ESTIMATION OF THE NUMBER OF LEUCOCYTES 253 



Perforation in Typhoid Fever. Here the leucocytosis 

 usually attains 15,000 in less than an hour, and may go much 

 higher. 



Secondary syphilis in most cases. 



Malignant Tumours. There is often, but not invariably, a 

 slight rise in the leucocytes with malignant tumours, but it 

 is hardly marked in the early stages. 



In addition to these pathological leucocytoses, there are 

 two physiological conditions associated with a moderate 

 leucocytosis. 



Digestion. Under normal conditions there is a rise of 1,000 

 to 3,000 soon after a meal. This must always be remembered 

 in interpreting a leucocyte count. A figure of 12,000 obtained 

 in a patient an hour or two after a full meal does not neces- 

 sarily indicate disease. If possible, examine the patient when 

 fasting. 



Pregnancy. The figure.8 rise gradually toward the end of 

 pregnancy, and at term may reach 15,000 or even higher. 

 Recollect this in interpreting counts in pregnancy or soon 

 after parturition. 



IV. NORMAL COUNTS (5,000 to 10,000, average 7,500) are 

 met with in a variety of conditions,. but in comparatively few 

 that are attended with pyrexia. Of these the most important 

 are : 



Tuberculosis, except tuberculous meningitis (15,000 to 

 25,000), and occasionally in tuberculous pleurisy (10,000 to 

 20,000). 



Typhoid fever. 



Malta fever. 



Measles. * 



Malaria. 



Mumps. 



Varicella. 



Pernicious anamia. 



Chlorosis. 



Primary syphilis. 



Influenza. 



In any of these there will be leucocytosis if an inflammatory 

 complication is present. Thus, in typhoid fever with perfora- 

 tion or pneumonia the count is raised. 



Very severe sepsis. 



