DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 243 



Conversely, a rise in the number of red corpuscles and haemo- 

 globin is a good sign when the existence of septic infection is 

 certain, whatever be the clinical condition ; a cessation of the fall 

 is good also, but to a less extent. (Beware, however, of mistaking 

 a concentration of the blood from diarrhoea or profuse vomiting 

 for a true rise.) As an example I may quote the case of a patient 

 ^nder Dr. Hayes in King's College Hospital, in whom about a 

 fortnight after parturition there were 1,306,000 reds, 26 per cent, 

 haemoglobin, 13,400 leucocytes, of which 87 per cent, were 

 polynuclears. Here 2,700,000 reds had been lost in two weeks, 

 indicating a very severe sepsis. Her condition appeared desperate; 

 yet in a week the reds had increased to 2,750,000, in a fortnight 

 more to 3,760,000, when for the first time she showed clinical 

 improvement. In nine days more they had reached 4,000,000, 

 and the patient was out of danger. Here a good prognosis was 

 given solely on the blood-counts. 



In these cases a great diminution or total disappearance of the 

 eosinophiles is a bad sign, their reappearance a good one. 



2. Suppuration. — Where the sepsis is localized and not so severe, 

 so that a limited focus of suppuration occurs, there is a leucocy- 

 tosis which, in round figures, exceeds 20,000, and the increase is 

 mainly due to a rise in the polynuclears. Various writers give 

 different figures as that above which pus is indicated : some take 

 15,000, which I find to be reached fairly often when there is no 

 pus ; others 25,000, which is frequently not reached when sup- 

 puration has occurred. The number 20,000 has been taken as 

 the result of a considerable amount of experience of all forms of 

 suppuration, and will prove a correct indication in at least 90 per 

 cent, of all cases. It is especially useful in appendicitis, in which 

 it is an almost certain guide. The glycogen reaction is usually 

 present, and is a valuable confirmatory test. 



The following considerations must be remembered : 



(a) The increase of leucocytes to the figures mentioned above 

 only occurs when the pus is pent up, not when it occurs on a 

 free surface and can escape. I have twice seen a rapid fall of 

 the leucocytes due to rupture of an appendicitic abscess into the 

 intestine. 



(6) Where the spread of the suppuration ceases (due to the death 

 or latency of the organisms it contains) the leucocytosis gradually 

 subsides, and an old, thick- walled collection of pus in the tissues 

 may give a normal count. This is especially common in gonor- 



