242 CLINICAL BACTERIOLOGY AND HjEMATOLOGY 



Fig. 3). In severe cases the majority of the red corpuscles ma] 

 be abnormal, and the appearance of the stained films is ver; 

 extraordinary. 



The prognosis of these cases is fairly good if proper treatmen 

 be adopted — much better than in the primary blood- diseases wit! 

 which they might be confounded. 



Sepsis, Suppuration, and Septicemia. — In most cases of infec 

 tion with septic bacteria, whether local or general, there is marke( 

 leucocytosis, due especially to an increase in the polynuclea 

 leucocytes. For instance, in an ordinary case of appendiciti 

 of average severity we may expect the number of leucocytes ti 

 rise gradually to 25,000 or 30,000, about go per cent, being poly 

 nuclears. At the same time there is usually a moderate fall ii 

 the amount of haemoglobin and in the number of red corpuscles 

 In practice we have to consider three types, in each of which thi 

 blood-counts vary. 



I. Very Severe Cases. — Puerperal and other forms of septicsemia 

 general septic peritonitis due to very virulent bacteria, especially 

 in an enfeebled patient, etc. 



Here there may be but slight leucocytosis, and this, taken ii 

 conjunction with the patient's general condition, is not a goo( 

 sign, but a bad one. In many cases the total number is withii 

 the normal limits, but whether this is the case, or whether thi 

 leucocytes are slightly increased, a clue to the condition will bi 

 given by the fact that the polynuclears show their usual increase 

 and the glycogen reaction is present and often very marked. 



The haemoglobin, however, gives much more valuable indica 

 tions ; the severer the case the more rapidly it falls, and vice versa 

 The same information can be obtained, though not so well, fron 

 the variation in the red corpuscles. Thus, in a case of severi 

 sepsis of any sort the red corpuscles and haemoglobin may fal 

 enormously in a few days. This is a very valuable test fo 

 puerperal fever. Under ordinary circumstances the amount c 

 blood lost at parturition should not lower the corpuscles belo\ 

 4,000,000, and if a count greatly below this is found in a few days 

 time, there having been no severe haemorrhage in the meantime 

 the diagnosis of septic infection is probable, whatever be th 

 numbers of the leucocytes; if at a later date the numbers ar 

 lower still, the diagnosis is almost certain. The haemoglobi: 

 may fall 10 per cent, per diem, or even more in a sever 

 case. 



