DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 2/Q 



The prognosis of these cases is fairly good if proper treat- 

 ment be adopted much better than in the primary blood 

 diseases with which they might be confounded. 



SEPSIS, SUPPURATION, AND SEPTIOEMIA. In most cases of 

 infection with septic bacteria, whether local or general, there 

 is marked leucocytosis, due especially to an increase in the 

 polynuclear leucocytes. For instance, in an ordinary case of 

 appendicitis of average severity we may expect the number 

 of leucocytes to rise gradually to 25,000 or 30,000, about 90 

 per cent, being polynuclears. At the same time there is 

 usually a moderate fall in the amount of haemoglobin and in 

 the number of red corpuscles. In practice we have to con- 

 sider three types, in each of which the blood-counts vary. 



i. Very Severe Cases. Puerperal and other forms of sep- 

 ticaemia, general septic peritonitis due to very virulent bac- 

 teria, especially in an enfeebled patient, etc. 



Here there may be but slight leucocytosis, and this, taken 

 in conjunction with the patient's general condition, is not a 

 good sign, but a bad one. In many cases the total number is 

 within the normal limits, but whether this is the case, .or 

 whether the leucocytes are slightly increased, a clue to the 

 condition will be given by the fact that the polynuclears show 

 their usual increase, and the glycogen reaction is present and 

 often very marked. 



The haemoglobin, however, gives much more valuable indi- 

 cations ; the severer the case the more rapidly it falls, and vice 

 versa. The same information can be obtained, though not so 

 well, from the variation in the red corpuscles. Thus, in a case 

 of severe sepsis of any sort the red corpuscles and haemo- 

 globin may fall enormously in a few days. This is a very 

 valuable test for puerperal fever. Under ordinary circum- 

 stances the amount of blood lost at parturition should not 

 lower the corpuscles below 4,000,000, and if a count greatly 

 below this is found in a few days' time, there having been no 

 severe haemorrhage in the meantime, the diagnosis of septic 

 infection is probable, whatever be the numbers of the leuco- 

 cytes; if at a later date the numbers are lower still, the diag- 

 nosis is almost certain. The haemoglobin may fall 10 per cent. 

 per diem, or even more in a severe case. 



Conversely, a rise in the number of red corpuscles and 

 haemoglobin is a good sign when the existence of septic 



