Encyclopaedia Britannica Volume 4, Slice 1 Part 28

Having ascertained that the clotting is due to the action of thrombin upon fibrinogen, we now see that the next step to be explained is the origin of thrombin. It has been shown that the final step in its formation consists in the combination of another substance, termed prothrombin, with calcium. Any soluble calcium salt is found to be effective in this respect, and conversely the removal of soluble calcium (e.g. by sodium oxalate) will prevent the formation of thrombin and therefore of clotting.

In the next place it can be proved that prothrombin does not exist as such in circulating blood, so that the problem becomes an inquiry as to the origin of prothrombin. Experiment has shown that in its turn prothrombin arises from yet another precursor, which is named thrombogen, and that thrombogen also is not to be found in circulating blood but only makes its appearance after the blood is shed. The conversion of thrombogen into prothrombin has been proved to be due to the action of a second ferment which has been named thrombokinase, and this latter is again absent from living blood. Hence the question arises, whence are derived thrombogen and thrombokinase? In the study of this question it has been found that if the blood of birds be collected direct from an artery through a perfectly clean cannula into a clean and dust-free gla.s.s vessel, it does not clot spontaneously. The plasma collected from such blood is found to contain thrombogen but no thrombokinase. A somewhat similar plasma may be prepared from a mammal's blood by collecting samples of blood from an artery into vessels which have been thoroughly coated with paraffin, though in this instance thrombogen may be absent as well as thrombokinase. If plasma containing thrombogen but no thrombokinase be treated with a saline extract of any tissues it will soon clot. The saline extract contains thrombokinase.

This ferment can therefore be derived from most tissues, including also the white blood corpuscles and the platelets. Thrombogen is produced from the leucocytes, but it is not yet certain whether it is also formed from the platelets. The discovery of the origin of the thrombokinase from tissue cells explains a fact that has long been known, namely, that if in collecting blood, it is allowed to flow over cut tissues, clotting is most markedly accelerated. The fact that birds' blood if very carefully collected will not clot spontaneously tends to prove that thrombokinase is not derived from the leucocytes, and makes probable its origin from the platelets, for it is known that birds' blood apparently does not contain platelets, at any rate in the form in which they are found in mammalian blood. When examining the general properties of platelets, attention was drawn to the remarkably rapid manner in which they undergo change on coming into contact with a foreign surface. It is apparently the actual contact which initiates these changes, changes which are fundamentally chemical in character, resulting in the production of thrombokinase and possibly also of thrombogen.

Thus as our knowledge at present stands the following statement gives a recapitulated account of the changes which const.i.tute the many phases of clotting. When blood escapes from a blood-vessel it comes into contact with a foreign surface, either a tissue or the damaged walls of the cut vessel. Very speedily this contact results in the discharge of thrombogen and thrombokinase, the former from the white blood corpuscles and also possibly from the platelets, the latter from the platelets or from the tissue with which the blood comes in contact. The interaction of these two bodies next results in the formation of prothrombin, which, combining with the calcium of any soluble lime salt present, forms thrombin or fibrin-ferment. The last step in the change is the action of thrombin upon fibrinogen to form fibrin, and the clot is complete.

The intrinsic value to the animal of these changes is quite plain. The power of clotting and thus stopping haemorrhage is of essential importance, and yet this clotting must not occur within the living blood-vessels, or it would speedily result in death. That the tissues should be able to accelerate the process is of very obvious value. That the inner lining of the blood-vessels does not act as a foreign tissue is possibly due to the extreme smoothness of their surface.

Further, an animal must always be exposed to a possible danger in the absorption of some thrombin from a ma.s.s of clotted blood still retained within the body, and we know that if a quant.i.ty of active ferment be injected into the blood-stream intravascular clotting does result. Under all usual conditions this is obviated, the protective mechanism being of a twofold character. First, it is found that thrombin becomes converted very quickly into an inactive modification. Serum, for instance, very quickly loses its power of inducing clotting in fibrinogen solutions.

