DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 229 



with slight polynuclear leucocytosis — about 12,000 to 18,000, of 

 which 80 to go per cent, are polynuclears ; or a condition closely 

 resembling pernicious anaemia, with a high colour-index, megalo- 

 cytes, and occasionally megaloblasts. In the latter case the 

 diagnosis from true pernicious anaemia may usually be made by 

 the fact that in carcinoma ventriculi there is polynuclear leucocy- 

 tosis instead of the leucopenia with lymphocytosis of pernicious 

 anaemia. The blood finding in this case is very suggestive. 



According to some authors there is no digestion leucocytosis in 

 cancer of the stomach, whilst there is in other diseases. There 

 appear to be numerous exceptions to this rule, though it is true 

 in the majority of cases, and might be allowed some weight in 

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

 a patient who has eaten nothing since the previous day ; 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 haemorrhage 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 usually associated with leucocytosis, the latter is not, 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. 



Peritonitis and Appendicitis. — See p. 222, Sepsis and Sup- 

 puration. 



Pleurisy and Empyema. — With a mechanical pleural effusion 



