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
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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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    CHAPTEK II. SURGICAL PATHOLOCiY OF TUK BLOOD. The part played by the constitiUMit clcinents of the blood in iiiflaniiiiatioii, siijipiiration, and other still more disastrous conditions is so great and so inijjortant that, before pro- ceeding to discussion of these lesions, it seems necessary to set forth a resume of facts illustrating the importance of accurate knowledge concerning this most important fluid. The total amount of blood in the human body has been variously estimated at from one-eleventh to one-twenty-fifth of the body weight, the average being about one-six- teenth. The amount which the body may lose and still retain vitality is very vague and differs not only with individuals, but very greatly under various conditions. Severe loss of blood is one to be atoned for as (juickly as })ossil)le, and is to be prevented as far as it can be after accidents or during o|)eration. For this reas(»n the so-called bloodless method of operating upon limbs, by the use of the rubber bandage, constituted a great advance in surgery. For the same reason the use of hemostatic forceps is of e(iual value in oj)erating upon other parts of the body; other things being equal the quickest and most satisfactory recoveries follow the bloodless operations, and it is an advantage to conserve this vital fluid as far as possible. It has been roughly estimated that the blood is divided about as follows, between the different parts of the body: the heart, lungs, and large vessels holding one-fourth, the skeletal muscles one-fourth, the liver one-fourth, the remaining (juarti-r l)eing distributed over the balance of the body. The blood varies within wide limits in its coagulability, and this variation occurs apparently even within conditions of health. In some patients the blood may be .seen to coagulate almost as rapidly as it collects upon the surface, while in others the expo.sed parts continue to ooze, and the checking of hemorrhage is a difficult, sometimes almost impossible, matter. There are certain diseases in which the blood is known to have reduc(;d power in this direction; for example. In the toxemias, especially those connected with biliary obstruction and jaundice. There were not a few of these cases of slow bleeding to death in days gone by, simply because the caj)illary hemorrhage could not be controlled. Recently, it has been shown that calcium chloride administered inter- nally has a marked effect in favoring coagulation, and when opportunity is afforded it should be given for several days previous to op(M-ating and as part of the necessary preparation. It may be administered in doses of from 1 to 2 CJm., and should be given three or four times, at lea.st, in twenty-four hours. A test of the coagulation time, normally three to five minutes, but lengthened under circumstances like those mentioned above, even to an hour, will often prove of great value. There are certain albumoses who,se effect on coagulation of the blood is very sug- gestive and very mysterious. A very minute dose of cobra poison, for instance, will make the blood of an experimental animal remain fluid for days, unless this animal has been previously immunized against it, in which case coagulation takes place even more rapidly than normally. A trace of serum from an immunized rabbit is enough to prevent the fluidifying effect of the cobra poison, but (piite insuflicient to neutralize its toxic effects. The surgeon practically never desires to reduce coagulability of the blood, but frequently to increase it. When it is increased by natural conditions or those not easily controlled, then it may lead to thrombosis and produce trouble in that way. Fibrin.—Increase of fibrin, hijperino.ns, accompanies the l(Mikocytosis of inflam- mation and su[)puration. It may be a])proximately estimated on the cover-gla.ss by noting the closeness of the network resulting after fifteen minutes' exposure. The inflammatory indication of leukocytosis may, therefore, be inferred from its determina- tion, while the leukocytosis of malignant dis(>ase will not be so accompanied. Ilyiieri- nosis is most marked in pyogenic processes, pneumonia and rheuniatisni. Its opposite, hupinosis, is met with in pernicious anemia. There is no change in the percentage of