Secondly, the body has been found to possess the power of making a substance, ant.i.thrombin, which can combine with thrombin forming a substance which is quite inactive as far as clotting is concerned.

Finally, there is evidence that normal blood contains a small quant.i.ty of this substance, ant.i.thrombin, and that under certain conditions the amount present may be enormously increased. (T. G. Br.)

_Pathology of the Blood._

The changes in the blood in disease are probably as numerous and varied as the diseases which attack the body, for the blood is not only the medium of respiration, but also of nutrition, of defence against organisms and of many other functions, none of which can be affected without corresponding alterations occurring in the circulating fluid.

The immense majority of these changes are, however, so subtle that they escape detection by our present methods. But in certain directions, notably in regard to the relations with micro-organisms, changes in the blood-plasma can be made out, though they are not a.s.sociated in all cases with changes in the formed elements which float in it, nor with any obvious microscopical or chemical alterations.

Immunity.

The phenomena of immunity to the attacks of bacteria or their toxins, of agglutinative action, of opsonic action, of the precipitin tests, and of haemolysis, are all largely dependent on the inherent or acquired characters of the blood serum. It is a commonplace that different people vary in their susceptibility to the attacks of different organisms, and different species of animals also vary greatly. This "natural immunity"

is due partly to the power possessed by the leucocytes or white blood corpuscles of taking into their bodies and digesting or holding in an inert state organisms which reach the blood--phagocytosis,--partly to certain bodies in the blood serum which have a bactericidal action, or whose presence enables the phagocytes to deal more easily with the organisms. This natural immunity can be heightened when it exists, or an artificial immunity can be produced in various ways. Doses of organisms or their toxins can be injected on one or several occasions, and provided that the lethal dose be not reached, in most cases an increased power of resistance is produced. The organisms may be injected alive in a virulent condition, or with their virulence lessened by heat or cold, by antiseptics, by cultivation in the presence of oxygen, or by pa.s.sage through other animals, or they may first be killed, or their toxins alone injected. The method chosen in each case depends on the organism dealt with. The result of this treatment is that in the animal treated protective substances appear in the serum, and these substances can be transferred to the serum of another animal or of man; in other words the active immunity of the experimental animal can be translated into the pa.s.sive immunity of man. According to the nature of the substances injected into the former, its serum may be ant.i.toxic, if it has been immunized against any particular toxin, or antibacterial, if against an organism. Familiar examples of these are, of the former diphtheria ant.i.toxin, of the latter anti-plague and anti-typhoid sera. An ant.i.toxin exerts its effects by actual combination with the respective toxin, the combination being inert. It is probable that the ultimate source of the ant.i.toxin is to be found in the living cells of the tissues and that it pa.s.ses from them into the blood. The action of an antibacterial serum depends on the presence in it of a substance known as "immune-body,"

which has a special affinity and power of combining with the bacterium used. In order that it may exert this power it requires the presence of a substance normally present in the serum known as "complement." The development of these "anti-bodies," though it has been studied mainly in connexion with bacteria and their toxins, is not confined to their action, but can be demonstrated in regard to many other substances, such as ferments, tissue cells, red corpuscles, &c. In some animals, for example, the blood serum has the power of dissolving the red corpuscles of an animal of different species; e.g. the guinea-pig's serum is "haemolytic" to the red corpuscles of the ox. This haemolytic power (haemolysis) can be increased by repeated injections of red corpuscles from the other animal, in this case also, as in the bacterial case, by the production and action of immune-body and complement. The antiserum produced in the case of the red corpuscles may sometimes, if injected into the first animal, whose red corpuscles were used, cause extensive destruction of its red corpuscles, with haemoglobinuria, and sometimes a fatal result.

