614 THE INTERNAL SECRETIONS AND IMMUNITY. 



four cases in which laparotomy was resorted to in this connec- 

 tion with the view of closing ulcers, in which none were found. 

 While the operation led to no complications, it is obvious that 

 leucocytosis, in this connection at least, proved misleading. 

 This assertion- is further strengthened by the fact that Cabot 

 states that an increase to 15,000 leucocytes may be witnessed in 

 the absence of complications. Colin K. KusseP analyzed the 

 question in thirty-six uncomplicated cases and obtained a varia- 

 tion ranging between 2000 and 12,000. In one of the cases a 

 leucocytosis of 28,000 led to operation; a perforation was found 

 and the patient recovered. In another case the leucocytosis 

 only reached 4800. Yet, operation led to the discovery of a 

 ruptured bowel and six other ulcers which had nearly pene- 

 trated the whole thickness of the intestine. The patient died. 

 A third case showed 14,500 leucocytes and was operated, but 

 no perforation was found. While this in no way detracts from 

 the great value of operative procedures in perforation, it seems 

 evident that as a sign of this complication leucocytosis is un- 

 reliable. 



Analysis of the cases in which laparotomy disclosed no 

 perforation notwithstanding leucocytosis, however, may furnish 

 a clue to the cause of these discrepancies and elucidate the 

 physiological function involved. In one of the cases referred 

 to by Kussel (Dr. -Hamilton's) the leucocytosis reached 16,000, 

 but was 14,500 when the operation was begun. There was pain 

 in the lower left quadrant and marked rigidity of the abdom- 

 inal muscles. Nothing unusual was found beyond the condi- 

 tion of the bowel "to be expected at that stage of the disease.'' 

 The next day the blood-counts revealed 10,000 leucocytes. The 

 usual intestinal ulcers could alone, therefore, have been the 

 source of the temporary exacerbation. In another case of the 

 same kind, with a pre-operative leucocytosis of 17,000, the only 

 feature found was unusual tension and swelling of the ileo- 

 caecal glands. As there was no perforation, we are relegated 

 to the ulcerative process alone as the source of the symptoms 

 witnessed. It is not with the perforation that this increase 

 of leucocyte-count could be associated, therefore, but with the 

 ulcerative inflammatory process. 



Colin K. Russel: Boston Med. and Surg. Jour., April 18, 190L 



