210 Clinical bacteriology and hematology 



Alterations in Disease. 



I. Lymphocytes. — They may be relatively increased {e.g., to 

 figures above 30 per cent.) when the total fiigures are normal or 

 raised. These have different meanings. 



Lymphocytosis with normal or lowered total counts occurs in 

 pernicious anaemia, typhoid fever, uncomplicated tuberculosis 

 (but not always), in some cases of purpura (so-called idiopathic 

 purpura), and occasionally in syphilis, Hodgkin's disease, and 

 some other diseases. 



Lymphocytosis with a high total count occurs as a normal 

 condition in infancy, and is accentuated both as regards the 

 percentage of lymphocytes and the total number of leucocytes in 

 almost all infantile diseases, especially rickets and hooping-cough. 



In adults a very high total count (100,000 or more) with a very 

 high percentage of lymphocytes (up to 99-5 per cent.) indicates 

 lymphatic leucocythagmia. Smaller increases sometimes occur 

 in other diseases. 



A relative diminution of the lymphocytes frequently occurs as a 

 result of the increase of other leucocytes, rarely as a true absolute 

 diminution. 



Large Hyaline Cells. — An increase or decrease of these is 

 occasionally observed, but so erratically that it is of no use in 

 diagnosis. 



Polynuclear Leucocytes. — This is the most common cell to undergo 

 increase, so much so that in the list of causes of leucocytosis 

 given on p. ig6 it may be assumed that the increase is due partly 

 or entirely to an increase of polynuclears, unless the opposite is 

 stated here. 



One special case needs a reference. In severe sepsis with a 

 normal or diminished polynuclear count it is usual for the 

 polynuclears to be relatively increased, just as they are when 

 the total count is raised. This is very important in diagnosis, 

 for in cases where sepsis is suspected a normal leucocyte count 

 must always be followed by a differential count, and if there is a 

 relative increase {e.g., 85 per cent, or more) of polynuclears it 

 must be regarded as a bad sign. A relative increase of poly- 

 nuclears with a normal or moderately raised total count may also 

 occur in malignant disease. 



A form of degeneration of the polynuclears requires notice, as 

 it is of some practical value. This is the iodine or glycogenic 



