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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    conditions that it is impossible to entirely avoid the subject in a work like this. 1 have accordingly condensed it and put the salient facts about leukocytes into the following table: Classification of Leukocytes. Granular. Non-f/raniilttr. (Oxyphile. A. With fine granules (polynuclcar) C. Hyaline. Transitional (large Neutrophile. The so-called 60-75 i)er cent. mononuclear) 4-8 per cent, neutral .stain being slightly B. With coarse granules (eosino- D. Lymphocytes (small mono- acid, philes) 2-5 per cent. nuclear) 20-30 per cent. ( Basophile ^- I'ine and coarse granules (base- G. Atypical hyaline (myelo- Pathological. ,,,.,' ^ philes mast-cells etc.). cytes). L O.xyphile. F. Atypical (myelocytes). In normal blood by far the greater part of the leukocytes consists of A and D. Lympho- cytosis means a relatively high percentage of C and D. Eosinophilla means an in- crease in the proportion of B. Basophile cells are not absolutely ])athological, for they may be present in very small numl)ers in normal blood. The number of leukocytes in normal l)lood will average about 7000 to 10,000 per cubic millimeter, the percentage of each variety being given in the above table. Leukocytes are sometimes diminished in number; under diseased conditions they are often increased, and these are then included under the term leukocytosis. Variations occur daily and almost hourly under normal conditions. Increase naturally occurs after digestion, when the number of leukocytes may be almost doubled, the same being due principally to lymphocytes which are washed into the blood system from the lymph nodes by the flow of lymph or chyle. In starvation, however, the number may be remarkably reduced and in the case of the fasting man, Succi, the leukocytes were reduced at the end of the first week to SGO per cubic millimeter. The rather unusual condition of reduction of the number of corpuscles is called leukopenia. Leukocytosis is usually the rule in carcinoma, with increase in A and F; the more rapid the growth, the greater this increa.se. In sarcoma this is even more pronounced; when occurring without hyperinosis the probability of malignancy is greater. Non- malignant tumors produce no such changes. The blood platelets or plaques first described by Bizzozero, in 1882, have no small interest for physiologists and pathologists, but little for the practising surgeon. They number perhaps 5,()00,000 per cubic millimeter and sustain a fairly constant ratio to the red cells. Their surgical interest is limited to the role which they may play in the formation of thrombus. The term phagoci/tosis has to do in a general way with those leukocytes which act as scavengers by removing from the blood its noxious elements, presumably by a process of ingestion and digestion (see Chapter III). Examination and estimation of the various formed elements of the blood are very valuable to the surgeon in the study of the anemias, of acute inflammation when the presence of pus is suspected, in the presence of suspected cancer, and in the presence of such conditions as Hodgkin's disease, the various disorders of the spleen, etc. The so-called primary anemias include only the pernicious anemias and chlorosis; all others are designated as secondary. This distinction is not for convenience only, but serves a useful purpose. Pernicious anemias produce a reduction both of the red corpuscles and the hemo- globin, the former usually in a greater degree than the latter, so that the color index (see below) is usually plus. Many of the cells become nucleated and, in general, their size is increased. In chlorosis the reduction of the hemoglobin is relatively large and the color index is extremely low. In the secondary anemias the red cells and hemo- globin are reduced disproportionately, so that the color index is minus. There may or may not be a relative increase of leukocytes and of the nucleated red cells, but these latter are not so likely to be as large as those seen in primary anemias. The color index is obtained by dividing the percentage of the hemoglobin present by the percentage of the red cells. Leukocytosis becomes pathological in conditions of acute inflammation where the neutrophiies (A) show the greatest relative increase. The degree of leukocytosis depends on two different factors: the intensity or the virulence of the infection, and the vitality or resisting power of the individual. These vary within such wide limits that it is hard to predicate anything definite in a given case. In general the increase is sup-