerous mass m the  anterior mediastinum, we met with a
large  quantity of pus-globules mixed  with the blood in the
right  ventricle of the heart.  But along with  these globules
we  found other bodies of an altogether peculiar aspect, and
which we have, in this case only, detected in the blood.  They
were  elliptical  lamellas, with  a  granite-like  surface, much
larger than globules of pus, and of a much more regular form
 than simple albuminous flakes.  But  these lamellas were not
 found only in the right ventricle mixed with pus-globules. We
 found a  great many of them  in a  little of the ichorous fluid
 taken from the centre of the cancerous tumour of the medias-
 tinum.  Are they, then, to  be considered as denoting the pre-
 sence of  softened cancerous matter, or of the  ichor which it
 furnishes ?   We can only say, that we have found the  same
 lamellas in other cancerous masses.  The subject merits further
 investigation.                                            *
   Before concluding this subject, I may add, that in a patient
 who  died of ulcerated cancer of the liver, I detected the pre-
 sence of some  pus-globules in  the thoracic duct; the contents
 of this vessel were reddish, and, along with the pus-globules,
 the microscope  showed globules of blood, the most of them
 serrated  at their circumference, and very distinct from globules
 of pus.
    If, then, either before or during  the development  of these
 various  accidental  productions, one of the elements of their
 formation consists in some  change effected  in  the composition
 of the blood, that change is, apparently, to be found neither in
 the fibrine, nor in the globules, nor in  the albumen, but rather 
128            PATHOLOGICAL HEMATOLOGY.

in those  numerous organic substances, mostly of an undeter-
mined character, and which are comprehended  in the term
extractive matter.   But are new substances generated?   Are
those which naturally exist modified  in  quantity or quality ?
What happens to the blood when tuberculous  matter, instead
of increasing,  disappears, leaving  a calcareous deposit  in its
stead?  When accidental productions are  formed of wholly
inorganic substances,  as by an  accumulation  of  the  salts of
lime, what takes the place of these salts in the  blood ?  What
happens to the blood in those cases where the whole vascular
system is filled with ossific concretions ?  Or what, when the
bones are softened, and, being deprived of a large portion of
their phosphate of lime, seem reduced almost to a cartilaginous
state ? Is it in some change in the composition of the blood,
appreciable by analysis, that we are to look for the cause of
those excessive secretions of uric acid  that  take place in gout
and gravel?  Medicine must wait for something of its advance-
ment, till these, and many analogous questions, are resolved.
                       ARTICLE VIII.

                Of the Blood in the Neuroses.

«.  The title of this article may, at first, seem singular.   For
 what could be found in the blood in diseases whose seat is the
 nervous system, whose symptoms are the various disturbances
 of the functions of that system, and which it is not customary
 to refer, either to an alteration of the solids, or of the fluids?
 I admit these notions, and yet I shall endeavour to prove, that
 even in the neuroses, the study of the state  of the blood may
 be important.
   Clinical observation has long since demonstrated, that one
 of the most  powerful causes of many nervous disorders, is a
 certain degree of feebleness of the constitution; whence, the
 incontestable advantage of a tonic treatment, in many of these
 diseases, which by reviving the strength, restores  the equili- 
OF THE BLOOD IN DISEASES.
129
brium of the nervous system, and removes the disorder of its
functions.
  The results of an examination of the blood are confirmatory
of those furnished by clinical experience.
  Thus, it is found, that in many cases of neurosis, the glo-
bules of the blood  are  very scanty.   Now it is well known
that the increase or decrease of the globules of the blood, in-
dicates  the vigour  or feebleness of  the  constitution.  If the
globules be diminished, either by depletion, or by insufficient
nourishment, the  nervous disorder will  certainly be aggra-
vated ;  but if the opposite course be pursued, in all proba-
bility the nervous  affection will be  mitigated.  In this  way
may be explained the happy influence which  the ferruginous
preparations, and substantial  and nutritious food, exert upon
the  termination  of certain neuroses: and it  is because the
globules are inevitably diminished by depletion and diet, that
we  so  often see  such  disturbance of the nervous functions
follow  great loss of blood, and a too  prolonged abstinence
from food.
   But are we  to be  understood as declaring  that such is the
 origin of every neurosis ?  Certainly not; there  are  diseases
 of this sort, and many  of them, in which the  quantity of glo-
 bules in the blood is normal, and in which, even the aspect of
 the patient gives no indication of constitutional feebleness.  In
 these cases, the blood has nothing to do with the production,
 nor with the maintenance, of the disease, whose etiology must
 be sought elsewhere, as well as the treatment most appropriate
 to  it.  These  various facts  are not inconsistent with one
 another ; they only throw new light  on one of the most im-
 portant of medical truths, namely, that two diseases may have
 identical symptoms,  without being of  the same  nature, and
 that however  close their resemblance, they may, still, require
 different modes of treatment, because very different conditions
 of the economy may give rise to, or maintain, them.
THE  END. 
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