The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
It is easily obtained by staining a cover-glass with a blood smear in a
gummy solution of iodine and potassium iodide. When 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 reaches
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 condition is referred to as _oligochromemia_. The
ideal normal standard is present in but a small proportion of cases,
even in strong young men in the third decade of life. The average
is considerably lower and can scarcely be placed above 90 per cent.
Females show a smaller amount than males--3 or 4 per cent. less. In
anemia its reduction is not usually proportionate to that in the number
of red cells. After hemoglobin loss, as after surgical operations,
much can be gained in the matter of prognosis by estimating the speed
of its regeneration. With regard to how much actual hemoglobin loss
a patient can bear, it seems to be more important to determine how
much still remains in the body. The minimum is apparently 20 per
cent. In three cases dying of collapse after operation, Mikulicz
found only 15 per cent. remaining. The rapidity of regeneration is
a fairly accurate indication of improvement in every other respect.
Regeneration is interfered with by constitutional syphilis, and, on
the other hand, is often apparently favored in cases of tuberculosis.
In malignant tumors the average of hemoglobin is reduced to about 60
per cent., and in these cases also complete regeneration is materially
retarded. Incomplete removal or recurrence of cancer prevents typical
regeneration or restoration, while, after successful or radical
removal, complete restoration to the previous standard, often with
positive gain, is obtained. Thus, a woman who had gained thirty
pounds after resection of a cancerous pylorus, showed, after three
months, hemoglobin repair to the amount of 65 per cent.
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