The cause of the coagulation of the blood : being the Astley Cooper prize essay for 1856, with additional observations and experiments, and with an appendix, showing the bearings of the subject on practical medicine and pathology

Front matter

22300005272

THE CAUSE

OF THE

Preface

In the forthcoming Essay, I lay before the reader the results of some inquiries, which, commencing in the year 1850, have been carried on so steadily to this date, that in reviewing the long interval, I can scarcely recall a day, some portion of which has not been set aside to the study of one or other of the subjects hereafter to be described. But the work has been so deeply interesting and progressive, that the years seem gone as an hour ; and if I have one regret at this moment, ffr is, that the same years with their labours cannot return.

In 1853, I became for the first time aware that the subject of the next Astley Cooper Prize, was " The Cause of the Coagulation of the Blood." Working on as I had previously done, I arrived in 1855 at what seemed to me to be a rational and true explanation of the phenomenon of coagulation. I therefore decided to send in an Essay in competition. This Essay, to which the prize was awarded in 1856, is here produced, with numerous additional experiments and ob-

Ym PREFACE.

serrations (marked off by brackets to distinguish them from the original), and with an Appendix which is also new.

I have been rendered fortunate and happy, in the whole course of these labours, by the kindly interest and willing assistance which have at all times been afforded to me by those numerous professional friends and savans who have come forward to witness and assist in my experiments, and to tender their opinions and suggestions. I have referred to many of these in the text, and return to all my warmest thanks.

To my colleagues of the Medical Society of London, I can never, in this respect, be too grateful. Before them, as an entire stranger, I laid timidly the first fruits of these inquiries, and as a friend the latest. But, from first to last, their fair criticism, kind encouragement, and scientific interest, have been the same, — to me invaluable. I return also my best thanks to theCouncil of the Royal College of Surgeons, for having granted me the free use of their great library ; and to their learned librarian, Mr. Chatto, for the courteous assistance which he has often rendered me.

To Dr. R. Willis, of Barnes, my hearty acknowledgements are specially due. Working together for many years in the same field of practical labour and observation, many of the facts relating to disease, recorded in these pages, were common to both of us, and afforded matter for our mutual study. Here the more extended learning of my fellow-labourer came willingly to my

PREFACE. 1X

assistance, and helped me not a little in the first steps of the way.

To Drs. Snow and Thudichum, and to Mr. Thomas Taylor, Lecturer on Chemistry at the Middlesex Hospital, I express equal gratitude.

In the past three years I have received the able assistance of Dr. Alexander Henry and Mr. Wentworth Scott ; and I can never forget or overestimate their unwearied and efficient services. The former in literary matters, the latter in experimental, have lent me their ready skill in the same free and unanimous spirit, and with the same intelligent industry and interest. During publication, too, Dr. Henry has relieved me of much anxiety, by undertaking the revision of the press — a labour in which he is a perfect master. In his laborious and learned way he has, moreover, carefully perused the historical chapters, so as to ensure for them the greater accuracy and value.

To Dr. Barker, of Bedford, my further thanks are due for carrying out at my request several experiments which required much time, expense, and trouble. Engaged as Dr. Barker is with the harassing duties of the busy medical practitioner, I can better feel than express the friendly manner in which he undertook, and so efficiently performed, the experiments recorded in this work as having been conducted by him.

I have to offer a word of apology and explanation for the delay which has occurred in the publication of this Essay. The work was intended for the latter part x PREFACE.

of last, or, at latest, the beginning of the present year, and it was sent to press with this intention. But having given at the Cheltenham meeting of the " British Association for the Advancement of Science " an exposition and full abstract of the Physiological part of this work, many inquiries soon began to be made of me, by medical friends, as to the bearings of the physiological question on Pathology and Practice. I was thus led into new lines of experimental inquiry, the result of which has been the preparation of the Appendix herewith published. This preparation, in the midst of other pressing scientific concerns, has taken up more time and Avork than I ought, in strict prudence, to have devoted to it, and is, after all, but an instalment of a wider series of inquiries. But if, as it is intended, the subject matter of the Addendum should ultimately prove of service to pathological and practical medicine, the good-natured Reader will, I hope, forgive the delay, in consideration of the labour which has called for it.

Whatever position the views published in this work may now or in after time take, I, as their author, can state thus much ; that they have been deduced without any preconceived ideas, and in an earnest attempt to follow out the pure inductive method of research ; that if they gain ground, the success is entirely due to the inductive principle ; and that if they fail, the failure is exclusively my own.

