288 CLINICAL BACTERIOLOGY AND H^MATOLOGY 



true test, however, is the bacteriological one; the blood is 

 sterile in simple endocarditis, whereas organisms are usually 

 found in ulcerative cases, though more than one examination 

 may be necessary. 



VALVULAR LESIONS require brief mention, since their 

 presence causes alterations which might cause embarrassment 

 in the diagnosis of other conditions if unrecognized. With 

 mitral lesions, if not fully complicated, there is a tendency for 

 an increase in the red corpuscles (due to venous stasis) which 

 may reach 8,000,000. In morbus cseruleus it may be still 

 higher 10,000,000 or more. In aortic disease, on the other 

 hand, there is a tendency to slight anaemia. The leucocytes 

 remain normal in both cases. 



PUERPERAL FEVER. The great difficulty in interpreting 

 blood findings in the puerperium is the fact that the blood is 

 not normal immediately before child-birth. The change 

 affects the leucocytes, which are increased, it may be as high 

 as 36,000 (Cabot); this is a very unusual figure, and on the 

 average the numbers do not exceed 16,000 in primiparse and 

 12,000 in multiparae. Leucocytoses within these limits are to 

 be looked on as being probably normal, and not as indicating 

 sepsis. More information may be gained by counts at inter- 

 vals. The figures should decrease rapidly after delivery, be- 

 coming normal in less than a fortnight, and if a count remains 

 the same on two successive days an inflammatory process is 

 suggested, and a definite rise constitutes almost absolute 

 proof. It is in these cases especially that the glycogen reac- 

 tion is of value, and its presence should outweigh that of the 

 total numbers. The differential count is not of much value 

 (since the polynuclears are increased in normal pregnancy) 

 unless these cells reach 90 per cent, or more. 



The chief reliance is to be placed on the haemoglobin. It 

 should be normal or slightly reduced at the end of pregnancy, 

 fall in proportion to the haemorrhage at parturition and for a 

 day or two after, and then be rapidly regenerated. Under 

 normal circumstances it should not be much below 70 per 

 cent., nor the red corpuscles much below 4,000,000. Figures 

 much below these (unless there has been great haemorrhage, 

 or unless it has been repeated) raise suspicions of sepsis, 

 whilst an observed fall is almost definite proof. This has 

 also much value in prognosis (see p. 280). 



