DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 289 



PERIMETRITIS, PARAMETRITIS, ETC. Here the usual rela- 

 tions hold good. There is a moderate leucocytosis in a non- 

 suppurative lesion, a high one when suppuration occurs. The 

 figures are usually somewhat lower than in other parts of the 

 body, and 18,000 may be taken as fairly definite evidence of 

 pus, provided other sources of leucocytosis can be excluded. 



OTHER PELVIC SWELLINGS. The blood-counts in these 

 cases have to be interpreted with much caution, and are often 

 very equivocal. Thus, pyoscdpinx is usually associated with 

 the ordinary signs of pus, but the cases are frequently tuber- 

 culous, when there is no leucocytosis, or gonorrhoeal, when 

 there is only leucocytosis if the count is made whilst suppura- 

 tion is in progress. The sterile collections of pus left after an 

 attack of gonorrhoeal salpingitis do not cause leucocytosis. 

 A normal count, therefore, does not exclude pus in the tubes. 

 Similarly, there are exceptions to the rule that simple ovarian 

 tumours and cysts are associated with normal blood. Where 

 there is inflammation and formation of adhesions there is 

 slight leucocytosis, where there is much peritoneal irritation 

 a higher one, and with twisting of the pedicle very high figures 

 may be reached. These latter are liable to be mistaken for 

 acute peritonitis, but the leucocytes do not give the iodine 

 reaction. Further, malignant ovarian tumours usually cause 

 slight leucocytosis and decrease of reds; this has been sug- 

 gested as of diagnostic importance, but it might be due to 

 so many other conditions that not much reliance can be placed 

 on it. A normal condition of the blood, however, would be 

 some evidence ag'ainst malignancy. In tubal gestation the 

 blood is normal. After rupture there is anaemia and increase 

 of the leucocytes, which may reach 24,000 or more. 



PEMPHIGUS, DERMATITIS HERPETIFORMIS, and ERYTHEMA 

 MULTIFORME, are associated with a high percentage of eosino- 

 philes, and this is of importance in the diagnosis of these 

 diseases from local infective processes, which they often 

 closely resemble. The eosinophiles in the former group of 

 diseases may be expected to exceed 10 per cent, and may be 

 much higher, and there may be a high leucocytosis. 