As the conclusions at which I have arrived are based on experimental evidence, so I hope to see them tested

PREFACE. xl

by similar evidence ; and I wish this remark to apply, not to the phenomenon of coagulation alone, but to every other experimental inference, and specially in regard to the artificial production of certain diseases explained in the last part of the work ; since this latter point bears the same relation to Pathology as the preceding to Physiology, and, in a practical sense, is equally important. The experiments have all been conducted with the utmost regard to simplicity of detail, and are described as they were performed, so as to render their repetition the more ready.

And whereas it is the business of no man here to set himself up as the prophet of Nature, nor to run before her, and so far to dominate over her as to dogmatically assert that she does things which she does not, because he has given the ipse dixi; so, in now recording certain new interpretations of some natural phenomena according to my best ability and closest observation, I hold myself still the servant of my divine mistress, ready at any moment, as I grow older and more learned in the knowledge of her laws, to be corrected by her, and to accept her, but none other, as umpire on each and all interpretations which are submitted to the reader. For I know that a true interpretation of a natural phenomenon is in the end irresistible, and that whatever is not true will fall of itself, unsustainable in the presence of the immutable and constantly recurring fact.

To the true scholar, Nature, the manuscript of the Supreme, is the only book of reference. To him, the

X11 PREFACE.

Elements are the letters of this book— their combinations the worcls— their manifestations or phenomena the thoughts. . Turning, up but a brief sentence of this inexhaustible work, I have tried its interpretation with willingness and industry, but with much more of reverence and admiration. How feeble my efforts are, how infinitely poor my abilities for the task, how marked my shortcomings, I know better than the most unfriendly critic could suggest. For it is the peculiarity, nay, the fatality, of natural and experimental studies, that the more one learns from them, the wider and wider expands the argument, and the stronger and stronger becomes the consciousness of the mind's limitation, and of the facts, .that the phenomena of the universe admit of no isolation, and are seen but as material visions, beginning in the unknown, ending in the unknown — having to us, indeed, no beginning and no end.

12, Hinde Street, Manchester Square, December 21st, 1857.

Chapter I. Historical Memoranda On The Supposed Causes Oe Coagulation Of

THE BLOOD.

TAGB

Object of the chapter ------ 1

Coagulation of blood noticed by the ancient Grecian philosophers - 2 Opinions of Plato and Aristotle - 2.3 Nature of buffy coat first pointed out by Malpighi - - .3

Confusion of ideas respecting different parts of the blood - . ib.

Mr. Gulliver's exposition of Hewson's views - . .4

State of tbe question since Hewson's time - - - 5

Present starting point of our knowledge, and question remaining for

solution .- . . . - ib

The various Theories and Hypotheses. — Temperature - .

Temperature probably the oldest hypothesis of coagulation - . u .

Fallacy of the idea that cold causes coagulation proved by Hewson - ib. Experiments of Metcalfe on effect of heat and cold on coagulation - ib. Eesult of inquiries into effect of temperature in regard to the coagulativo

power of blood of warm or cold-blooded animals - 7

Metcalfe's resume of facts connected with the effect of temperature on

' coagulation ....

Is beat evolved during coagulation ? Exposure to the Air -

Hewson's theory of exposure to the air being the main cause of coagulation Condition of blood in vacuo: opinions of Lehmann and Soudaraore Effect of simple exclusion from air : observations of Drs. Carpenter and Babington

Sir H. Davy's experiments on exposure of blood to gases

8 !)

ih.

ib.

ib.

„ 1 v^j.uauio Ul kllUUU I.U gUSeS -

Best and Motion ...

Lancisi's explanation of deposition of fibrin in aneurism ^ xiv

Contents

Fibrinous deposits in the heart explained by Collins and Browne as

occurring from slow motion of blood - - .11

Experiments and opinions of Spallanzani, Magendie, Simon, and Carswell 1 2 Opinion of Bostock on rest as the cause of coagulation - - ib.

Chapter II. Cause Of The Phenomenon Of Coagulation : Present Position Of The

QUESTION.

Fibrin essential to Coagulation - - - 39

Proofs of this position - - - - ib.

