The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
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 quarter being 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 exposed 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 reduced 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 capillary hemorrhage could
not be controlled. Recently, it has been shown that calcium chloride
administered internally has a marked effect in favoring coagulation,
and when opportunity is afforded it should be given for several days
previous to operating and as part of the necessary preparation. It may
be administered in doses of from 1 to 2 Gm., and should be given three
or four times, at least, 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 whose effect on coagulation of the blood
is very suggestive 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 quite
insufficient 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.
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