252 CLINICAL BACTERIOLOGY AND H^MATOLOGY 



II. HIGH LEUCOCYTOSIS (20,000 to 100,000). Suppuration 

 in all situations and of all kinds, the degree of the leucocytosis 

 being a measure of the virulence of the organism and the 

 resisting power of the patient. 



Pneumonia, in which the same facts hold. 



Ho o ping-cough. 



Meningitis, especially suppurative meningitis, whether cere- 

 bro-spinal, pneumococcic, etc. In tuberculous meningitis 

 there may be as many as 25,000 leucocytes. In this it differs 

 from most uncomplicated tuberculous affections, in which 

 there is usually no leucocytosis. 



Pleurisy, especially empyema. A leucocyte count of 20,000 

 does not exclude tuberculous pleurisy, but tells strongly 

 against it. 



Scarlet fever. 



Diphtheria. 



Hemorrhage. After a very severe haemorrhage, whether 

 internal (e.g., rupture, extra-uterine gestation) or external 

 (e.g., from gastric ulcer), figures over 20,000 are occasionally 

 seen, but usually rule lower (12,000 to 15,000). The number 

 usually falls in a few days. 



Similar figures are seen immediately before death, especially 

 if the death is lingering', and very hig*h figures are occasionally 

 seen. It is sometimes of value in prognosis. 



In ovarian cysts with twisted pedicle, in intussusception and 

 volvulus, the figures may exceed 20,000. 



III. MODERATE LEUCOCYTOSIS (10,000 to 20,000). Here 

 come mild cases of almost all the diseases mentioned above. 

 Thus, a very mild case of pneumonia may show a leucocytosis 

 within these limits, or be normal. 



Inflammatory. Leucocytosis in inflammatory conditions 

 other than suppuration rarely exceeds 20,000 and does not 

 often reach 16,000; this is a most important diagnostic feature. 



Rheumatism, in the absence of complications. 



Tonsillitis, except when very severe, when higher figures 

 may be seen. 



Secondary ancemia (see p. 273). 



Gout. Here the condition is normal during the interval, 

 with a slight leucocytosis during the attack. 



Smallpox, during the pustular stage. In severe cases the 

 count may exceed 20,000, and figures much above this indicate 

 a bad prognosis. 



