The principles and practice of modern surgery — John Shaqi
The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
From this it will appear that the absence of leukocytosis in cases
where it naturally would be expected is a serious indication and
justifies an unfavorable prognosis; or else it may be interpreted in
evidently favorable cases as indicating infection of very mild grade.
There are but few diseases in which leukocytosis by itself (or for that
matter any other indication which the ordinary examination or blood
count may give) is wholly sufficient for diagnostic purposes. But a
blood count and estimate of the amount of hemoglobin present will often
be of such advantage to the surgeon that he may well afford to wait in
order to secure them. This is rarely necessary in acute cases, but in
chronic cases, and especially the anemias, he may gain great benefit by
such investigation. In _trichinosis_, for example, eosinophilia is most
pronounced, B forming even as high as 70 per cent. of the leukocytes
present.
The anemias which are of particular interest to the surgeon may be
classified as follows:
1. _Anemias without marked leukocytosis._
A. Characterized by oligocythemia.
B. Characterized by diminution of hemoglobin.
2. _Anemias with marked leukocytosis._
A. Leukemia (leukocythemia).
B. Pseudoleukemia (Hodgkin’s disease).
1. A. Anemias due to hemorrhage may assume one of two forms, that
resulting from sudden and extensive loss of blood or that resulting
from constant oozing. Example of the former is seen in hemorrhages
of the stomach or intestines after perforating ulcer, etc. Examples
of the latter are met with in hemophilia and in uterine hemorrhages,
or in excessive menstruation where the loss of blood extends over
a considerable length of time. It is known, moreover, that certain
entozoa in the intestines will produce a chronic anemia. Thus the
red corpuscles may be reduced to even less than 1,000,000 per cubic
millimeter. Immediately after acute hemorrhage the hemoglobin
percentage is still normal, but after a short time it becomes reduced.
If such cases do not speedily end fatally, nucleated red corpuscles
appear in the blood and the observer will recognize both normoblasts
and megaloblasts. At the same time the bone-marrow, which is normally
yellow, becomes red, vascular, and richly cellular, and seems to
furnish these cells just mentioned. Certain drugs, like potassium
chlorate and glycerin, affect also the number of red corpuscles,
but such poisons as these cause not only disintegration of the red
cells, but produce also jaundice and hemoglobinuria. Pernicious anemia
sometimes interferes with or fatally complicates surgical treatment.
It is characterized by the extreme changes already mentioned, with
which it marches steadily to a fatal termination. Quincke has reported
an instance in which their number was reduced to 43,000 per cubic
millimeter, while the hemoglobin was reduced to 20 or 25 per cent. of
the normal amount.
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