328 SURGERY 



cytes or white blood globules normally exist in the blood in the 

 proportion of about 7500 in a cubic millimeter. An increase of 

 1500 or more in the number of the white cells indicates a condi- 

 tion known as leukocytosis. 



Now, a normal leukocytosis is observed in health after meals, 

 during pregnancy, following violent exercise, a cold bath, and 

 massage. An abnormal leukocytosis is observed in such diseases 

 as erysipelas, osteomyelitis, suppuration, malignant tumors, and 

 in pneumonia. The term leukemia indicates a permanent leuko- 

 cytosis. In the differential diagnosis of surgical affections, blood 

 analysis is of great assistance. For example, in shock from hemor- 

 rhage there is oligocythemia. In shock from concussion or com- 

 pression of the brain, there is no decrease in red blood cells. In 

 appendicitis and pus tubes, there is a leukocytosis, while in float- 

 ing kidney, ovarian neuralgia, gall-stones, renal and intestinal colic, 

 it is absent. 



In meningitis, in cerebral abscess and cerebral hemorrhage, 

 there is leukocytosis, while in other intracranial lesions it is absent, 

 In all forms of sepsis, leukocytosis is present. Blood plaques nor- 

 mally exist in the blood in the proportion of 200,000 cm. to 

 500,000 cm. In disease, the plaques are increased. 



Hemoglobin normally exists in the blood in about 90 %, and be- 

 low 20 % is the minimum in life. The relation of hemoglobin to the 

 erythrocytes and the rapidity with which it regenerates after in- 

 juries, surgical operations collapse, and hemorrhages, enables the 

 surgeon to determine the prognosis. Syphilis and cancer retard 

 the regeneration of hemoglobin, while tuberculosis, curious to 

 state, increases the regeneration. In operation for removal of can- 

 cer, for example, the amount and rapidity of regeneration of the 

 hemoglobin enables the surgeon to determine whether complete 

 removal of the malignant tumor has been accomplished, and whether 

 the rapidity is sufficient to justify the conclusion that perfect health 

 can be reinstated. 



4. The Improvement of Old -and the Discovery of New Operations 

 with their Mortality. It is obvious that a consideration of this part 

 of the subject can only embrace a cursory review of the field of oper- 

 ative surgery. No attempt will be made to describe in detail an 

 operative procedure. A mere reference to the improvements in old 

 operations and the discovery of new operations will be made as 

 affording tangible evidence of what surgery has accomplished for 

 mankind. The operations that have been discovered and performed 

 within the past 100 years will be mentioned, and an endeavor will 

 be made to show to what extent the science of surgery has been a 

 benefaction to the human race. In order to demonstrate this pro- 

 position, it is necessary to record the date of the first performance 



