. Manual of operative surgery. lenectomy was performed. In fiveweeks after operation the hemoglobin was50 per cent, and red cells 2^^ millions. In three months the patient could walk. Eppinger and Ranzi operated on a moribund patient with only 500,000red cells who recovered to such an extent as to be able to do moderate work. Balfour advocates transfusion of blood not only as a therapeutic measurebut for prognosis. If improvement results splenectomy will probably be ofvalue; if transfusion proves without value splenectomy will fail. C. H. Peck and others (Trans. Surg. Sect., A. M. A., 1916) ad
. Manual of operative surgery. lenectomy was performed. In fiveweeks after operation the hemoglobin was50 per cent, and red cells 2^^ millions. In three months the patient could walk. Eppinger and Ranzi operated on a moribund patient with only 500,000red cells who recovered to such an extent as to be able to do moderate work. Balfour advocates transfusion of blood not only as a therapeutic measurebut for prognosis. If improvement results splenectomy will probably be ofvalue; if transfusion proves without value splenectomy will fail. C. H. Peck and others (Trans. Surg. Sect., A. M. A., 1916) advocate splen-ectomy in hemolytic jaundice. In cases of leucocythaemia the spleen ought never to be removed. Splenectomy.—Place the patient in an exaggerated Mayo-Robson position,, in marked lordosis. Step I. Method A.—Make a left rectus incision almost identical with Rob-sons incision for exposure of the gall-bladder but on the opposite side. Method B.—Make an incision parallel to and a little below the costal border. Fig. 683. ^.?)^ THE SPLEEN from the epigastrium to a point opposite the end of the eleventh rib from whichpoint the incision may be continued vertically downwards for a short distanceif necessary. Step 2.—Explore the region of the spleen. If adhesions are present neverrupture them bhndly; usually it is easy to expose, doubly ligate and divide thoseto the omentum, the colon and the abdominal wall. Adhesions to the dia-phragm are more difficult to master—if it is impossible to doubly ligate thembefore division. Hartmann advises that the operation be given up otherwisedisaster is invited.
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