NEW RESEARCHES ON THE COMPOSITION OF THE BLOOD IN HEALTH AND DISEASE. By MM. A. BECQUEREL and A. RODIER, Docteurs en Medicine.

THIS paper is the recapitulation of the researches made by these observers during the last year, in the view of confirming, completing, or extending the consequences to which their former labours gave rise. They have availed themselves of every opportunity which offered itself for analysing the blood in the conditions of the system to be hereafter specified; but never has a venesection been performed with the object of affording them such. The details they enter into as to the various precautions to be taken in conducting the analyses, and the tables exhibiting the results of these, are given at too great length to admit of transcription. We must content ourselves with stating some of the general results, referring our readers to the original for more minute particulars.

1. The various descriptions of albuminous matters contained in the blood are endowed with a powerful affinity for water. It results, that when we wish to dry them, these matters yield with great difficulty the last portions of fluid; and, even when they are deprived of these, they instantly commence reabsorbing water from the atmosphere, which is just as difficult of expulsion. The presence of this water, unless the most minute precautions be taken, may interfere in a very material manner with the results of our calculations. Numerous experiments have shown the authors that to desiccate about 100 grammes of blood or serum continuous exposure for 48 hours to a temp. of about 178° F. is required, and that the powder must be weighed while hot, the instant it is removed from the apparatus, for in a few minutes only water will have been absorbed. The vague expression" albuminous matters" has been designedly adopted, for it is not easy to decide whether it is the albumen or the other materials of the blood which manifest such an avidity for water. Some experiments, however, lead to the opinion that this property especially belongs to the alkaline salts, to free soda, and the extractive matters soluble in water.

2. Blood which has been taken and is exposed to the air is submitted to an incessant evaporation, proportionate to the extent of its surface, the temperature, and the humidity of the air. This concentrates the solid parts, and gives rise to very variable results, only to be avoided by keeping the blood in a vessel hermetically sealed. In the hot days of summer, blood taken in large receptacles, sometimes in this way becomes reduced to at least a third of its volume. It should be received into vessels which are deeper than they are broad.

3. The quantity of serum of the blood determined with proper precautions, is in general proportionate to the quantity of solid matter this fluid holds in solution. The equilibrium may, however, be destroyed. Thus the density is greater

when there is little albumen, properly so called, and much extractive matters and free salts. It is less, on the other hand, when there is excess of albumen, and, which is rarer, excess of fatty matters and little extractive matters and free salts.

4. The serum of the blood, whatever its composition, being mixed in different individuals with variable proportions of globules, it follows that, in the complete analyses of the blood, the figures representing the solid matters of the serum have not an absolute value, and we can only compare the relation of the water to these same figures. To obtain an idea of the composition of the serum in health and disease, we must consider it apart, and analyse it separately, after spontaneous coagulation has separated the globules and the fibrine. This important precept was laid down more than 20 years ago by MM. Dumas and Prevost, although other experimenters seem since to have lost sight of it entirely. In all their analyses they have always represented the analysis of the entire blood in one table, and the composition of the serum in another; and it is only in this way we can ascertain the exact modifications of the albumen and other portions in solution.

5. When a bleeding to some extent is practised, and that not too rapidly, the blood has not the same identical composition during its whole progress. The latter portions are more watery and less rich in solid matters. The impoverishment is continuous, although a certain quantity must be lost before it is perceived. The diminution of solid parts takes place especially at the expense of the globules, and, to a slight degree, at that of the solid matters of the serum. The proportions of the serum continue much the same. In what manner is this impoverishment to be explained? In the present state of science we believe the explanation of MM. Prevost and Dumas to be the best. "When a small animal,” they say, "is bled to a notable extent, the veins absorb with rapidity, at the expense of the remainder of the system, a proportion of liquid perhaps equivalent to that which has been lost, whence it happens that the mass of particles seems diminished in a given quantity of blood." The impoverishment is therefore only apparent, and it is therefore not a matter of indifference at what period of the bleeding we take the blood, the analysis of which is to represent the condition of the system at the time the abstraction is made. It is the first portion that should be chosen.

6. Anterior bleedings exert a sensible effect upon the composition of the serum. It becomes more watery, less dense, and less rich in solid matters. The quantity abstracted and the number of bleedings will much influence this impoverishment, as will also abstinence and the progress of the disease. It is manifested especially in respect to the albumen properly so called, while the amount of extractive and fatty matters and free salts vary little. Pure albumen is the element of the serum which seems to separate with the greatest difficulty. Thus, when a person who has been bled several times becomes convalescent and eats, and the solid parts of the serum are consequently more and more increased, if a new bleeding is practised, as for a complication, the albumen is found to have increased less than any other element. In estimating the effects of prior bleedings we must, however, confine ourselves to short periods, as from 24 to 48 hours, and to the same disease. If a longer period elapses, or the bleeding is employed for a complication, the serum may have repaired its losses, or have become modified by the new

affection.

