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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    of an infection by some as yet unknown organism. It is of interest to the surgeon because if tlie spleen is removed early there are fair prospects of recovery. 2. A. Anctnias with marked leukocytosis include especially those first sjioken of by Virchow as leukemia. Originally he applied the term to a particular alteration of the blood, but it is now made to cover a group of diseases, all of which are characterized by peculiar and more or less similar increase of white corpuscles. Sometimes these are increased to such an extent as to make the blood grossly resemble a mixture of blood and pus. This resemblance led some of the earlier observers to speak of the condition as suppuration of the blood. The number of leukocytes is sometimes enormously increased; 1 to 10 of the red cells is quite common and 1 to 5 not exceedini^lv rare. Cases have Ix'en known in which the white cells outnumbered the red. In well-marked cases of leukemia, the red cells will be somewhat diminished, while the white will number from 100,000 to 500,000 jier cubic millimeter. Accom- panving this change in the blood there are alterations in the spleen, the l\Tnph nodes, and the bone-marrow, sometimes one predominating, sometimes another. It has been customary in fact to speak of splenic, lymphatic, and medullary leukemia, but these forms are not sharply difi'ercntiated and a pure type of either form is rare. In this countrv we speak mainly of lijmphafir and splrnomeduUary forms, the latter being much more common. The latter is accompanied by enlargement of the sjileen, while in the Ivmphatic form the lymph nodes are involved and may become as large as walnuts. In the lymphatic form over \)() per cent, belong to C and D; in the splenomedullary or splenomvelogenous form the increase of F and G is most marked, while A will be reduced to 50 per cent, and D to about 10 per cent. The red corpuscles are decreased in number, but not necessarily in an inverse ratio; their number may be reduced even to 2,000,000 in extreme cases. In these cases, besides the change in number and form of the leukocytes already described, there are frequently found in the blood very minute crystals first described by Charcot. These are small, often adherent to the leukocytes, and most fre- quently found when eosinophile cells predominate; their exact significance is not known. The pathology of leukemia is too remote from the purpose of this work to receive con- sideration here. Without asserting its germ character one may say that it is under sus- picion, and that various observers have described appearances supposed to indicate a specific cause, probably a protozoon. 2. B. Pseudoleukemia.—This has, in time past, gone under many different names, of which the most common is Ilodcjkins di.^ea.'ie (q. v.). !Many speak of it as malig- nant hjmphoma. This is doubtless a disease with a specific cause, as yet unrecognized, which jiroduces very significant changes in the bood, especially in the white corpuscles. The spleen and lymph nodes are both involved, mainly the latter. The general blood changes are quite varial)le and one may find many types. As a rule, these comprise not .so much an increase in the number of leukocytes as a decrease in the number of red cells by which an apparent leukocytosis is brought about; hence the expression pseudo- leukemia. ]\Iany cases, however, will present a certain degree of actual leukocytosis, the proportion of the whites to the reds being about 40 to 50. What interpretation in general is to he given to leukocytosis.'' A condition deserving this name is, first of all, essentially temporary. In acute infectious diseases it shows itself during the febrile stage and the principal increa.se is in the finely granular oxyphile cells. In such diseases as erysipelas, as well as pneumonia, it lasts but a short time after the crisis has been reached and the temperature has fallen. In diseases like acute appendicitis and acute peritonitis from any cause a marked leukocytosis may be regarded as indicating the presence of pus; it should be em])hasized, however, that pus may he present without this indication, and it has been previously stated that such a fact is to be interpreted either as an example of a mild degree of infection or an exceedingly reduced vitality. DifEerential Leukocyte Count.—It .seems to be now quite clearly demonstrated that the mere estai)lishment of a certain degree of leukocytosis does not furnish the surgeon a relial)le guide for determining the presence of pus, it being an index of reaction rather than of actual severity of any particular kind of infection. A much more reliable guide is found in the proportion of j)olynuclear cells to the total number of leukocytes counted, /. e., by what may be called a differential count. In order to make this reliable, the normal ratio should first be determined. This is put at a point between OS and 80