Opsonic action depends on the presence of a substance, the "opsonin," in the serum of an immunized animal, which makes the organism in question more easily taken up by the phagocytes (leucocytes) of the blood. The opsonin becomes fixed to the organisms. It is present to a certain extent in normal serum, but can be greatly increased by the process of immunization; and the "opsonic index," or relation between the number of organisms taken up by leucocytes when treated with the serum of a healthy person or "control," and with the serum of a person affected with any bacterial disease and under treatment by immunization, is regarded by some as representing the degree of immunity produced.

Agglutinative action is evidence of the presence in a serum of a somewhat similar set of substances, known as "agglutinins." When a portion of an antiserum is added to an emulsion of the corresponding organism, the organisms, if they are motile, cease to move, and in any case become gathered together into clumps. In all probability several different bodies are concerned in this process. This reaction, in its practical applications at least, may be regarded as a reaction of infection rather than of immunization as ordinarily understood, for it is found that the blood serum of patients suffering from typhoid, Malta fever, cholera, and many other bacterial diseases, agglutinates the corresponding organisms. This fact has come to be of great importance in diagnosis.

The precipitin test depends on a somewhat a.n.a.logous reaction. If the serum of an animal be injected repeatedly into another animal of different species, a "precipitin" appears in the serum of the animal treated, which causes a precipitate when added to the serum of the first animal. The special importance of this fact is that it can be utilized as a method of distinguishing between human blood and that of animals, which is often of importance in medical jurisprudence.

In this summary the facts adduced are practically all biological, and are due to the extraordinary activity with which the study of bacteriology (q.v.) has been pursued in recent years. The chemistry of the blood has not hitherto been found to give information of clinical or diagnostic importance, and nothing need here be added to what is said above on the physiology of the blood. Enough has been said, however, to show the extraordinary complexity of the apparently simple blood serum.

The methods at present employed in examining the blood clinically are: the enumeration of the red and white corpuscles per cubic millimetre; the estimation of the percentage of haemoglobin and of the specific gravity of the blood; the microscopic examination of freshly-drawn blood and of blood films made upon cover-gla.s.ses, fixed and stained. In special cases the alkalinity and the rapidity of coagulation may be ascertained, or the blood may be examined bacteriologically. We have no universally accepted means of estimating, during life, the total amount of blood in the body, though the method of J.S. Haldane and J. Lorrain Smith, in which the total oxygen capacity of the blood is estimated, and its total volume worked out from that datum, has seemed to promise important results (_Journ. of Physiol_. vol. xxv. p. 331, 1900). After death the amount of blood sometimes seems to be increased, and sometimes, as in "pernicious anaemia," it is certainly diminished. But the high counts of red corpuscles which are occasionally reported as evidence of plethora or increase of the total blood are really only indications of concentration of the fluid except in certain rare cases.

It is necessary, therefore, in examining blood diseases, to confine ourselves to the study of the blood-unit, which is always taken as the cubic millimetre, without reference to the number of units in the body.

Anaemia.

_Anaemia_ is often used as a generic term for all blood diseases, for in almost all of them the haemoglobin is diminished, either as a result of diminution in the number of the red corpuscles in which it is contained, or because the individual red corpuscles contain a smaller amount of haemoglobin than the normal. As haemoglobin is the medium of respiratory interchange, its diminution causes obvious symptoms, which are much more easily appreciated by the patient than those caused by alterations in the plasma or the leucocytes. It is customary to divide anaemias into "primary" and "secondary": the primary are those for which no adequate cause has as yet been discovered; the secondary, those whose cause is known. Among the former are usually included chlorosis, pernicious anaemia, and sometimes the leucocythaemias; among the latter, the anaemias due to such agencies as malignant disease, malaria, chronic metallic poisoning, chronic haemorrhage, tubercle, Bright's disease, infective processes, intestinal parasites, &c. As our knowledge advances, however, this distinction will probably be given up, for the causes of several of the primary anaemias have been discovered. For example, the anaemia due to _bothriocephalus_, an intestinal parasite, is clinically indistinguishable from the other forms of pernicious anaemia with which it used to be included, and leucocythaemia has been declared by Lowit, though probably erroneously, to be due to a blood parasite closely related to that of malaria. In all these conditions there is a considerable similarity in the symptoms produced and in the pathological anatomy. The general symptoms are pallor of the skin and mucous membranes, weakness and la.s.situde, shortness of breath, palpitation, a tendency to fainting, and usually also gastro-intestinal disturbance, headache and neuralgia. The heart is often dilated, and on auscultation the systolic murmurs a.s.sociated with that condition are heard. In fatal cases the internal organs are found to be pale, and very often their cells contain an excessive amount of fat. In many anaemias there is a special tendency to haemorrhage. Most of the above symptoms and organic changes are directly due to diminished respiratory interchange from the loss of haemoglobin, and to its effect on the various organs involved. The diagnosis depends ultimately in all cases upon the examination of the blood.

