The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis.

  • Wharton, Henry R. (Henry Redwood), 1853-1925
Date:
1902
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis. 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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    lated. It is also occasionally absent in inflammatory conditions in which it would be expected, for reasons which are as yet unknown, so that it is not an absolutely reliable symptom. Leucocytosis is present also in a number of conditions without inflammation. Any serious hemorrhage may cause a relative increase in the leucocytes for a time, their number returning to the normal proportion when the antemia becomes less acute. The increase is observed when the blood flows into one of the cavities of the body, as well as when it escapes externally, being marked in ruptured ectopic gestation, in which we have observed a count of twenty-six thousand five hundred. The intravenous infusion of normal salt solution will also cause a leucocy- tosis. The administration of certain drugs, such as salicylic acid, causes a leucocytosis, and it is the rule after the ansesthetic inhalation of ether. We have observed it to occur after operations undertaken with intraspinal cocaine anaesthesia, although it is not so i-apid as with ether ansesthesia, the count with the latter being doubled in a few minutes. Cases of sarcoma often show a leucocytosis, and it is said also to occur in carcinoma in the late stages, although its ]3resence in the latter is denied by some unless there is ulceration. From these facts it is evident that while leucocytosis is a symptom which may be very useful in diagnosis, it must be interpreted with care, just as we have learned that even the temperature of a patient cannot always be accepted as a reliable symptom. Before we assume that the leucocytosis indicates a suppurative inflammation, we must exclude other possible causes for the in- crease, such as ijneumonia, or a previous ether anaesthesia, or hemorrhage. Leucocytosis is most useful in the diagnosis between conditions which re- semble each other in other respects, but differ in their effect upon the leuco- cytes. Thus, leucocytosis is present in su^jpurative or gangrenous appendicitis and in peritonitis (unless overwhelming sepsis has developed), but is absent in intestinal obstruction and in typhoid fever. It is absent in malarial fevers, and present in pyaemia. It is present in actinomycosis and glanders, absent in tuberculosis. In typhoid fever the leucocytes are abnormally scanty, but if perforation takes place they increase, although they may not reach the normal even then. (See Peritonitis.) When the leucocyte count is not definite, successive examinations made at intervals of an hour or more will show whether there is a tendency towards an increase or decrease. Treatment.—The general indications to be observed in the treatment of inflammation are, (1) to combat the active and passive congestion of the parts, (2) to relieve tension, (3) to give free issue to the products of inflam- mation, (4) to promote the early separation of sloughs, and (5) to assist elimination of toxines by the skin, bowels, and kidneys. Ko specific has yet been discovered to act directly against the bacteria which cause cellulitis and allied inflammatory processes, unless the claims of the new serum therapy be established. The most that the surgeon can do at present is to assist the tis- sues in their attempt to neutralize and limit the action of the invading germs. Elevation.—The active congestion can be relieved in the first place by placing the inflamed part on a higher level than the rest of the body and by securing as complete immobilization as possible. In some peculiar cases local bloodletting by scarification is useful, but general bleeding should never be employed, for the patient wUl need all his vitality to resist septic infection.