7. We may offer the following statement of the physiological condition of the blood. 1000 of serum contain as a mean 90 solid parts. Of these 90 the albumen may be represented by 80. The extractive matters and free salts by 8, and the fatty matters by 2. The limits of the physiological condition are 86 and 95: or, much more frequently, 88 and 92. The mean density of the serum is 1027, the physiological limits being 1028 and 1026. The highest figures are found in strong persons, in good health, and living well. The influence of age, sex, and temperament is uncertain. In a former essay the authors had given the following as the weights of the principal elements in 1000 parts of blood.

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Water, 780; globules, 141; fibrine, 22; solid matters of serum, 80. In women the weight of the globules was stated at but 127, the proportion of water being so much the greater. Subsequent researches have confirmed these, every possible care having been taken to select from those persons who applied voluntarily for and insisted upon being bled, only such as gave every sign of health. "Such cases are of rare occurrence, and exact the most rigorous examination, and we have eliminated from them all such as manifested signs of plethora."

8. Condition of the Serum in various Diseases. (A.) Plethora.—In our former observations we stated that the composition of the blood in plethora did not differ sensibly from that of health, and that the examination of the symptoms rather led us to admit, with some restrictions, the old opinion, that in this condition there is an augmentation of the mass of the blood. Our later researches have entirely had reference to the composition of the serum, and have been conducted upon six men and one woman. These prove its composition to be identical with that of health. Its mean density was 1028. The mean amount of solid parts was 917, being a little above the physiological mean: but on looking over the various analyses, they are found to be within the physiological limits, although occupying a high position in the scale of these. It is pure albumen, which furnishes the preponderance, the other solids being as in health.

(B.) Simple Fever.-In four of seven individuals examined the serum did not deviate from the normal state; but in four others its density (1026) was diminished, and the mean of the solid portions was as low as 85-such diminution especially manifesting itself as regards the albumen. This, however, the authors believe rather arises from the abstinence the patients were obliged to observe, than from the effects of the disease.

(c.) Typhoid Fever.-Analyses have been made of the blood from 25 bleedings performed on 17 persons. In 17 first bleedings the density of the serum was low (1026), and it sank in proportion to the gravity of the disease, until it reached 1023. In 7 out of 16 cases the serum was too abundant, in 7 in small quantity, and in 2 normal. In 7 instances it was limpid. The mean of solid matter was only 85.5 to 914-5 water; and the part defective was albumen. In two cases it was normal in amount, and in 1 slightly increased. In 6 second bleedings the density was lowered from 1026 to 1024, and the proportion of solid matters to 81. Two patients were bled a third time, the diminution still continuing.

(D.) Phlegmasia-Modern investigation has shown that, whenever the phlegmasia is sufficiently characterised to induce fever, the proportion of fibrine is augmented, and is increased, remains stationary, or is diminished, according to the progress of the inflammation.

The present analyses only relate to the serum. Upon 38 patients suffering from well-marked inflammations, venesection was practised 51 times-24 being men, and 14 women. The first bleedings produced a diminished density of the blood, especially in severe cases. The density varied from 1030 to 1023. Its mean 1027-5, being of less value in some affections on account of its oscillations. The serum was usually abundant and clear. The mean of the solid matter was 88·4; i. e. at the lower limits of the physiologyical scale; but the amounts varied very considerably. After the second bleeding the density was diminished to 1026, and the analyses only gave 817 of solid parts. All these effects are increased by repeating the bleeding. In slight inflammations, in those of short duration, and in patients who have taken nourishment up to nearly the time of the attacks, the serum may be scarcely at all different to that of the normal state. In severe cases, those which have severely tried the patient's powers, and have required abstinence, the conditions above named are most obvious. Still there are exceptions, but such patients are usually able to take food.

(E.) Pulmonary Tubercles.-Considered in relation to the alterations which

take place in the blood, patients affected with phthisis present different characteristics according to the degree of the development of the organic product. In the earliest stages in some patients the constitution seems not to have in anywise suffered, while in others, an anæmic condition precedes, or is coeval with the tubercles. In the second period, when the tubercles soften, or they are surrounded by inflamed textures, fever is conjoined to the anæmic condition. In the third stage, when hectic, diarrhoea, &c., are present, anæmia if it has not before appeared, manifests itself. The modifications of the blood, that under these circumstances occur, may be reduced to two principal ones, which may manifest themselves in different degrees and combinations. These are the diminution of globules when anæmia is present, and the increase of fibrine when phlegmasia complicates the original disease. The condition of the serum has been studied by the authors in 16 patients who had undergone 24 bleedings, prescribed for the relief of hæmoptysis, violent febrile action, or some intercurrent phlegmasia. Although, owing to the variability of some of the results, no absolute rule can be laid down, yet, as a general remark, it may be stated that, when any complication existed, anæmia become developed or abundant, hæmoptysis had occurred, the solid portions of the serum diminished in quantity, the water increasing, and the density becoming less-the albumen being the portion of the solid matters in which the diminution occurs. change of the blood in phthisis bears most analogy to that which occurs in phlegmasiæ.

