. The spleen and anæmia; experimental and clinical studies . inevitably follow the better selection of casesand better preparation for operation. A third considera-tion is that the term pernicious anaemia may later befound to include more than one clinical entity. (Comparethe great variations that occur in the size of the spleen,in the bone-marrow reactions, in the evidences of haemol-ysis, and in the duration of the disease.) If this werefound to be true, it might well be that some of the appar-ently discordant results that have been observed after sple-nectomy are due to the fact that the op
. The spleen and anæmia; experimental and clinical studies . inevitably follow the better selection of casesand better preparation for operation. A third considera-tion is that the term pernicious anaemia may later befound to include more than one clinical entity. (Comparethe great variations that occur in the size of the spleen,in the bone-marrow reactions, in the evidences of haemol-ysis, and in the duration of the disease.) If this werefound to be true, it might well be that some of the appar-ently discordant results that have been observed after sple-nectomy are due to the fact that the operation was ofvalue in one or more types and contra-indicated in theothers. The results of these studies are included inTable LXV. SPLENECTOMY TREATMENT 317 ga ? 5*CC^<5. .5»«J 0 ?r r2 8 gj kjo&£ 2, g D 3 a < ,«§§ gj3 2 jo jrri i g-.^B p- hrig P 3 L,e-t2 _hM 0 2 S-Th _0 £ - ^g-Sgg5gg»«^siP P 5- «*• P* O O e* 1 tr. §?«■ 3#:- 318 THE SPLEEN AND ANAEMIA Analysis of Results.—It will be seen that of the 153individuals whose spleens were removed, thirty died withinsix weeks, presumably from the effects of the operation, amortality of per cent. Of the remaining 123 patients,all but twenty-four showed a distinct improvement, bothin general condition and in blood picture. Of the twenty-four individuals that survived the operation but failed toimprove, a few were obviously harmed by it. To thisgroup belongs Pappenheims case, splenectomized at afavorable time, when the patient was in the stage of a re-mission. The condition, nevertheless, was aggravated bythe operation: the blood showed signs of increased destruc-tion and a serious relapse began. The improvement notedin the majority of cases lasted varying periods. Thus atthe end of six months, of fifty-three patients who had sur-vived operation for more than six weeks and were stillunder observation, forty-four had still continued to im-prove
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