Though the relative proportions of the leucocytes are probably continually undergoing change even in health, especially as the result of taking food, the number of red corpuscles remains much more constant.

Through the agency of some unknown mechanism, the supply of fresh red corpuscles from the bone-marrow keeps pace with the destruction of effete corpuscles, and in health each corpuscle contains a definite and constant amount of haemoglobin. The disturbance of this arrangement in anaemia may be due to loss or to increased destruction of corpuscles, to the supply of a smaller number of new ones, to a diminution of the amount of haemoglobin in the individual new corpuscles, or to a combination of these causes. It is most easy to ill.u.s.trate this by describing what happens after a haemorrhage. If this is small, the loss is replaced by the fully-formed corpuscles held in reserve in the marrow, and there is no disturbance. If it is larger, the amount of fluid lost is first made up by fluid drawn from the tissues, so that the number of corpuscles is apparently diminished by dilution of the blood; the erythroblasts, or formative red corpuscles, of the bone-marrow are stimulated to proliferation, and new corpuscles are quickly thrown into the circulation. These are apt, however, to be small and to contain a subnormal amount of haemoglobin, and it is only after some time that they are destroyed and their place taken by normal corpuscles. If the loss has been very great, nucleated red corpuscles may even be carried into the blood-stream. The blood possesses a great power of recovery, if time be given it, because the organ (bone-marrow) which forms so many of its elements never, in health, works at high pressure. Only a part of the marrow, the so-called red marrow, is normally occupied by erythroblastic tissue, the rest of the medullary cavity of the bones being taken up by fat. If any long-continued demand for red corpuscles is made, the fat is absorbed, and its place gradually taken by red marrow. This compensatory change is found in all chronic anaemias, no matter what their cause may be, except in some rare cases in which the marrow does not react.

It is often very difficult, especially in "secondary" anaemias, to say which of the above processes is mainly at work. In acute anaemias, such as those a.s.sociated with septicaemia, there is no doubt that blood destruction plays the princ.i.p.al part. But if the cause of anaemia is a chronic one, a gastric cancer, for instance, though there may possibly be an increased amount of destruction of corpuscles in some cases, and though there is often loss by haemorrhage, the cancer interferes with nutrition, the blood is impoverished and does not nourish the erythroblasts in the marrow sufficiently, and the new corpuscles which are turned out are few and poor in haemoglobin. In chronic anaemias, regeneration always goes on side by side with destruction, and it is important to remember that the state of the blood in these conditions gives the measure, not of the amount of destruction which is taking place so much as of the amount of regeneration of which the organism is capable. The evidence of destruction has often to be sought for in other organs, or in secretions or excretions.

Of the so-called primary anaemias the most common is _chlorosis_, an anaemia which occurs only in the female s.e.x, between the ages of fifteen and twenty-five as a rule. Its symptoms are those caused by a diminution of haemoglobin, and though it is never directly fatal, and is extremely amenable to treatment with iron preparations, its subjects very frequently suffer from relapses at varying intervals after the first attack. Its causation is probably complex. Bad hygienic conditions, over-fatigue, want of proper food, especially of the iron-containing proteids of meat, the strain put upon the blood and blood-forming organs by the accession of p.u.b.erty and the occurrence of menstruation, all probably play a part in it. It has also been suggested that internal secretions may be concerned in stimulating the bone-marrow, and that in the female s.e.x in particular the genital organs may act in this way.

