2l5 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



spinal, pneumococcic, etc. In tuberculous meningitis there may 

 be as many as 25,000 leucocytes. In this it differs from most 

 uncomplicated tuberculous affections, in which there is usually no 

 leucocytosis. 



Pleurisy, especially empyema. A leucocyte count of 20,000 

 does not exclude tuberculous pleurisy, but tells strongly against it. 



Scarlet fever. 



Diphtheria. 



Hemorrhage. — After a very severe haemorrhage, whether internal 

 {e.g., rupture, extra-uterine gestation) or external [e.g., from 

 gastric ulcer), figures over 20,000 are occasionally seen, but 

 usually rule lower (12,000 to 15,000). The number usually falls 

 in a few days. 



Similar figures are seen immediately before death, especially if 

 the death is lingering, and very high figures are occasionally seen. 

 It is sometimes of value in prognosis. 



In ovarian cysts with twisted pedicle, in intussusception and 

 volvulus, the figures may exceed 20,000. 



III. Moderate Leucocytosis (10,000 to 20,000). — Here come 

 mild cases of almost all the diseases mentioned above. Thus, a 

 very mild case of pneumonia may show a leucocytosis within 

 these limits, or be normal. 



Inflammatory. — Leucocytosis in inflammatory conditions other 

 than suppuration rarely exceeds 20,000, and does not often reach 

 16,000 ; this is a most important diagnostic feature. 



Rheumatism, in the absence of complications. 



Tonsillitis, except when very severe, when higher figures may 

 be seen. 



Secondary anamia (see p. 236). 



Gout. — Here the condition is normal during the interval, with a 

 slight leucocytosis during the attack. 



Small pox, during the pustular stage. In severe cases the count 

 may exceed 20,000, and figures much above this indicate a bad 

 prognosis: 



Perforation in Typhoid Fever. — Here the leucocytosis usually 

 attains 15,000 in less than an hour, and may go much higher. 



Secondary syphilis in most cases. 



Malignant Tumotirs. — There is often, but not invariably, a slight 

 rise in the leucocytes with malignant tumours, but it is hardly 

 marked in the early stages. 



In addition to these pathological leucocytoses, there are 



