244 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



rhceal pyosalpinx ; the gonococcus dies out rapidly, but the pui 

 remains, and unless you examine the case early there will be nc 

 leucocytosis, or but little. 



(c) The leucocytosis gives no indication of the seat of the pus 

 there may be a small abscess in the body far from the regior 

 under suspicion. 



{d) The height of the leucocytosis gives no indication of the size 

 of the abscess nor of its severity. 



(e) In interpreting a high leucocytosis to mean pus, you musi 

 exclude the other causes of a similar blood condition — pneumonia 

 etc. Thus, in a severe abdominal disease leucocytosis may be 

 due to an ovarian cyst with a twisted pedicle, a ruptured tuba, 

 gestation, etc. 



(/) Cold (tuberculous) abscesses do not usually give a poly 

 nuclear leucocytosis ; if there i's one, it indicates a secondarj 

 septic infection, and is a decidedly bad sign. 



3. In moderate cases of septic or other form of inflammation, sup- 

 puration of free surfaces, etc., there is usually a moderate 

 leucocytosis (up to 18,000), with increase of the polynuclears. 



Typhoid Fever. — In the early stages there is usually some 

 concentration of the blood, the red corpuscles often exceeding 

 6,000,000 ; at a later period they fall somewhat, but rarely below 

 4,000,000. In most other diseases ( malaria, septicaemia, tubercu- 

 losis, etc.) for which typhoid is likely to be mistaken the rule is to 

 find marked diminution of the red corpuscles ; when these are high 

 with a fever of some duration typhoid fever should be suspected. 



The leucocytes are usually normal or diminished in numbers 

 ^3,000 to 6,000), and there is often slight excess of lymphocytes 

 (average about 50 per cent.). This is not unlike what occurs in 

 tubercle and malaria, but is of diagnostic value in distinguishing 

 typhoid from septicaemia, in which case there may be no excess 

 of leucocytes, but there is usually a relative excess of polynuclears. 

 The number of leucocytes in typhoid is of some value in prog- 

 nosis ; the lower the count, the more severe the case, though to 

 this rule, as to all others in blood-work, there are exceptions. 



In the later stages of the disease the diagnosis is best made by 

 Widal's reaction. 



Complications. — H.ere the condition of the patient must be taken 

 into account ; a complication (e.g., perforation) which causes a 

 rapid and marked leucocytosis in a patient who has not been 

 greatly enfeebled by a long and severe illness may cause no 