Imperfect a.s.sumption of function by these organs at p.u.b.erty, caused perhaps by some of the above-mentioned conditions, might lead to sluggishness in the bone-marrow, and to the supply to the blood of the poorly-formed corpuscles deficient in haemoglobin which are characteristic of the disease. Chlorosis is the type of anaemias from imperfect blood-formation. Lorrain Smith has produced evidence to show that the total amount of haemoglobin in the body is not diminished in this disease, but that the blood-plasma is greatly increased in amount, so that the haemoglobin is diluted and the amount in each blood-unit greatly lessened.

_Pernicious anaemia_ is a rarer disease than chlorosis, occurs usually later in life, and is distributed nearly equally between the two s.e.xes.

But it is of great importance because of its almost uniformly fatal termination, though its downward course is generally broken by temporary improvement on one or more occasions. The symptoms are those of a progressive anaemia, in which gastro-intestinal disturbance usually plays a large part, and nervous symptoms are common, and they become at last much more severe than those of any secondary anaemia. The patient may die in the first attack, but more usually, when things seem to be at their worst, improvement sets in, either spontaneously or as the result of treatment, and the patient slowly regains apparent health. This remission may be followed by a relapse, that again by a remission, and so on, but as a rule the disease is fatal within, at the outside, two or three years.

The prime cause of the disease is not known. It seems probable indeed that the causal factors are numerous. Severe malarial infection, syphilis, pregnancy, chronic gastro-intestinal disease, chronic gas-poisoning, are all, in different cases, known to have been causally a.s.sociated with it, and it is probable that a congenital weakness of the bone-marrow has often to do with its production, as in many cases a family or hereditary history of the disease can be obtained. The condition is now regarded as a chronic toxaemia, partly because of the clinical symptoms and pathological appearances, partly because a.n.a.logous conditions can be produced experimentally by such poisons as saponin and toluylendiamin, and partly because of the facts of _bothriocephalus_ anaemia. The site of production of the toxin, or toxins, for it is possible that several may have the same effect on the blood, is possibly not always the same, but must often be the alimentary ca.n.a.l, as _bothriocephalus_ anaemia proves. Not all persons affected with this intestinal tapeworm contract the disease, but only those in whose intestines the worm is dead and decomposing or sometimes only "sick."

The expulsion of the worm puts an end to the absorption of the toxin and the patients recover. No adequate explanation of the formation of the toxin in the immense majority of the cases, in which there is no tapeworm, has yet been given. It is certain that no organism as yet known is concerned.

This toxaemia affects the marrow and through it the blood, the gastro-intestinal apparatus and the nervous system, especially the spinal cord, in different proportions in different cases. The effect upon the marrow is to alter the type of red corpuscle formation, causing a reversion to the embryonic condition, in which the nucleated red corpuscles are large (megaloblasts), and the corpuscles in the blood formed from them are also large, are apparently ill suited to the needs of the adult, and easily break down, as the deposits of iron in the liver, spleen, kidneys and marrow prove. Whether this reversion is due to an exhaustion of the normal process or to an inhibition of it is not definitely known. The result is that the circulating red corpuscles are enormously diminished; it is usual to find 1,000,000 or less in the cubic millimetre instead of the normal 5,000,000. Though the haemoglobin is of course absolutely diminished, it is always, in severe cases, present in relatively higher percentage than the red corpuscles, because the average red corpuscle is larger and contains more haemoglobin than the normal. The large nucleated red corpuscles (megaloblasts) with which the marrow is crowded, often appear in the blood.

Other anaemias, such as those known as _lymphadenoma_, or Hodgkin's disease, _splenic anaemia_, _chloroma_, _leucanaemia_ and the _anaemia pseudo-leucaemica_ of children, need not be described here, as they are either rare or their occurrence or nature is still too much under discussion.

