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tion from physiologists which it merits. It has been an interesting subject of inquiry in connexion with that of the pulse, and the effort has been made to ascertain the ratio of the inspirations to the cardiac contractions."

The particulars of these observations are set forth in tables ; but we must confine ourselves to the general statement of results furnished by the author.

“ Table A. is derived from the observation of the pulses of 170 men ; the aggregate of whose age was 10,895, and that of the pulsations 12,211. The respirations were counted in 146 instances, the total number of inspirations being 3045. The medium age was, therefore, 64.09 years: the medium pulse 71•83 the medium respiration 20:51; and the ratio of respiration to pulsation as 1:3:51.

Table B. is derived from the observations of the pulse of 203 females, the aggregate of whose ages was 14,326, that of their pulses 15,838. The respiration was counted in 143 individuals, and its aggregate was 3154. The medium age was 70:57 years; the medium pulse 78'02 ; the medium respiration 22°06; and the ratio of respiration to pulse 1:3.53.

“ From the preceding facts it would seem to follow that, the medium pulse of the aged men may be stated to be 71.83; that of aged females 78.02. Whilst the respiration of the former is 20:51, that of the latter 22:06 per minute. The ratio of the respiration to the pulse in aged men is as 1:3.51, in women as 1:3:53.

“ The idea may be entertained that the frequency of the pulse of the aged, as stated in the preceding tables, may depend upon some accidental instances of extreme frequency, which should be rejected. In order to the proper appreciation of the truth, the tables C and D are presented, in which the individuals examined are grouped agreeably to the frequency of the pulse. From the table C it is very apparent that, in above one half of the aged men, 52 per cent., the pulse ranges from 76 to 84; that in more than one-third, 43 per cent., it is over 63; whilst in about 2 per cent. it averages, say 55, and in rather more than 3 per cent. it is over 96. From the table D. it is evident that the pulse of aged females varies from 70 to 104 in nearly four-fifths of the individuals—79-93 per cent. of those examined ; that in more than two-thirds, 69.45 per cent. the range of the pulse was between 75 and 86; that in 7'39 per cent., the pulse was between 95 and 96; that in 2:41 per cent. it was at 104; whilst it was below 70 in but a small number, namely, 37 out of 203, being rather less than a fisth of the whole, or 18-34 per cent. The pulse was below 60 only in 5 instances, or in 2:41 per cent. of the whole number.”

After comparing these results with those obtained by the above-cited Parisian enquirers, Dr. Pennock thus concludes.

" From the preceding facts and researches, it is evident that the frequency of the pulse of the aged is much greater than that usually assigned to it; whilst that of the respiration is equal to that generally admitted in reference to the adult in middle age.

Generally,' say Hourmann and Deschambre, it is in old age that the pulse presents extremes of slowness or of frequency; but the first case is the exception, the second is the rule : the error of past time has been to take the one for the other.”—American Journal Med. Sciences, July 1847.

[Every attentive practitioner must have had occasion to verify the truth of the above proposition respecting the pulse, though probably on a smaller scale and less exactly. It is a point of great importance to be borne in mind, not only while directing the treatment of a case, but in prognosticating the soundness of a convalescence, which the persistence of a supposed anormal frequency of pulse might otherwise seem to forbid. Rev.]

1847)

Composition of the Blood in Scorbutus.

525

Ox SCORBUTUS AS OBSERVED IN THE SALPETRIERE IN 1847, AND

ON THE COMPOSITION OF THE BLOOD IN THIS DISEASE. By Dr. FAUVEL,

Since Scorbutus, yielding to the progress of hygiene, has almost disappeared in localities wherein it was heretofore endemic, no important work has appeared upon the history of this disease, of which the physicians of the last century have described the frequency and terrible effects. The work of Lind, so replete with facts and erudition, has not been surpassed, and the picture he sketched of the symptoms of the disease has served for the model of the most recent descriptions. The researches upon the composition of the blood in various diseases, undertaken with so much éclat in our own times, has however recalled the attention of physicians to this malady of a prior epoch. The reason of this new interest may be readily understood, when we consider that the fate of an entire doctrine depended upon the solution of the problem of the condition of the blood in Scorbutus.

