Part 14

The results of further investigations, which we here shortly repeat in tabular form, shew that in this experiment No. I. we are not dealing with an abnormal phenomenon of an exceptional animal.

------------------------------------------------------ | Number of white blood corpuscles No. of |--------------------------------------------- Expt. | Before the | At the end of | At the end of | splenectomy| the first year| the second year ------------------------------------------------------ 1 | 10,700 | 14,200 | 18,000 2 | 12,000 | 27,600 | 32,000 4 | 15,000 | 19,200 | 19,000 ------------------------------------------------------ Average | 12,600 | 20,333 | 23,300

By estimating the percentage proportion of the single kinds of white corpuscles, Kurloff obtained the following result:

Key: A - Number of the Experiment B - Polynuclear granular cells C - Lymphocytes D - Mononuclear E - Eosinophil

---------------------------------------------------------------------------- || Before the operation || At the end of the || At the end of the || || first year || second year A || B | C | D | E || B | C | D | E || B | C | D | E ---------------------------------------------------------------------------- 1 || 4782| 3788| 1969| 117|| 4232| 1568| 2101| 170|| 6570| 4410| 1692| 5202 2 || 6276| 3360| 2244| 72|| 5464|16615| 2980|2539|| 5824|20861| 2688| 2240 4 || 6715| 5250| 2595| 450|| 6568|10041| 3686| 96|| 7108| 3009| 2138| 7543

From these researches we draw the following conclusions.

1. The spleen is not an indispensable, vitally important organ for the guinea-pig, since that animal bears splenectomy without loss of health, developes normally, and gains well in weight.

2. The hypertrophy and hyperplasia of the lymph glands, particularly of the mesenteric glands, which develop after the operation correspond to a =lymphocytosis=, which makes its appearance in the course of the first year after the operation so constantly that it may be looked upon as a =characteristic sign of the absence of the spleen=. This increase may amount to double and more. We must therefore assume that the deficiency of splenic function may be met by the lymphatic glandular system. This period of lymphæmia may doubtless in some animals persist for years in exceptional cases; in the majority, however, the lymphæmia diminishes in the course of the first year, and indeed subnormal quantities of lymphocytes may then be produced.

3. The cells of the bone-marrow, on the contrary, and the polynuclear pseudoeosinophil cells do not show the least variation in the course of the first year. Bearing in mind that under normal conditions these cells are met with exclusively in the bone-marrow, and that inflammation in animals after removal of the spleen is accompanied by an acute pseudoeosinophil leucocytosis, exactly as in normal animals, one must admit that the production and function of this kind of cell are quite independent of the spleen. Hence there can be no doubt about their myelogenic nature.

4. It is especially important that the mononuclear and the leucocytes associated with them, undergo no increase. As these cells under normal circumstances occur both in the spleen and in the bone-marrow, we must assume that normally also the bone-marrow is responsible for the majority of this kind in the blood, and that the deficiency in the splenic contribution can be easily covered by a slightly raised activity of the bone-marrow. Were the share of the spleen important, from general biological considerations, an over-production of the kind of cell in question must occur in the vicarious organs.

5. The increase of the eosinophil cells, which constantly makes its appearance in the second year after the operation, is highly interesting, and leads to a really enormous rise in their absolute and relative numbers. Their percentage number once rose to 34.6%, and their absolute quantity amounted at the end of the second year on the average to 30-50-fold their original number (see table).

=Hence it follows from Kurloff's researches that the spleen of the guinea-pig plays quite an unimportant part in the formation of the white blood corpuscles, and that after splenectomy in the first year compensation occurs only in the lymph-glands, followed in the second year by a great increase of the eosinophil cells. It is to be particularly insisted once again that the spleen has nothing at all to do with the formation of the pseudoeosinophil polynuclear cells, which are the analogues of the polynuclear neutrophils of man.=

* * * * *

How do observations on man stand in the light of Kurloff's observations, which might be regarded as depending on peculiarities of the particular kind of animal?

