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THEORY OF DYSCRASIA. ITS LOCAL ORIGIN. 131

admitted to be true as regards the dependence of the blood upon the absorption of new nutritive matters from the stomach, to the tissues of the body themselves also. When the drunkard's dyscrasia is spoken of, nobody of course imagines that every one who has once been drunk labours under a permanent alcoholic dyscrasia, but the common opinion is, that, when continually fresh quantities of alcohol are ingested, continually fresh changes also declare themselves in the blood, so that its altered state must continue as long as the supply of fresh noxious matters takes place, or as, in consequence of a previous supply, individual organs remain in a diseased condition. If no more alcohol be ingested, if the organs which had been injured by the previous indulgence in it be restored to their normal condition, there is no doubt but that the dyscrasia will therewith terminate. This example, applied to the history of all the remaining dyscrasiæ, elucidates in a very simple manner the proposition, that every dyscrasia is dependent upon a permanent supply of noxious ingredients from certain sources. As a continual ingestion of injurious articles of food is capable of producing a permanently faulty composition of the blood, in like manner persistent disease in a definite organ is able to furnish the blood with a continual supply of morbid materials.

The essential point, therefore, is to search for the local origins of the different dyscrasiæ, to discover the definite tissues or organs from which this derangement in the constitution of the blood proceeds. Now I am quite willing to confess that it has not in many cases hitherto been possible to find out these tissues or organs. In many cases, however, success has been obtained, although it cannot be said in every instance in what way the blood has become changed. Thus we have that remarkable condition, which may very well be referred to a dyscrasia, the scorbutic condition, purpura, and the petechial dyscrasia. In vain will you look

around for decisive information as to the nature of this dyscrasia, and as to the kind of change experienced by the blood when purpura or scurvy shew themselves. What has been found by one has been contradicted by another, and it has even been shewn that sometimes no change had taken place in the proportions of the grosser constituents of the blood. There remains in this case, therefore, a quid ignotum, and you will, I am sure, deem it excusable, if we are unable to say whence a dyscrasia proceeds, of which we are altogether unacquainted with the nature. However, the knowledge of the nature of the change in the blood does not involve an insight into the requisite conditions for the dyscrasia, and just as little is the reverse the case. In the case of the hæmorrhagic diathesis, also, it must at all events be regarded as an important step in advance, that we are in a number of instances able to point to a definite organ as its source, as, for example, to the spleen or liver. The chief point now is to determine what influence the spleen or the liver exercises upon the special composition of the blood. If we were acquainted with the nature of the changes effected in the blood by the influence of these organs, it might not perhaps be difficult from our knowledge of the diseased organ also at once to infer what kind of change the blood would experience. But it is nevertheless an important fact that we have got beyond the mere study of the changes in the blood, and have been able to ascertain that there are definite organs in which the dyscrasia has its root.

In conformity herewith we must conclude that, if there is a syphilitic dyscrasia in which a virulent substance circulates in the blood, this cannot be permanently present there, but that its existence must be due to the persistence of local depôts (Heerde), whence new quantities of noxious matter are continually being introduced into the blood. By following this track we arrive at the conclusion which we have already mentioned, and which is of extreme

LOCAL ORIGIN OF DYSCRASIE.

133

importance in a practical point of view, that, namely, every permanent change which takes place in the condition of the circulating juices, must be derived from definite points in the body, from individual organs or tissues; and this fact, moreover, is educed, that certain organs and tissues exercise a more marked influence upon the composition of the blood than others; that some bear a necessary relation to this fluid, others, only an accidental one.

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LECTURE VII.

MARCH 6, 1858.

THE BLOOD.

Fibrine. Its fibrille.-Compared with mucus, and connective tissue.Homogeneous condition.

Red blood-corpuscles. Their nucleus and contents.-Changes of form.Blood-crystals (Hæmatoidine, Hæmine, Hæmatocrystalline).

Colourless blood-corpuscles - Numerical proportion.-Structure.-Compared

with pus-corpuscles.-Their viscosity and agglutination.-Specific gravity. -Crusta granulosa. - Diagnosis between pus-, and colourless bloodcorpuscles.

I INTEND to lay before you to-day, gentlemen, some further particulars with regard to the history of the blood.

I concluded my last lecture by impressing upon you the necessity of localizing the different dyscrasia; employing the term localize, not in its ordinary sense, as the dyscrasia have heretofore been considered as localized, but rather in a genetical meaning, in accordance with which we constantly refer the dyscrasia to a pre-existing local affection, and regard some one tissue as the source of the persistent changes in the blood.

If now we consider the different dyscrasia with regard to their importance and their source, two great categories of dyscrasic conditions may at the very outset be distinguished, according namely as the morphological elements of the blood become changed, or the deviation is more of a chemical one, and seated in the fluid constituents.

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Among these latter, it is the fibrine, which, in consequence of its coagulability, first, and that very soon after the blood has been removed from the living body, assumes a visible form, and which for this reason has frequently passed for a morphological constituent of the blood. This notion concerning it has of late been maintained in many quarters, and has indeed always had a traditional existence. in medicine, inasmuch as from ancient times fibrine was constantly brought forward in addition to the red constituents of the blood as a special element, and it was the custom to estimate the quality of the blood not only from the number of the blood-corpuscles, but frequently in a much more positive manner from the amount of fibrine.

This dissociation of fibrine from the other fluid constituents of the blood is to a certain extent of real value, because fibrine, like the blood-corpuscles, is quite a peculiar substance, and so exclusively confined to the blood and the most closely allied juices, that it really may be viewed as connected rather with the blood-corpuscles than with the mere fluids which circulate as serum. If we consider the blood in its really specific constituents, in those, by means of which it becomes blood, and is distinguished from other fluids, it cannot be denied that, on the one hand, the corpuscles with their hæmatine and, on the other, the fibrine of the liquor sanguinis are the elements, in which the specific differences must be sought for.

If now we next proceed to consider these constituents a little more closely, the morphological description of fibrine is comparatively rapidly made. On examining it, as it appears in blood-coagula, it is nearly always found in the form described by Malpighi, the fibrillar. Its fibres generally form extremely fine interlacements, delicate networks, in which they usually cross and join one another in a somewhat tortuous form. The greatest variations exhibited by these

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