228 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



according to Horder it may reach 25,000. I have several times 

 met with 20,000 or thereabouts. Tuberculous pleurisy is usually 

 without marked leucocytosis, but occasionally the figures may reach 

 18,000 to 20,000. 



Syphilis. — There is usually progressive secondary anaemia with 

 moderate leucocytosis (12,000 to 16,000), due mainly to increase of 

 lymphocytes, often of the large type, but the figures are too incon- 

 stant to be of much value in diagnosis (see p. 180, Justus's test). 



Purpura Hemorrhagica. — There is naturally advancing 

 anaemia, which may be associated with a low or normal colour- 

 index. In the most common type of case, in which the prognosis 

 is relatively good, there is also the usual slight polynuclear leuco- 

 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 recognised.* 



Malignant Tumours. — These are frequently associated with a 

 moderate leucocytosis, with increase of the polynuclears, and slight 

 anaemia. 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 whilst 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 unaccom- 

 panied 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 vomit (p. 115). 

 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), 



* Some at least of these cases are really acute lymphatic leucocythsemia 

 without glandular lesions. 