Question of existence or non-existence of fibrin in the blood within the

body here unimportant - - - - 40

Temperature and its Effects - - - . - 41

Evidence regarding effects of temperature - . - ib. Influence of temperature on coagulation not reconcileable with most

other hypotheses and theories - - . - ib. Exposure to the Air - - . . - 42 Experiments of Hewson examined - - . - ib. Observations on the subject of gaseous evolution - - - ib. Theory of Best as the Cause of Coagulation - . - 43 Simple physical principles involved - . . - ib. Circumstances favouring the view - . . - ib. Circumstances opposing it - - - . - 45 The theory does not account in full for coagulation . . Hypothesis of the Vital Principle - . . - ib. No intelligible definition of the term " vital force" agreed on . ib. Contradictory uses of the term - - . . - 46 Tendency of modern physiologists to explain so-called vital acts on physical or chemical grounds . . . - ib Vital hypothesis of coagulation disproved - . - 47 Hypothesis of a Nervous Force - . . - 48 What is " nervous force" 1

; 10.

And how and where does it affect the blood ? Chemical Theories -

Observations speciaUy made on blood drawn from the body - . ,7,

Vagueness of experiments with substances not naturally contained in blood - .....

ib.

C u xviii

CONTENTS.

PAOP.

Experiment 40. Effect of copious drinking of water - . 130

Experiments 41-44. Poisoning with antimony - . . 182-4 State of blood after death modified by immediately laying open the

blood-vessels 135

Blood retained fluid in small cavities and within the skull - - 13(1

Coagulation retarded, not prevented, by death by shock - - 137

Experiments 45-47. Animals killed by shock ... 137-8 Immediato inferences from preceding observations on states of blood

after death 138

Chapter IV

EXPERIMENTAL INQUIRY INTO THE PHYSICAL AGENCIES INFLUENCING THE COAGULATION OF THE BLOOD.

1. Effects of Temperature ..... 140 Limits of temperature within which differences in period of coagulation

are produced - - - - - ib.

Difficulties attending the question .... 141

Period of coagulation varies in different animals - - ib. Temperature of the blood to be observed; not merely of the medium in

which it is placed ..... 143

Temperature of surrounding atmosphere to be noted - - '143 Vessels of same size and shape to be used - - - ib. Experiments 48-55. Exposure of blood to various degrees of temperature 144-8 Experiments 50-59. Mixture of water at different temperatures with

Experiments 60-63. Effects of receiving blood into ice - - 150-3

Experiments 04-69. Observations on frozen blood - - - 153-5

General conclusions : heat quickens coagulation : cold retards it - 1-55

Effects of heat and cold on coagulation observed in the slaughter-house 157

High temperature probably quickens extrication of gases - - 158

2. Effects of Addition of Water to freshly drawn Blood - - ib. Introductory remarks : precautions in experiments - - ib. Experiments 70-89. Dilution of blood with water - - 159 05 General deductions from experiments of diluting blood with water - 165

3. Effects of mixing Blood with other Fluids of Different Densities - 10G Experiments 90-110. Admixture of blood with water, albumen, syrup,

and mucilage ------ l06^1

General remarks on the effects here produced - - - 171

4. Effects of Exposing Blood to, or of Excluding it from, the Air - 172 Experiments 111-110. Coagulation in open and closed vessels - 172-4 Experiments 117-120. Coagulation in tubes of different diameters and

CONTENTS. xi*

PAOE

Experiments 121-127. Blood under diminished atmospheric pressure - 170-80

Effect of the vacuum on coagulation shewn in cupping - - lal

Experiments 128-132. Effects of drawing blood through pointed tubes - 181-:)

Coagulation of flowing blood in streams of different diameters - 181

Instrument for observing thin and broad blood-streams - *&• Experiments 133-137. Transmission of blood through tubes of different

Experiment 138. Exposure of blood to the air in a stream - - 187

Effects of driving currents of air through blood - - - lB8

Apparatus - - - - " - ib.

Experiments 139-141. Air driven through blood - - - 189-90

Exclusion of blood from air : its results in regard to coagulation - 190

Experiment 142. Blood eo closed in glass tube - - - 191

Experiment 143. Blood enclosed in a portion of intestine - - 192

Experiments 144-146. Occlusion of blood in veins - - 193-°

Experiment 147. Blood effused into soft parts - - - 190

Experiment 148. Occlusion of blood in veins and heart - - 197 Observations on the killing of animals in the slaughter-house, in regard

to the coagulation of blood ----- 198

Experiments 149-150. Blood enclosed in portions of vein - - 200 1

General observations on occlusion of blood within vessels • - 201

Apparatus for subjecting blood to artificial pressure - - 202

Experiments 151-153. Blood enclosed in portions of vein under mercury 203-5

Fluidity of blood in the body of the leech - 205

Experiments 154-157. Observations on leech-drawn blood - - 206-9

Blood under oil ------ 209

Dr. Babington's experiment - - - - - ib.

