224 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



it is an almost certain guide. The glycogen reaction is usually 

 present, and is a valuable confirmatory test. 



The following considerations must be remembered : 



(a) The increase of leucocytes to the figures mentioned above 

 only occurs when the pus is pent up, not when it occurs on a 

 free surface and can escape. I have twice seen a rapid fall of 

 the leucocytes due to rupture of an appendicitic abscess into the 

 intestine. 



(b) Where the spread of the suppuration ceases (due to the death 

 or latency of the organisms it contains) the leucocytosis gradually 

 subsides, and an old, thick-walled collection of pus in the tissues 

 may give a normal count. This is especially common in gonor- 

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

 remains, and unless you examine the case early there will be no 

 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 region 

 under suspicion. 



(d) The height of the leucocytosis gives no indication of the 

 size of the abscess or of its severity. 



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

 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 tubal 

 gestation, etc. 



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

 nuclear leucocytosis; if there is one, it indicates a secondary 

 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 



