Examination of the blood in surgery / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1905
Catalogue details

Licence: In copyright

Credit: Examination of the blood in surgery / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Typhoid Fever. Although this is a medical rather than a surgical disease, yet it is frequently important to be able to diagnosticate between appendicitis and typhoid, The surgical complications and sequels of typhoid also are assuming more and more importance in surgery, as their frequency and gravity are understood. A leucocytosis above 12,000, as pointed out by Kast and Giitig (31), almost certainly rules out typhoid, whereas 7,000 and below, and especially 5,000 and below makes the probability of typhoid very great. The leukopenia of typhoid is very striking and enables us with con- siderable certainty to diagnosticate typhoid not only from appendicitis, but from other abdominal suppurative diseases, such as ovarian cyst, pyosalpinx, etc. Thus Grawitz (2, p. 51), in a case in which a diagnosis of typhoid fever was made in consequence of the general condition and hypertrophy of the spleen, a leucocytosis of 30,000 with 80 °/o of poly- nuclear cells, led to a puncture of'the spleen in which a large abscess was found. During the first week of typhoid, however, there is apt to be a slight and fluctuating leucocytosis, which may obscure the diagnosis. But at that time we have the additional advantage that in 93 % of the cases in the first week, as shown by Coleman and Buxton (32) the bacilli of typhoid can be demonstrated in the blood. Most of the surgical complications of typhoid fever also produce a well-recognized leucocytosis, as is well shown by Cabot (7, pp. 203-204). If perforation takes place, and, for want of adhesions, is followed by general peritonitis, there will almost always be a rise in the leucocyte count, though it may not be prompt enough to act as a reliable guide to operation. If the resistance of the patient is good, there will be pro- bably a considerable increase in the number of leucocytes followed pretty rapidly by a diminution in their number as the sepsis increases. We must, of course, correlate this with all the other symptoms, and while we cannot say positively from the leucocytosis alone that there has been a perforation, yet such a sudden rise or a sudden rise followed by a fall is very significant. In one respect the leucocyte count may be of great aid; namely, it may disprove a supposed typhoid perforation by showing that from the moment of the supposed perforation there has been no rise and later fall of the leucocytosis. To determine this fact, Tuffier advises that there shall be even hourly examinations in cases of suspected typhoid perforation.