Chemistry having confirmed the importance of the inflammatory crust of the blood which clinical experience had long since ascertained, it was next inquired, whether, in another pathological condition, an inverse appearance of the blood did not correspond to an inverse chemical change. This question was only imperfectly answered by the analysis of the blood in some of the pyrexiæ, since in these a diminution of the fibrine was found to be far from manifesting itself as a constant fact in these diseases. Was it otherwise in regard to Scorbutus ? Everything led to the supposition. The dissolved state of the blood, mentioned and differently interpreted by Hoffinan, Boerhaave, Huxham, Lind, and many others, gave a great probability to the conjecture: while Magendie succeeded in inducing phenomena in animals, analogous to those of Scorbutus, by the injection into the veins of defibrinated blood or alkaline solutions.

Such was the state of the question when, in 1841, Andral, analysing the blood of a man affected with scorbutus, found the proportion of fibrine less than the normal mean; and from that time the former conjectures were considered as confirmed; a rational explanation of symptoms was given ; and an ingenious theory of hæmorrhages, which appear in certain diseases of which scorbutus may be considered the type, was furnished. In the phlegmasiæ in which there is an increased quantity of fibrine in the blood, no hæmorrhagic tendency is observed : but in typhus, scorbutus, and in other diseases in which the blood is in a more or less dissolved state, that is containing little fibrine, hæmorrhages are frequent, and are produced independently of the essential differences which separate the various diseases. The hæmorrhage is then a common phenomenon, dependent upon a common change in the composition of the blood in all these cases. If to this we add, that in certain other morbid states, in which the quantity of globules is greater than in the normal state, at the same time that the fibrine is unchanged, the hæmorrhagic tendency is produced but with different characters, we naturally arrive at the distinction founded upon a change in the composition of the blood peculiar to each of these.

In vain did Mr. Busk declare that in several scorbutic patients he had found the fibrine augmented; and in vain did M. Stæber refer to the conclusions of Parmentier and Deyeux that the scorbutic blood they examined was identical with inflammatory blood. These statements were received with incredulity, as arising from some error in diagnosis or the process of examination. Yet it was desirable that new and numerous analyses should sanction the principle laid down by M. Andral from a solitary case: and this year an unusual opportunity offered itself to me at the Salpêtrière. Among the old women there, a few spots of ecchymosis on the limbs are not infrequently seen : but for more than a year no

NEW SERIES, NO. XII.--VI.

N N

case of scorbutus had shewn itself; when last March, a woman æt. 76, strong and well for her age, became suddenly attacked by symptoms of it. Certain of these symptoms led to her being bled, and as no inflammatory complication was present, the usual state of the blood described by authors was expected to be found; but to my astonishment next day I found the clot covered by a yellow, firm, elastic, fibrinous layer, just such a one as is met with in simple pneumonia-the remainder of the clot offering no signs of dissolving. MM. Becquerel and Rodier were made acquainted with this unexpected result, and as a little epidemic of about thirty cases manifested itself during the next two months, they had ample opportunity of instituting more exact enquiries into the condition of the blood. The blood of five patients were submitted by them to analysis, and the following are the conclusions arrived at by these able chemists.

“1. That far from presenting a dissolved state, as the usually received theory supposes, the blood in these cases offered a well separated, and sometimes very firm clot, swimming in a limpid serum uncoloured by the presence of globules. 2. The density of the defibrinated blood was in all the cases below the normal mean (1057), and the figure 1038.3 observed in one case was lower than had ever yet been met with by MM. B. and R. Moreover this diminution of density, in the five cases, was not in relation with the respective proportions of water and solid matters of the blood-an extraordinary fact quite inexplicable. 3. That the density of the serum was notably lower than the normal figure. 4. That the quantity of globules was always less than normal, and was found very much diminished in the case corresponding to the lowest density of the blood. 5. That the fibrine, contrary to received ideas, was not diminished in any of the cases. In two cases it offered the normal proportions (2:2), while in the three others it was sensibly augmented, viz. 3, 3:6, and 4'l. It appeared to be endowed with all its ordinary physiological properties. 6. That the organic matters of the serum, of which albumen constitutes the larger portion, had undergone a notable diminution, while the water existed in a considerable proportion." 7. That in no case were the inorganic matters superabundant, and nothing proved an excess of alkalis, which sometimes authors have declared to be the case in the blood of the scorbutic."

