248 CLINICAL BACTERIOLOGY AND H^EMATOLOGY 



cytosis met with in secondary anaemia, or it may reach a very 

 high grade. In some cases, however, in which the prognosis is 

 extremely bad, there is leucopenia with lymphocytosis. In one 

 case (under Dr. Dalton at King's College Hospital) which was 

 fatal in a few days the leucocytes were 2,000 and the lymphocytes 

 over 95 per cent. A blood-count should always be made in 

 purpura haemorrhagica, when these cases (probably quite different 

 in nature) may be diagnosed early and their gravity recognized. 



Malignant Tumours. — These are frequently associated with a 

 moderate leucocytosis, with increase of the polynuclears, and slight 

 ansemia. The leucocytosis is said to be more marked in the sar- 

 comata than in the carcinomata. These facts are very rarely of 

 value in diagnosis, since while the growth is small and removable 

 the blood is usually normal (except in an ulcerated carcinoma of 

 the gastro-intestinal tract), and in any case there are so many 

 examples of malignant growth with normal blood, and so many 

 causes of slight leucocytosis, that its presence is not much 

 help. Malignant tumours of the oesophagus are occasionally 

 unaccompanied by leucocytosis, but most follow the general 

 rule. 



Cancer of the Stomach. — The frequency with which difficulty 

 arises in the early diagnosis of this condition renders any assist- 

 ance important, and although the indications given by the blood- 

 count are not conclusive, they are helpful in conjunction with the 

 clinical examination and the investigation of the test meal (p. 133J. 

 In some cases the blood is normal, but usually there is one of 

 two conditions : either a marked secondary anaemia with a rather 

 low colour-index (averaging 0-63 according to Osier and McCrae), 

 with sHght polynuclear leucocytosis — about 12,000 to 18,000, of 

 which 80 to 90 per cent, are polynuclears ; or a condition closely 

 resembling pernicious anaemia, with a high colour-index, megalo- 

 cytes, and occasionally megaloblasts. In the latter case the 

 diagnosis from true pernicious anaemia may usually be made 

 by the fact that in carcinoma ventriculi there is polynuclear 

 leucocytosis instead of the leucopenia with lymphocytosis of 

 pernicious anaemia. The blood finding in this case is very 

 suggestive. 



According to some authors there is no digestion leucocytosis in 

 cancer of the stomach, whilst there is in other diseases. There 

 appear to be numerous exceptions to this rule, though it is true 

 in the majority of cases, and might be allowed some weight in 