Leucocytosis.

The number and nature of the leucocytes in the blood bears no constant or necessary relation to the number or condition of the red corpuscles, and their variations depend on entirely different conditions. The number in the cubic millimetre is usually about 7000, but may vary in health from 5000 to 10,000. A diminution in their number is known as _leucopenia_, and is found in starvation, in some infective diseases, as for example in typhoid fever, in malaria and Malta fever, and in pernicious anaemia. An increase is very much more frequent, and is known as _leucocytosis_, though in this term is usually connoted a relative increase in the proportion of the polymorphonuclear neutrophile leucocytes. Leucocytosis occurs under a great variety of conditions, normally to a slight extent during digestion, during pregnancy, and after violent exercise, and abnormally after haemorrhage, in the course of inflammations and many infective diseases, in malignant disease, in such toxic states as uraemia, and after the ingestion of nuclein and other substances. It does not occur in some infective diseases, the most important of which are typhoid fever, malaria, influenza, measles and uncomplicated tuberculosis. In all cases where it is sufficiently severe and long continued, the reserve s.p.a.ce in the bone-marrow is filled up by the active proliferation of the leucocytes normally found there, and is used as a nursery for the leucocytes required in the blood. In many cases leucocytosis is known to be a.s.sociated with the defence of the organism from injurious influences, and its amount depends on the relation between the severity of the attack and the power of resistance.

There may be an increase in the proportions present in the blood of lymphocytes (_lymphocytosis_), and of eosinophile cells (_eosinophilia_). This latter change is a.s.sociated specially with some forms of asthma, with certain skin diseases, and with the presence of animal parasites in the body, such as ankylostoma and filaria.

Leucaemia.

The disease in which the number of leucocytes in the blood is greatest is _leucocythaemia_ or leucaemia. There are two main forms of this disease, in both of which there are anaemia, enlargement of the spleen and lymphatic glands, or of either of them, leucocytic hypertrophy of the bone-marrow, and deposits of leucocytes in the liver, kidney and other organs. The difference lies in the kind of leucocytes present in excess in the blood, blood-forming organs and deposits in the tissues.

In the one form these are lymphocytes, which are found in health mainly in the marrow, the blood itself, the lymph glands and in the lymphatic tissue round the alimentary ca.n.a.l; in the other they are the kinds of leucocytes normally found in the bone-marrow-myelocytes, neutrophile, basophile and eosinophile, and polymorphonuclear cells, also neutrophile, basophile and eosinophile. The clinical course of the two forms may differ. The first, known as lymphatic leucaemia or _lymphaemia_, may be acute, and prove fatal in a few weeks or even days with rapidly advancing anaemia, or may be chronic and last for one or two years or longer. The second, known as spleno-myelogenous leucaemia or _myelaemia_, is almost always chronic, and may last for several years. Recovery does not take place, though remissions may occur. The use of the X-rays has been found to influence the course of this disease very favourably. The most recent view of the pathology of the disease is that it is due to an overgrowth of the bone-marrow leucocytes, a.n.a.logous in some respects to tumour growth and caused by the removal of some controlling mechanism rather than by stimulation. The anaemia accompanying the disease is due partly to the leucocyte overgrowth, which takes up the s.p.a.ce in the marrow belonging of right to red corpuscle formation and interferes with it. (G. L. G.)

FOOTNOTE:

[1] The suffix _-phile_, Greek [Greek: philein], to love, prefer, is in scientific terminology frequently applied to substances that exhibit such preference for particular stains or reagents, the names of which form the first part of the word.

BLOOD-LETTING. There are certain morbid conditions when a patient may obtain marked relief from the abstraction of a certain amount of blood, from three or four ounces up to twenty or even thirty in extreme cases.

