The first was a patient, which we were ourselves enabled to
investigate by the courtesy of Dr A. Neumann. The patient's
spleen was removed by E. Hahn on account of an echinococcus on
Feb. 5, 1895. One may well assume that before the operation the
spleen no longer discharged its normal function. On Sept. 2,
1897, we found the following numerical proportions:
Polynuclear neutrophil 76.5%,
Lymphocytes 18.4%,
Eosinophil 3.4%,
Large mononuclear 1.1%,
Mast cells 0.4%.
A condition therefore which was quite normal. In this
connection it must be mentioned that an incipient phthisis
pulmonum existed at the time, to which we must attribute an
increase of the polynuclear elements, and without which the
percentage figures of the lymphocytes and eosinophils would
perhaps have been greater.
For the knowledge of the two other cases we are indebted to the
kindness of Professor Jounescu of Bucharest. The one case was
of a man of about 40 years of age, in whom splenectomy was
undertaken on Sept. 27, 1897, for an enlarged spleen. Healing
by first intention. The white blood corpuscles were permanently
increased. The proportion of white to red was 1:120 to 1:130,
the average number of red was 3,000,000. Our own examination of
preparations obtained some two months after the operation,
shewed a distinct lymphaemia, and also a preponderance of the
larger lymph cells. The eosinophil and mast cells were plainly
increased. We are unable to give more exact numerical data, as
the preparations sent to us were not spread with sufficient
regularity.
From the second case, which was also operated upon for
enlargement of the spleen, we unfortunately only obtained much
damaged preparations. Nevertheless so much could with certainty
be established--that there was no considerable increase of the
lymphocytes. The eosinophils on the contrary were increased
distinctly, the mast cells to a lesser extent. It is probable
that the increase of both of the latter kinds of cell was not a
consequence of the extirpation of the spleen alone, but rather
the expression of the reactive changes, which had already begun
before the operation, from the exclusion of the splenic
function.
Cases of splenectomy of this kind are transitional to the chronic
diseases of the spleen. The latter present great difficulties, for one
never knows how far in the most chronic diseases the other organs are
damaged or influenced by the general illness.
An increase of the lymphocytes, so long as an affection of the lymphatic
glands may be excluded, should be referred to functional exclusion of
the spleen.
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