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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    Personally I rely very little on the thermometer in appendicitis, perito- nitis, and other abdominal inflammations, for I have seen an appen- dical abscess containing a pint of pus (Ij and a peritoneum full of pus with a normal temperature in both cases. The X Kays have very fre- quently been a source of error. Yet no surgeon would hesitate to admit the value of these and other similar means of examination, nor would he decline the aid that they might give him. His attitude would be twofold : on the one hand he would insist that methods should be improved so that sources of error could be eliminated; and, on the other, that the information derived from any one of these methods of examination should never be allowed to stand alone, but should be correlated with all the other clinical evidence which would throw any light on the case. Examination of the blood, I believe, stands on precisely the same basis. Tuffier has well said of hematology : « It has won the right to be included among our anatomico-pathological means of investigation », and again that it is to be employed « on the sole condition that the examination shall be made and repeated with care and by a competent observer, and interpreted solely in conjunction with the symptoms and a complete clinical investigation » (2). Those who are optimistic and enthusiastic as to the results from exa- mination of the blood, who possess what Tutfier has well described as a « robust faith », and speak sometimes of the « exact nature of leuco- cytosis » and again as to the value of the leucocyte-count in surgery, «that the question is no longer sub judice », are quite as much in error in my opinion as those who are so pessimistic regarding the value of hematological investigations as practically to place no dependence upon them. My own feeling is that many and possibly all of the many different examinations of the blood and its components are either of definite value or before long will become so. Upon some we can depend as yet but little. In fact, as to some, our knowledge is still crude and imper- fect. Upon others we can depend more, but must accept their conclu- sions with caution, and if they are in contradiction with the results from other well-established long-known methods of investigation, our skepticism should be increased ; that others are assuming a definite positive value; but that no one of the results of hematology has yet won such an assured position of certainty that we can always depend upon it for diagnosis, prognosis, and especially for treatment when a human life is at stake. Hematology is fighting its way to the front. In spite of its very recent