DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 281 



common in gonorrhoeal pyosalpinx; the gonococcus dies out 

 rapidly, but the pus remains, and unless you examine the case 

 early there will be no leucocytosis, or but little. 



(c) The leucocytosis gives no indication of the seat of the 

 pus; there may be a small abscess in the body far from the 

 region under suspicion. 



(d) The height of the leucocytosis gives no indication of 

 the size of the abscess nor of its severity. 



(e) In interpreting a high leucocytosis to mean pus, you 

 must exclude the other causes of a similar blood condition 

 pneumonia, etc. Thus, in a severe abdominal disease leucocy- 

 tosis may be due to an ovarian cyst with a twisted pedicle, a 

 ruptured tubal gestation, etc. 



(/) Cold (tuberculous) abscesses do not usually give a poly- 

 nuclear leucocytosis; if there is one, it indicates a secondary 

 septic infection, and is a decidedly bad sign. 



3. In moderate cases of septic or other form of inflamma- 

 tion, suppuration of free surfaces, etc., there is usually a 

 moderate leucocytosis (up to 18,000), with increase of the 

 polynuclears. 



TYPHOID FEVER. In the early stages there is usually some 

 concentration of the blood, the red corpuscles often exceeding 

 6,000,000; at a later period they fall somewhat, but rarely 

 below 4,000,000. In most other diseases (malaria, septicaemia, 

 tuberculosis, etc.) for which typhoid is likely to be mistaken 

 the rule is to find marked diminution of the red corpuscles; 

 when these are high with a fever of some duration typhoid 

 fever should be suspected. 



The leucocytes are usually normal or diminished in numbers 

 (3,000 to 6,000), and there is often slight excess of lymphocyte's 

 (average about 50 per cent.). This is not unlike what occurs 

 in tubercle and malaria, but is of diagnostic value in dis- 

 tinguishing typhoid from septicaemia, in which case there may 

 be no excess of leucocytes, but there is usually a relative 

 excess of polynuclears. The number of leucocytes in typhoid 

 is of some value in prognosis; the lower the count, the more 

 severe the case, though to this rule, as to all others in blood- 

 work, there are exceptions. 



In the later stages of the disease the diagnosis is best made 

 by Widal's reaction. 



Complications. Here the condition of the patient must be 