Experiments 158-160. Coagulation under oil - - - 209-11

Experiments with cold and pressure ... - 211

Apparatus used - - - - - - ib.

Experiment 161. Blood under mercurial pressure - - - 213

Conditions required for carrying out this experiment - - 214

Experiments 162-164. Blood subjected to cold and pressure - - 215-7

Description of trocar and canula for drawing blood from animals - 217

5. Influence of Motion on freshly drawn Blood - - - 218

Experiments 165-168. Agitation of blood in closed vessels - - 219-21

Whipping out fibrin from blood .... 221

Observations in the slaughter-house - - - ib.

Explanation of modifications in the results of simple agitation - 222

Blood in circular motion - 223

Apparatus for artificial circulation .... 2M

Experiments 169-170. Blood in circular motion - - . 220-7 Summary of facts regarding physical agencies, supplied by experiments

related 227

XX

CONTENTS.

Chapter V. Experimental Inquiry Into The Chemical Agencies Influencing The

COAGULATION OF THE BLOOD.

PAGE

Previous experiments made with substances either not belonging to the

body, or with blood-salts in unnatural proportions - - 229

Institution of a rational inquiry into the chemical agencies affecting

coagulation 230

Two divisions of the inquiry - - . . . ib.

Constitutional parts of the blood - . . - 231

Eejection of insoluble saline substances from examination - - 232

1. Solubility of Fibrin - - - - - ib. Precautions observed in succeeding experiments - - - ib. Experiments 171-176. Fibrin in solutions of the fixed alkalies - 232-3 Exiieriments 177-191. Fibrin in various saline solutions - - 234-0 Fibrin soluble in alkaline solutions ; insoluble in pure saline solutions - 230 Experiments 192-208. Fibrin in solutions of various organic substances 236-9

2. Effects of Chemical Agents on freshly drawn Blood - - 239 Precautions observed in experiments - ' - - ib. Experiments 209-219. Effects of fixed alkalies on blood - - 240-2 Experiments 220-217.- Effects of various salts on blood - - 242-9 Experiments 248-271. Effects of various acids on blood - - 249-55 Experimen ts 272 270. Effects of various organic substances on blood - 255-0 Experiments 277-280. Effects of galvanism on blood - - 250-8 Summary ------- 258

Alleged effects of chloride of sodium on blood - - - ib.

Free fixed alkali not the cause of fluidity - - - 259

Effect of serum on newly drawn blood ... - 260

Experiments 281-289. Admixture of serum with blood - - 260-2

Conclusions from these experiments ... - 262

Hypothesis of norr-existence of fibrin in blood does not explain Uuidity - 263

Contact with oxygen does not explain coagulation - - - ib.

Effects of acids - ib.

Chapter VI

EXPERIMENTAL INQUIRY INTO THE CHEMICAL AGENCIES INFLUENCING THE COAGULATION OF THE BLOOD (CONTINUED).

Evolution of Gaseous Matters from Blood ■ - - 264

Conclusions derived from preceding inquiiies - - ib. Escape of volatile substance from blood referred to by Scudamore and

CONTENTS. xxi

PAGE

Experiments on physical agencies point to evolution of gaseous matter - 205

Necessity for testing the theory - 206

Transmission of blood-vapour through blood - - - 267

Description of apparatus - - • - - tot

Experiments 290-391. Transmission of blood-vapour through blood - 208-9

Effect of these experiments limited - 209

Alleged component parts of blood-vapour - 2?0

Blood-vapour tested for carbonic acid - - - - ib.

Experiments 292-294. Carbonic acid, oxygen, and nitrogen, driven

through blood ------ 271-2

Evolution of Ammonia from Blood - ... - 272

Search for ammonia suggested by influence of fixed alkalies - - ib.

Two points to be investigated ----- 273

Blood-vapour tested for presence of ammonia - - - ib.

Experiment 295. Blood-vapour tested with hydrochloric acid - ib.

Causes of failure of ordinary test by visible appearance of white fumes - ib. Experiments 290-209. Formation of ammonio-chloride of platinum

from blood-vapour ..... 274-5

General results of these experiments .... 276

Experiments 000-301. Formation of ammonio-chloride of platinum from

blood-vapour - - - - - ib.