This may be effected by venesection, or the application of leeches, or more rarely by cupping (q.v.). Unfortunately, in years gone by, blood-letting was used to such excess, as a cure for almost every known disease, that public opinion is now extremely opposed to it. In certain pathological conditions, however, it brings relief and saves life when no other means would act with sufficient promptness to take its place.

Venesection, in which the blood is usually withdrawn from the median-basilic vein of the arm, has the disadvantage that it can only be performed by the medical man, and that the patient's friends are generally very much opposed to the idea. But the public are not nearly so prejudiced against the use of leeches; and as the nurse in charge can be instructed to use these if occasion arises, this is the form of blood-letting usually practised to-day. From one to twelve leeches are applied at the time, the average leech withdrawing some two drachms of blood. Should this prove insufficient, as much again can be abstracted by the immediate application of hot fomentations to the wounds. They should always be applied over some bony prominence, that pressure may be effectively used to stop the haemorrhage afterwards. They should never be placed over superficial veins, or where there is much loose subcutaneous tissue. If, as is often the case, there is any difficulty in making them bite, the skin should be p.r.i.c.ked at the desired spot with the point of a sterilized needle, and the leech will then attach itself without further trouble. Also they must be left to fall off of their own accord, the nurse never dragging them forcibly off. If cold and pressure fail to stop the subsequent haemorrhage, a little powdered alum or other styptic may be inserted in the wound. The following are the main indications for their use, though in some cases they are better replaced by venesection, (1) For stagnation of blood on the right side of the heart with constant dyspnoea, cyanosis, &c. In acute lung disease, the sudden obstruction to the pa.s.sage of blood through the lungs throws such an increased strain on the right ventricle that it may dilate to the verge of paralysis; but by lessening the total volume of blood, the heart's work is lightened for a time, and the danger at the moment tided over. This is a condition frequently met with in the early stages of acute pneumonia, pleurisy and bronchitis, when the obstruction is in the lungs, the heart being normal. But the same result is also met with as a result of failure of compensation with back pressure in certain forms of heart disease (q.v.). (2) To lower arterial tension. In the early stages of cerebral haemorrhage (before coma has supervened), when the heart is working vigorously and the tension of the pulse is high, a timely venesection may lead to arrest of the haemorrhage by lowering the blood pressure and so giving the blood in the ruptured vessel an opportunity to coagulate. (3) In various convulsive attacks, as in acute uraemia.

BLOOD-MONEY, colloquially, the reward for betraying a criminal to justice. More strictly it is used of the money-penalty paid in old days by a murderer to the kinsfolk of his victim. These fines completely protected the offender from the vengeance of the injured family. The system was common among the Scandinavian and Teutonic races previous to the introduction of Christianity, and a scale of payments, graduated according to the heinousness of the crime, was fixed by laws, which further settled who could exact the blood-money, and who were ent.i.tled to share it. Homicide was not the only crime thus expiable: blood-money could be exacted for all crimes of violence. Some acts, such as killing any one in a church or while asleep, or within the precincts of the royal palace, were "bot-less"; and the death penalty was inflicted. Such a criminal was outlawed, and his enemies could kill him wherever they found him.

BLOODSTONE, the popular name of the mineral heliotrope, which is a variety of dark green chalcedony or plasma, with bright red spots, splashes and streaks. The green colour is due to a chloritic mineral; the red to haemat.i.te. Some coa.r.s.e kinds are opaque, resembling in this respect jasper, and some writers have sought to restrict the name "bloodstone" to green jasper, with red markings, thus making heliotrope a translucent and bloodstone an opaque stone, but, though convenient, such a distinction is not generally recognized. A good deal of bloodstone comes from India, where it occurs in the Deccan traps, and is cut and polished at Cambay. The stone is used for seals, knife-handles and various trivial ornaments. Bloodstone is not very widely distributed, but is found in the basaltic rocks of the Isle of Rum in the west of Scotland, and in a few other localities. Haemat.i.te (Gr.

[Greek: aima], blood), or native peroxide of iron, is also sometimes called "bloodstone."