INFLAMMATION AND LEUCOCYTE RESPONSE 61 



tious diseases just mentioned there are a relative increase in mono- 

 nuclear cells and a relative decrease in granulocytes. 



In lobar pneumonia, meningitis, and severe septic infection the 

 white count is usually 20,000 to 30,000 with a high percentage 

 (over 90 per cent) of neutrophiles. Occasionally one finds a low 

 total white count with a high percentage of neutrophiles in malig- 

 nant septicemias. In appendicitis great variations are observed. 

 One usually thinks that a patient with a "pus appendix" will have 

 a white count of between 16,000 and 20,000 with 90 to 98 per cent 

 neutrophiles. On the other hand, cases of catarrhal appendicitis 

 usually show white count under 15,000 per cubic millimeter and 

 from 80 to 85 per cent neutrophiles. Exceptions are frequently 

 encountered, hence the surgeon must always regard the laboratory 

 findings as of less importance than his clinical findings and the 

 condition of the patient. 



The student should become familiar with other conditions (be- 

 sides infection) that affect the white count. There is usually a 

 Icucocytosis following hemorrhage of any consequence; and an 

 increase in leucocytes is observed in pregnancy, during labor, and 

 also during digestion and after cold baths. ' A leucocytosis is fre- 

 quently observed when the patient is moribund and is prol)ably 

 due to a terminal infection. 



In acute infections, Sondern suggests that the percentage of 

 neutrophiles indicates the degree of toxic absorption while the 

 number of leucocytes per cubic millimeter of capillary blood reflects 

 the power of resistance of the patient. Wilson (1919) has devised 

 a formula to express this information in numerical terms. The 

 student should consult his original papers for a more extensive 

 discussion of the subject. Todd and Sanford (1931, p. 293) incor- 

 ])orate Wilson's formula in a short discussion of his work. 



Arneth AND Schilling Counts. — In an attempt to obtain addi- 

 tional information that might indicate the severity of an infection 

 and perhaps whether the ])rognosis is good or bad, Arneth and 

 more recently Schilling (1929) and Haden have suggested the use 

 of indices and hemograms 1)ased u])on tlie relative num])er of young 

 and old neutrophiles in the peripheral circulation at different 

 stages of infection. 



