The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome.

  • Roswell Park
Date:
1907
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    j)().si-(l ((» he proportioiijitc to the severity of the infection, (houj^h the fj^reater the reac- tionary ahility of tlie i)atient the hirger the nninl)er of white cells. \Vhere vitality is very low leukocytosis is less proiiouncetl. It is possible to have toxemia to such a degree that the activity of the ItMikocytes seems to he destroyed. The following summary from Cahot |)uts things in very distinct form. Infection mild, vital reaction good—small leukocytosis. Infection less mild, vital reaction less good— moderate leukocytosis. Infection .severe, vital reaction good—very marki'd leukocytosis. Infection severe, vital reaction poor—no leukocytosis. From this it will appear that the absence of leukocytosis in ea.ses where it naturally would be ex])cctcd is a serious indication and justifies an unfavorable prognosis; or else it may be iiitciprctcd in evidently favorable cases as indicating infection of very mild grade. There art' but few diseases in which leukocytosis by itself (or for that matter any other indication wiiicli the ordinary examination or l)lood count may give) is wholly siiliicicnt for diagnostic ])urposcs. But a blood count and estimate of the amount of hemoglobin |)resent will ofttMi be of such advtintage to the surgeon that he may well aiford to wait in order to secure them. This is rarely necessary in acut(> cases, but in chronic cases, and esiXH'ially the anemias, he may gain great benefit by such investigation. In trichi- nosl'i, for example, eosinophilia is most pronounced, B forming even as high as 70 per cent, of the leukocytes present. The anemias which are of particular interest to the surgeon may be classified as follows: 1. Anemias wlflioid marked Iriikori/to.ns. A. Characterized by oligocythemia. B. Characterized by diminution of hemoglobin. 2. Anemias with marked leukocijfosis. A. Leukemia (leukocythemia). B. P.seiidoleukemia (Hodgkin's disease). 1. A. Anemias due to hemorrhage may assume one of two forms, that resulting from sudden and extensive loss of blood or that resulting from constant oozing. Example of the former is seen in hemorrhages of the stomach or intestines after perforating ulcer, etc. Examples of the latter are met with in hemophilia and in uterine hemorrhages, or in excessive menstruation where the loss of blood extends over a considerable length of time. It is known, moreover, that certain entozoa in the intestines will produce a chronic anemia. Thus the red corpuscles may be reduced to even less than 1,000,000 per cubic millimeter. Immediately after acute hemorrhage the hemoglobin percentage is still normal, but after a short time it becomes reduced. If such cases do not speedily end fatally, nucleated red corpuscles appear in the blood and the observer will recog- nize both normoblasts and megaloblasts. At the same time the bone-marrow, which is normally yellow, becomes red, vascular, and richly cellular, and seems to furnish these cells just mentioned. Certain drugs, like potassium chlorate and glycerin, affect also the number of red corpuscles, but such poisons as these cause not only disintegration of the red cells, but produce also jaundice and hemoglobinuria. Pernicious anemia sometimes interferes with or fatally complicates surgical treatment. It is character- ized by the extreme changes already mentioned, with which it marches steadily to a fatal termination. Quincke has reported an instance in which their number was reduced to 43,000 per cubic millimeter, while the hemoglobin w^as reduced to 20 or 25 per cent, of the normal amount. 1. B. The best example of anemia which depends upon diminution of the hemo- globin content of the red cells is that known as chlorosis. In this there are few' recog- nizable signs of destruction of corpuscles, even under chemical microscopic examination; consequently the blood picture is very simple. The color index is very low, yet similar conditions may also be seen in syphilis, tuberculosis, and cancer. The underlying feature of all of these cases is malnutrition. Within a few years a peculiar form of intense anemia has been described by Banti and others, and is often spoken of as s'plenic anemia or Bantis disease. It is charac- terized by three stages: first, of splenic enlargement and anemia; second, a transitional stage; third, a stage of ascites which increases up to death. It is quite closely allied to Hanot's hypertrophic cirrhosis of the liver. It is quite generally regarded as an example