Is it not remarkable thus to see the most rational previsions entirely overturned ? Theory declared that in scorbutus the quantity of fibrine was diminished, whence arose a defective plasticity, the cause of the characteristic hæmorrhages. It added that such diminution of fibrine might be the sole change, without necessitating that of the other organic elements of the blood. But the exact reverse of this has come to pass. The globules and albumen, which should {bave remained uninfluenced, are found to descend much below the physiological mean; while the fibrine exhibits an opposite tendency, so as to approach it to the condition observed in inflammations. Since the above analyses have been made, M. Andral has himself made another, and found the fibrine as high as 4-5; and M. Prus states that, he has frequently observed, at the Salpêtrière, facts analogous to these now brought forward. On the other hand, is it not interesting to see so large a diminution of albumen without any dropsy resulting, save a little odema in the neighbourhood of much ecchymosis? Is there not here something which materially interests the theory of the production of dropsy by a diminution of the albumen of the blood ?

But it will be said, do you pretend by these few cases to invalidate all the descriptions of the state of the blood in scorbutus handed down to us by the old writers? By no means. Only we would draw different conclusions from them. In fact, if we consult the principal authors who have written upon scorbutus, it becomes evident that they have given this name to diseases of a different nature, to true typhus; or that they have not taken into account the intercurrent affections arising during an epidemic of scorbutus, as of those which result from a putrid infection produced by the crowding together of patients in too small a 1847)

Fauvel and Andral on Scorbutus.

527

space, as on board a ship. The dissolved state of the blood occurring under these circumstances would be easily explained.

And even supposing that in the great and destructive epidemics of scorbutus, the blood, deprived of fibrine, lost its power of coagulation, does it follow that this should always be the case? Is the quantity of fibrine constantly diminished in typhoid fever? To arrive at a knowledge of a disease, is it not necessary to study it in its most simple form, and to disengage it as much as possible from the complications which change its essential characters? It is precisely because the scorbutus we have observed presented itself in a simple but characteristic form, that the results we have adduced have an undeniable importance. They are neither numerous or conclusive enough to serve as a basis for any particular doctrine. They have only a negative value as tending to cast doubt on the doctrine of scorbutus prevailing in our time. They demonstrate the necessity of new researches, directed in other manners and by other proceedings, and undertaken upon a vast scale. Lastly, they confirm the utility of bearing in mind the maxim which Lind called the attention of the physicians of his time to-Chymia egregia ancilla medicinæ ; non alia pejor domina.

Dr. Fauvel supplies a minute medical history of the cases observed by him, in proof of their being examples of genuine scorbutus : but to this we need very briefly refer. It showed itself chiefly in persons advanced in age, the youngest being 69 and three more than 80. They were all previously in good health, and fed upon substantial food. Among the principal symptoms observed was(1). A yellowish colouration of the entire skin, quite sui generis, most comparable to the light yellow tinge which succeeds to ecchymosis. It affected especially the face, and extended to the conjunctivæ; but the urine giving no traces of colouring matter proved it was not icterus, which it so much resembled. This colour diminished and disappeared in proportion as the case proceeded on to recovery. (2). The hæmorrhagic spots offered very different characters even upon the same subject, varying from mere red points to true purpural petechiæ. The most important variety was a true scorbutic hæmorrhage, consisting of large ecchymoses or infiltrations into or below the subcutaneous cellular tissue of the lower extremities-occasionally constituting quite projecting tumefactions. Great pains frequently accompanied these effusions; and indurated ædematous infiltrations of the limb, together with pain and tenderness of the joints, were sometimes found. (3). The changes of the gums were quite peculiar, not consisting in a general tumefaction and softening of their tissue as seen in some stomatites; but of fungous vegetations developed around the neck of each tooth, and being therefore only numerous in proportion to the number of teeth which remained. They were soft, and bled easily. Mastication was difficult, and the mouth exhaled a very fetid odour. (4). The prostration of strength of both body and mind was remarkable; although the tendency to syncope, mentioned by Lind, was not remarked—the patients, however, retaining the recumbent posture.