Formation of microscopic crystals of chloride of ammonium - - ib. Conditions required in experiment ... - 277 Experiments 302-305. Formation of chloride of ammonium from blood-vapour 278-9 Apparatus for excluding air - - - - - 280

Another apparatus - - - - - 281

Experiments 300-307. Formation of chloride of ammonium from blood-vapour ........ 280-1

Apparatus for examining human blood .... 282

Experiments 308-310. Ammonia evolved from human blood - - 382-3

Points established by these experiments .... 283

Objection to the experiments with cupping-glass - - - ib.

Apparatus for preventing reabsorption of ammonia by blood - - 284 Experiments 311-315. Formation of chloride of ammonium from blood

Experiment 316. Ammonia evolved from blood-clot - - 287

Effect of Ammonia on Fibrin and Blood - - - - ib.

Ecasons for adopting synthetical method of inquiry - - - ib.

Effect of ammonia on fibrin - 288

Experiments 317-319. Fibrin in solutions of ammonia - - ib. Circumstance leading to observation of solvent effect of ammonia on

Experiment 320. Effect of ammonia on fibrinous concretion - - 289

Reason of slow solution of fibrin by ammonia - . . ib>

Effect of ammonia on blood ..... 2Uq

Experiments 821-830. Effect of receiving blood into solutions of ammonia of various strengths ..... 00,0.4 xxii

CONTENTS.

. . I'AOE

Transmission of ammonia, in vapour, through blood - . 203

Description of apparatus - - . . - ib

Experiments 840-842. Ammonia vapour driven through blood . 296-7

Experiments 343-347. Effect of sesquicarbonate of ammonia on blood 207-8

Experiments 348-350. Relative effects of potassa, soda, aud ammonia - 298-9

Effect of physical agencies on ammoniated blood - - . 299

Recapitulation of results of preceding experiments - - - ib. Experiments 351-300. Effects of different temperatures on ammoniated

Experiments 361-363. Admixture of ammoniated blood with water - 304 Experiments 364-376. Effects of exposure to, and exclusion from, air on

ammoniated blood ..... 304-8

Experiment 377. Transmission of ammoniated blood through tubes of

different diameters ..... 308

Experiments 378-388. Effects of rest and motion on ammoniated blood 309-13 Effect of physical agencies the same on ammoniated as on ordinary blood 313 Addition of water in excess an apparent exception - - ib. Experiment 389. Addition of water to blood - - ib. Production of coagulation in blood surcharged with ammonia - 314 Experiment 390. Coagulation of ammoniated blood by exposure to increased temperature - ... . - ib.

Effect of fixed alkalies and lime on ammoniated blood - - 315 Experiments 391-393. Coagulation of ammoniated blood by potassa

and lime 316-17

Care required in these experiments - - - 317

Re-solution and recoagulation of blood-clot - - - ib.

The process difficult - - - - - - to.

Experiment 394. Solution and recoagulation of coagulated fibrin - 818

Experiments 395-398. Re-solution and recoagulation of blood-clot - 319 22

Facts deduced from analytical and synthetical experiments - - 322

Processes analogous to coagulation . - - - 323 Mixture of isinglass with defibrinated blood - - -

Solution of shell lac in ammonia - - - il>.

Form in which ammonia exists in blood - - - 324

Is it simple ammonia (N H3), or one with a basic radical ? - - 325 Rapidity of evolution of ammonia proportionate to rapidity of coagulation -

Reason of rapid evolution - - -

Question of mode of formation of ammonia

Reasons why ammonia has not hitherto been detected in heathy blood - 327 Evidence of excess of ammonia in blood in disease Quantity of fibrin in blood modified by several conditions Proportion of ammonia to fibrin must be taken into account - Definite relationship between fibrin and its solvent - Two modes of determining the proportion of ammonia required to hold

fibrin in solution - Difficulties of the analytical process ib.

CONTENTS. xxm

I'AOE

Eesults of the synthetical process - - ' 330

Experiment 399. Blood retained fluid by ammonia and motion - 331

Slow putrefaction of blood surcharged with ammonia Other uses of ammonia in the body -

CHAPTEE VII.

PHENOMENON OK THE BUFFY COAT.

Nature of the process by wbich the buffy coat is formed - - 333

Modified by physical agencies - - - - - ib.

The formation favoured by slow coagulation or by simple excess of fibrin 334

These conditions sometimes present together - - - ib.

Effect of ammonia on buffy blood .... 335

Alleged mutual attraction of blood-corpuscles - - - 336

Theory of Hunter and Schrceder van der Kolk - - - ib.

CHAPTEE VIII.

SUMMARY OF CONCLUSIONS AND PROPORTIONS.

First major proposition ..... 333

Second major proposition ..... 339 Minor propositions • - - - - - ib.