286 CLINICAL BACTERIOLOGY AND H^MATOLOGY 



0*63 according to Osier and McCrae), with slight polynuclear 

 leucocytosis about 12,000 to 18,000, of which 80 to 90 per 

 cent, are polynuclears; or a condition closely resembling per- 

 nicious anaemia, with a high colour-index, megalocytes, and 

 occasionally megaloblasts. In the latter case the diagnosis 

 from true pernicious anaemia may usually be made by the fact 

 that in carcinoma ventriculi there is a polynuclear leucocytosis 

 instead of the leucopenia with lymphocytosis of pernicious 

 anaemia. The blood finding in this case is very suggestive. 



According to some authors there is no digestion leucocy- 

 tosis in cancer of the stomach, whilst there is in other diseases. 

 There appear to be numerous exceptions to this rule, though 

 it is true in the majority of cases, and might be allowed some 

 weight in forming a diagnosis. To test for it enumerate the 

 leucocytes in a patient who has eaten nothing since the pre- 

 vious day; let him take a meal (of which meat should form 

 part), and repeat the examination in three or four hours' time ; 

 a rise of 2,500 to 3,500 may be considered normal. 



ULCER OF THE STOMACH with haemorrhage leads to second- 

 ary anaemia, but, unlike carcinoma of the stomach, is usually 

 unassociated with leucocytosis. There are exceptions to this 

 rule, and when the ulcer reaches the peritoneum and causes 

 local peritonitis, or ruptures and causes general peritonitis or 

 localized abscess, leucocytosis occurs. 



CIRRHOSIS OF THE LIVER. In ordinary uncomplicated 

 alcoholic cirrhosis there may be anaemia, but there is no 

 leucocytosis, or at most very little. In most of the diseases 

 for which it may be mistaken an ordinary polynuclear leucocy- 

 tosis is present. 



Hanot's cirrhosis is said to be accompanied by leucocytosis, 

 but, as this may be intermittent, the diagnostic value of the 

 test cannot be great in cases where no leucocytosis is found. 



ABSCESS OF THE LIVER AND HYDATID CYST. The former 

 disease is usually associated with leucocytosis, the latter is not, 

 though here, again, there are exceptions. Some importance 

 should be attached to the simple count, but more to the differ- 

 ential count, since in hydatid the eosinophiles are usually 

 raised (57 per cent, has been recorded, but 6 to 8 per cent, is 

 more usual) and in ordinary septic disease are absent, low, or 

 normal, and these rules apply .whether the leucocytes are 

 normal or increased. There is a "complement-deviation" 



