LEUCOCYTOSIS 



233 



Septic processes. The leukocyte count is of great value, especially 

 when we obtain a leukocytosis with 80 to 90% of polymorphonuclears, 

 as in appendicitis, cholecystitis, or other suppurative conditions. 

 Read article under the blood cultures, Chap. XXIX. A marked 

 leukocytosis is of diagnostic importance in acute ulcerative endocarditis 

 provided it is not fulminant in type. 



FIG. 55. Leukocytosis (40,000); sixteen polymorphonuclears in field. (Cabot.) 



According to Cabot, leukocytosis varies in infections as follows: 



1. Severe infection good resistance; early, marked and persistent leukocytosis. 



2. Slight infection slight resistance; leukocytosis present, but not marked. 



3. In fulminating infections we may have no increase in whites, but a higher per- 

 centage of polymorphonuclears. 



4. Slight infection and good resistance may not be productive of leukocytosis. 



It is in connection with the question of operation in appendicitis or similar condi- 

 tions that the matter of a leukocyte count is of prime importance. If there be a 

 leukocytosis but with less than 75% of polymorphonuclears it indicates an infection 

 of little virulence or a walled-off process with an exacerbation. It is difficult to form 

 an opinion when the polymorphonuclears are under 80%. Leukocytosis with poly- 

 morphonuclear percentage of 85 to 90 indicates immediate operation; percentages 

 over 90 point to peritonitis and if with such percentages of polymorphonuclears there 

 is absence of leukocytosis the prognosis is grave. 



The blood of cases with malignant tumors tends to show a moderate 

 leukocytosis except in epithelioma of the skin. When a cancer is 

 ulcerating quite a high white count may be obtained. 



Spirochaete fevers, as relapsing fever, may give a leukocytosis of from 25,000 to 

 50,000. 



Smallpox, especially at time of pustulation, plague, scarlet fever, 

 and liver abscess give a leukocytosis of from 12,000 to 15,000. 



