ESTIMATION OF THE NUMBER OF LEUCOCYTES I97 



In ovarian cysts with twisted pedicle, in intussusception and 

 volvulus, the figures may exceed 20,000. 



III. Moderate Leucocytosis (10,000 to 20,000).^ — Here come 

 mild cases of almost all the diseases mentioned above. Thus, a 

 very mild case of pneumonia may show a leucocytosis within 

 these limits, or be normal. 



Inflammatory . — Leucocytosis in inflammatory conditions other 

 than suppuration rarely exceeds 20,000, and does not often reach 

 16,000 : this is a most important diagnostic feature. 



Rheumatism, in the absence of complications. 



Tonsillitis, except when very severe, when higher figures may 

 be seen. 



Secondary anamia (see p. 217). 



Gout. — ^Here the condition is normal during the interval, with a 

 sUght leucocytosis during the attack. 



Small-pox, during the pustular stage. In severe cases the count 

 may exceed 20,000, and figures much above this indicate a bad 

 prognosis. 



Perforation in Typhoid Fever. — Here the leucocytosis usually 

 attains 15,000 in less than an hour, and may go much higher. 



Secondary syphilis in most cases. 



Malignant Tumours. — There is often, but not invariably, a slight 

 rise in the leucocytes with malignant tumours, but it is hardly 

 marked in the early stages. 



In addition to these pathological leucocytoses, there are two 

 physiological conditions associated with a moderate leuco- 

 cytosis. 



Digestion. — Under normal conditions there is a rise of 1,000 to 

 3,000 soon after a meal. This must always be remembered in 

 interpreting a leucocyte count. A figure of 12,000 obtained in 

 a patient an hour or two after a full meal does not neces- 

 sarily indicate disease. If possible, examine the patient when 

 fasting. 



Pregnancy. — The figures rise gradually toward the end of 

 pregnancy, and at term may reach 15,000 or even higher. 

 Recollect this in interpreting counts in pregnancy or soon after 

 parturition. 



IV. Normal Counts (5,000 to 10,000, average 7,500) are 

 met with in a variety of conditions, but in comparatively few 

 that are attended with pyrexia. Of these the most important 