The treatment employed consisted in the use of a tisane acidulated with lemon, a mixture containing tannin and antiscorbutic syrup, linseed cataplasms watered with a decoction of bark, as substantial a regimen as the state of the mastication admitted of, composed of rich soups, roast meat, and as large a proportion of green vegetables as possible. In the course of treatment the juice of antiscorbutic herbs was substituted with great advantage for the tannin. Of nine patients, four were completely cured in an average period of two months, four still continued under treatment, and one died. --Archives Generales, t. xiv., pp. 262-287.

Subsequently to the results of MM. Becquerel and Rodier's investigations being communicated to the Academy, M. Andral read an account of a new analysis which he had at the same time made of the blood drawn from a wellmarked case of scorbutus under his own care at La Charité. The following is the substance of his important remarks.

I expected to find it diffluent and dissolved, but to my great astonishment

N N

*

it was not so. It consisted, in fact, of a small dense coagulum as resistent as that of phlegmasiæ, and covered by a well-marked buffy coat, and was suspended in a large quantity of serum. In the 1000 parts it gave the following proportions : Fibrine..

4'420 Globules

44.400 Solid matters of the Serum, 76.554 Water.. ..

874.626

1000.000 “ This blood in its composition resembled that of chlorotic patients by the diminution of its globules, and the large quantity of water, although the patient presented other symptoms than those of mere chlorosis. As to the fibrine, instead of being less than, it exceeded, the physiological mean. This is quite a different result from that I obtained in the other published case, in which the globules were in nearly their normal proportion, and the fibrine was in very small quantity. So, too, I found very little (about 1 per 1000) in a patient attacked with purpura hæmorrhagica.

“ The fact which I have narrated, and which is confirmatory of those recently laid before the Academy, proves that the symptoms ordinarily characterising scorbutus may be produced without being necessarily accompanied by a diminution of fibrine. "It is not then in such diminution we can place the proximate cause of scorbutus ; and it is not by it even we can hope to explain several of its symptoms, especially its characteristic hæmorrhages. In this respect, as well as in several others, we may perhaps compare scorbutus with typhoid fever. In the latter, in fact, the lowering the proportion of fibrine is often met with, but it is not necessary for the existence of the disease. Observation only authorizes us to state that the diminution is considerable in proportion as the dynamic form of the disease is well pronounced. The same thing takes place in the eruptive fevers ; so that, in these different cases, the diminution of fibrine cannot be considered as one of the necessary elements of the disease, but only as one of the more or less frequently occurring effects of the cause which has produced it, and which exerts its influence alike upon the vital forces which it tends to depress, upon the nervous system which it throws into great perturbation, and upon the blood in which it tends to produce an alteration, the reverse of that observed in pblegmasiæ. The same thing appears to me to take place in scorbutus. Like typhoid fever, it may become developed without the blood baving previously lost its fibrine, and therefore a diminution of this is neither a necessary and constant occurrence, but only an effect, a result of prior morbid modifications, a result which is produced more or less frequently according to the severity, duration, &c., of the disease.

“ Are we to refer the hæmorrhages of scorbutus to this diminution of fibrine as their cause? There can be no doubt that hæmorrhages which, like those of scorbutus, are multiplied and repeated at a great many points of the economy, are especially seen in those cases in which the blood itself has become more poor in fibrine than in the physiological state. But these are two facts which it seems to me are only coincident in their relation : both doubtless being most frequently produced under the influence of a common cause: both are hut manifestations of that cause, but the one does not seem to me to engender the other. The case I have related presents an example of remarkable hæmorrhages without any such diminution. Moreover, is it so easy to understand theoretically why a diminution of the quantity of fibrine should lead to a flow of this fluid from its vessels? Is the diameter of the globules diminished, so that they can more easily traverse the vascular parietes? Are we to admit that this passage may be favoured by an antecedent hypnæmia, when, after the violent distension of the yessels produced by inflammatory congestion such effect is not produced, and

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