DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 249 



forming a diagnosis. To test for it enumerate the leucocytes in 

 a patient who has eaten nothing since the previous da}- ; let him 

 take a meal (of which meat should form part), and repeat the 

 examination in three or four hours' time ; a rise of 2,500 to 3,500 

 may be considered normal. 



Ulcer of the Stomach with hemorrhage leads to secondary 

 anaemia, but, unlike carcinoma of the stomach, is usually un- 

 associated with leucocytosis. There are exceptions to this rule, 

 and when the ulcer reaches the peritoneum and causes local 

 peritonitis, or ruptures and causes general peritonitis or localized 

 abscess, leucocytosis occurs. 



Cirrhosis of the Liver. — In ordinary uncomplicated alcoholic 

 cirrhosis there may be anaemia, but there is no leucocytosis, or at 

 most very little. In most of the diseases for which it may be 

 mistaken an ordinary polynuclear leucocytosis is present. 



Hanot's cirrhosis is said to be accompanied by leucocytosis, 

 but, as this may be intermittent, the diagnostic value of the test 

 cannot be great in cases where no leucocytosis is found. 



Abscess of the Liver and Hydatid Cyst. — The former disease 

 is usuallyassociated with leucocytosis, the latter isnot, though here, 

 again, there are exceptions. Some importance should be attached 

 to the simple count, but more to the differential count, since in 

 hydatid the eosinophiles are usually raised (57 per cent, has been 

 recorded, but 6 to 8 per cent, is more usual) and in ordinary 

 septic disease are absent, low, or normal, and these rules apply 

 whether the leucocytes are normal or increased. There is a 

 " complement-deviation " test, similar in general terms to the 

 Wassermann reaction for syphilis, which appears to give 

 satisfactory results. The antigen used is hydatid fluid from a 

 previous case. 



Peritonitis and Appendicitis. — See p. 242, Sepsis and Sup- 

 puration. 



Pleurisy and Empyema. — With a mechanical pleural effusion 

 (cardiac or renal) there is no leucocytosis. With simple non-tuber- 

 culous pleurisy the blood is usually normal, and the same holds 

 in the tuberculous cases, but here the leucocytes are occasionally 

 raised to 18,000 or more. Such cases may be distinguished from 

 pneumonia or empyena by the presence of the iodine reaction in 

 the latter and its absence in pleurisy. Empyemata are associated 

 with a high leucocytosis, except sometimes in the tuberculous 

 forms. 



