The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
_a._ Normal Red Corpuscle (normocyte). _b, c._ Anæmic Red Corpuscles.
_d-g._ Poikilocytes. _h._ Microcyte. _i._ Megalocyte. _j-n._
Nucleated Red Corpuscles. _j, k._ Normoblasts. _l._ Microblast. _m,
n._ Megaloblasts.
Gibson has suggested the formation of a chart where the number 10,000
of leukocytes shall appear upon the same line with 75 per cent. as the
average normal proportion of polynuclears. Then drawing a parallel
line, which shall indicate on one side each 1000 in increase of the
former and each advance of one in the percentage, it will be seen that
15,000 leukocytes will correspond to 80 per cent. of polynuclears,
20,000 to 85 per cent., etc. When upon this chart there is drawn a line
between that dot which represents the total leukocytosis on one side
and that on the other which indicates the percentage of polynuclears,
then the more horizontal this line the less the disproportion, while
the more marked the angle it makes with the base line the greater the
disproportion appears. It furnishes an admirable graphic record which
the eye appreciates at once.
It would appear, then, that a differential blood count made in this
way, and thus recorded, affords the most valuable diagnostic and
prognostic aid in acute surgical diseases, indicating especially the
presence of suppuration or of gangrene.
=Glycogen in the Blood and the Iodine Reaction.=--Glycogen occurs in
the blood especially 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 glycogen present in cases
of suppuration and surgical sepsis, _i. e._, in those cases 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 diagnosis. It is of great assistance also in distinguishing
between a deep-seated pneumonia and serous pleurisy, since in the
latter there is no reaction, or in distinguishing between pleurisy with
effusion and empyema; again, in distinguishing gonorrheal arthritis
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.
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