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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    jxT (rill, by various writers. As (j!il)s()ii (Aiina/.s <if Surf/rry, April, 1000) says, 75 t)cr cent, may be considered the best working averajje. Tliis avera{,'e should be maintained P cent, may oe considered uie uesi worKmfjf averajije. i ins averaj^e as the total number of leukocytes increases, or else there is a dis|)ro|)orti()n which becomes significant. With a moderate leukocytosis there is a notable increase in polynuclear cells, and it may be estimated that there is either a .severe form (jf lesion or less resistance to absor|)tion, or both. (Jibson has suggested the formation of a chart where the number 10,()()() of leukocytes shall a|)i)ear upon the same line with 7) per cent, as the average normal proj)orti(m of polynuclears. 'I'hen drawing a |)arallel line, which shall indicate on one side each 1000 in increa.se of the former and each advance of one in the j)ercentage, it will be .seen that 15,000 leukocytes will correspond to 80 per cent, of polynuclears, 20,000 to 85 per cent., etc. When uiJon this chart there is drawn a line between that dot which represents the total leukocytosis on one side and that on the other which in<licat(>s the percentage of j)olynucU-ars, then the more horizontal this line the less the disproportion, while the more marked the angle it makes with the base line the greatei' the dis|)n)porti(jn apjjcars. It furnishes an admirable graphic record which the eye apprcciati-s at once. It would aj)})ear, then, that a differential blood count made in this way, and thus recorded, affords the most valuable diagnostic and |)rognostic aid in acute surgical di.sea.ses. indicating especially the presence of suppuration or of gangrene. Glycogen in the Blood and the Iodine Reaction.—Glycogen occurs in the blood esjJccially in three classes of cases: those where there is marked respiratory disturbance in certain of the anemias, and, what is of especial interest to the surgeon, toxemias, either of chemical or bacterial origin. It is usually present in the .secondary and pernicious anemias as well as in acute and late leukemias. It is considered by .some that in these cases it really indicates the occurrence of some bacterial infection. Especially is gly- cogen present in cases of suj)j)uration and surgical sepsis, i. c, in those ca.ses where leukocytosis is usually, but not invariably, present; indeed, it would .seem to be a most significant indication. While the iodine test is more easily carried out than is a blood count, the latter affords more information. The reaction is reliable and its relative intensity gives an idea of the intensity of the inflammatory process. In many cases with obscure symptoms and without leukocytosis its presence will afford much aid in diagno.sis. It is of great a.ssistance also in di.stinguishing between a dcep-.seated pneu- monia and .serous ])leurisy, .since in the latter there is no reaction, or in distinguishing between pleurisy with effusion and empyema; again, in distinguishing gonorrheal arthri- tis from true rheumatism. In a case of strangulated hernia the presence of the iodine reaction would indicate that pressure had produced gangrene, whereas its absence would indicate a relatively lesser degree of destruction. It has been aptly said that the presence of iodine reaction indicates that the patient is .seriously sick. It is easily obtained by staining a cover-glass with a blood smear in a gummy solution of iodine and potassium iodide. W hen the blood is normal all the cells take on a uniform, bright-yellow color, while the white cells stain more lightly than does their protoplasm. When the glycogen reaction is present, brown granules are seen in the protoplasm of the polynuclear leukocytes, which may often take on a different brown tint. Frequently brown particles are to be seen outside of the corpuscles, while occasionally the other forms of leukocytes show also the reaction. The value of a careful blood examination is well illustrated by Plate I, prepared by Dr. Irving P. Lyon, in which are displayed the alterations of greatest interest to the surgeon. HEMOGLOBIN. The principal interest of the red blood corpuscles for the surgeon, aside from their relative number and shape, inheres in their relation to hemoglobin, and hemoglobin is of particular interest here because much can be learned by estimating the proportion in which it is present. Hemoglobin has, furthermore, an interest which rcachcK beyond the mere blood appearance, since it is considered to be the apparent source from which both the urinary and biliary pigments are produced. That the amount contained in the blood varies within wide limits under different conditions has long been known. When notably reduced in amount the conflition is referred to as oligorlirninemia. The ideal normal .standard is present in but a small proportion of cases, even in strong j'oung men in the 3