Completely analogous material is afforded by cases, in which in healthy people a splenectomy has been necessary in consequence of trauma. Unfortunately the material available for this purpose is extremely rare; and it would be of the utmost value if the alterations of the blood in such a case were systematically studied for a period of years. We have ourselves begun our observations in two patients directly after the operation, but were unable to continue them, as death occurred within the first week after the extirpation. Up to the present only seven cases of rupture of the spleen with subsequent splenectomy have been published, as is stated in the collection of cases of v. Beck. In two only, of these seven cases, one of Riequer's (Breslau) the other of v. Beck's (Karlsruhe) was a cure effected. Through the courtesy of the above-mentioned gentlemen, we were able to investigate specimens from these two patients.

In the case of v. Beck the operation was performed on June 15, 1897. We received a dry blood preparation about 6 months after operation. Investigation showed a considerable lymphæmia: the bulk of the lymphocytes belonged to the larger kinds: the eosinophil cells were certainly not increased. For other reasons an exact numerical analysis could not be undertaken. We hope to be able to follow the further course of this case.

In the second case the operation was performed on May 17, 1892, by Dr Riequer of Breslau, for trauma, and later described. We made counts in oldish and fresh preparations. It is worthy of notice that this case is not uncomplicated, as an amputation of the thigh was performed shortly after the splenectomy on account of gangrene.

We found the following figures.

------------------------------------------------------------------------ Preparations from | Polynuclear | Lymphocytes | Eosinophil | Large | | | | mononuclear ------------------------------------------------------------------------ June 12, 1892 | 81.9% | 15.9% | 1.3% | -- October 11, 1892 | 80.0% | 13.7% | 4.0% | 1.7% September, 1897 | 56.8% | 33.1% | 3.5% | 1.5% ------------------------------------------------------------------------

It is much to be regretted that dry preparations only at the beginning and at the end of the five year period of observation were at our disposal. It appears from the paper of Riequer as if in this case the lymphocytosis had established itself one month after the operation, and had lasted for a very long time, just as Kurloff has found in some animal experiments. Just as little as a polynuclear increase is abnormal, is an increase of the lymphocytes remarkable; and in this case the lymphocytic increase was recognisable after the end of the fifth year. The eosinophil cells oscillate at this period about the upper normal limit. From all that we know, it is probable that their number in the meantime had undergone an intercurrent increase.

The cases are more frequent in which a splenectomy has been undertaken on account of disease of the spleen. Amongst these, the clearest results are à priori to be expected from splenic cysts, since the part of the spleen not affected by the cyst formation often shews quite a normal structure, and therefore is physiologically active. On the other hand, the excision of chronic splenic tumours may be--for the blood condition--of no importance inasmuch as the function of the spleen may have previously long been eliminated by pathological changes.

Amongst these cases, we must in the first place mention the well-known and carefully investigated case of B. Credé. In a man 44 years of age the spleen was extirpated on account of a large splenic cyst. Within two months of the operation there developed a thoroughly leukæmic condition of the blood, exclusively brought about by the increase of the lymphocytes, as is seen from the results of Credé and the table contained in his paper. It is further remarkable that four weeks after the operation a painful doughy swelling of the whole thyroid appeared, which remained, with variations, for nearly four months. With the general recovery of the patient this shrank to a small remnant. We notice further that this very interesting swelling of the thyroid, which doubtless stands in the closest connection with the splenectomy, is nevertheless no constant accompaniment of this operation, as for instance in the case of v. Beck, where it was not present.

The most recent work on extirpation of the spleen for tumours is from Hartmann and Vasquez. As the result of their researches the authors arrive at the following conclusions:

1. A slight post-operative increase of the red blood corpuscles and a true acute hyperleucocytosis occur and pass rapidly away.

2. The hæmoglobin equivalent of the corpuscles sinks at first but recovers its original value by degrees.

3. 4-8 weeks afterwards a lymphocytosis of varying duration is established.

4. Later, after many months, a moderate eosinophilia occurs.

We have ourselves been able to investigate three conclusive cases.