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.