The

(F.) Diseases of Spinal Marrow.-When these are accompanied by paraplegia there is usually a diminution of the quantity of globules, and that in proportion to the weakness of the patient and the duration of the disease. In some cases the proportion of globules was less than that observed in some examples of chlorosis, without however any bruit de souffle of the carotids being heard. Sometimes the amount of fibrine is normal, and at others, if there be an intercurrent inflammation, it may beome increased, which occasionally too it does without the existence of any such cause. The serum is usually very dense, containing almost always a large proportion of solid matters, as albumen, extrative, &c.

(G.) Bright's Disease.-Six patients only have offered the means of observation in this affection, and the conclusions drawn from them confirm those published by MM. Andral and Gavarret. These are the small amount of globules: the fibrine normal unless a phlegmasia has supervened: the great diminution of the albumen of the serum (the solid portion of serum varying from 73 to 64,) and that in proportion as the disease is chronic in its progress and the bleeding has been repeated. Of course the density of the serum is diminished.

The

(H.) Pregnancy and the Puerperal State.-The former researches of the authors were confirmatory of the account of the blood of pregnant women furnished by MM. Andral and Gavarret, viz. that the proportion of globules is diminished, while that of the fibrine is slightly increased. They added another new characteristic, viz. the diminution of the albumen of the serum, and the consequently lesser quantity of this fluid. Additional researches confirm these conclusions. The mean density of the serum examined in 13 females was only 1025.8. mean of its solid portions was but 85. As to the puerperal states, M. Andral suggests, in his "Hæmatologie," that the production of fibrine towards the termination of pregnancy is in some manner connected with the phlegmasia which so often arises in the puerperal state. The authors in their former essay had referred to two cases, one of eclampsia, followed by puerperal fever, and the other of puerperal fever, in both of which a considerable diminution of the density and of the solid parts of the serum was observed, and they asked whether a diminution of albumen, equal or greater to that in Bright's disease, might not be an essential feature of puerperal fever. Since then a M. Hersent has had abundant opportunities of pursuing the investigation, and he has published the result. He states "1. That the appreciable changes of the blood in puerperal fever

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consist in a large increase of water; an extreme diminution of the amount of globules, and an equal deficiency of albumen, 2. That the extent of these changes and the gravity of the disease are proportionate. 3. Probably the vitiation of the blood pre-existed before the explosion of the disease; but that it cannot be considered its cause, although its existence adds very much to the rarity of the case." The authors now refer to several additional analyses they have made in puerperal fevers of different degrees of severity, and conclude with the following observation. "In proportion then as the pregnancy reaches its termination, independently of the diminution of globules which frequently occurs, and the increase of fibrine which is more rare, the albumen of the serum becomes very notably diminished in amount. May we not enquire whether such diminution, which is often excessive, will not explain certain dropsies (independently of those induced by the obstruction of the venous circulation by the developed uterus) which appear towards the end of pregnancy; and if the diminution which occurs in eclampsia and puerperal fever may not exert some influence on the production of these diseases?"

(1.) Chlorosis and Anemia.-The condition of the blood has been studied in nine cases of chlorosis, in all of which the serum was found superabundant and limpid. Its density was within the normal limits, as was also the proportion of its solid parts, varying from 85 to 89, and furnishing a mean of 87.9. In this disease the changes in the blood had, therefore, reference to the small proportion of globules. In 26 analyses of blood in symptomatic anemia the globules were less than 100. The serum was clear, abundant, and of a density of 1026, its solid parts only amounting to 87-7, the loss being in albumen.

The authors thus sum up the results of their examination of the serum in the above-mentioned diseases.

"The density of the serum, and the proportion of the solid parts which it contains, remain within the physiological limits under the following circumstances: viz. plethora, slight or chronic diseases (causing little disturbance of the general system and in which nourishment is still taken), chlorosis, the commencement of pregnancy, and the onset of some acute diseases, &c. In all these cases the proportion, however, approaches the lower limits of the physiological condition.

"The solid portions of the serum, and especially the soluble albumen, are subjected to a very sensible diminution under the influence of certain conditions, which however do not at all act in the same manner or with the same intensity. Thus the impoverishment is inconsiderable under the influence of fasting, anterior depletion, and slight phlegmasiæ. It is more marked in severe disease, especially when this is prolonged, in severe phlegmasiæ, typhoid fever, sympathetic anamia, the termination of chronic disease, the end of pregnancy, &c. Lastly, it is extremely great in Bright's disease, puerperal fever, and certain diseases of the heart producing dropsy.

"The increase of the proportion of solid matters of the serum is a very rare event. It is found in too isolated cases to admit of any general rule being laid down. It is, however, nearly constantly observed in diseases of the spinal-marrow."-Gazette Medicale, Nos. 26, 27, 32 and 36.

THE CESARIAN OPERATION CONSIDERED IN A THEOLOGICAL POINT

OF VIEW.

Some months since a woman died in Brittany, being about six months advanced in pregnancy. The parish priest sent for a medical man to remove the child by the Cæsarian section, in order that it might be baptised, if still alive. Upon his refusing to do so, the priest sent for a farrier, who removed a dead fœtus by the Cæsarian section. These facts being severely commented upon in some of