DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 23 1 



In morbus caeruleus it may be still higher — 10,000,000 or more. 

 In aortic disease, on the other hand, there is a tendency to slight 

 anasmia. The leucocytes remain normal in both cases. 



Puerperal Fever. — The great difficulty in interpreting blood 

 findings in the puerperium is the fact that the blood is not normal 

 immediately before child-birth. The change affects the leucocytes, 

 which are increased, it may be as high as 36,000 (Cabot) ; this is a 

 very unusual figure, and on the average the numbers do not exceed 

 16,000 in primiparse and 12,000 in multiparae. Leucocytoses within 

 these limits are to be looked on as being probably normal, and not 

 as indicating sepsis. More information may be gained by counts 

 at intervals. The figures should decrease rapidly after delivery, 

 becoming normal in less than a fortnight, and if a count remains 

 the same on two successive days an inflammatory process is 

 suggested, and a definite rise constitutes almost absolute proof. 

 It is in these cases especially that the glycogen reaction is of 

 value, and its presence should outweigh that of the total numbers. 

 The differential count is not of much value, since the polynuclears 

 are increased in normal pregnancy, unless these cells reach 90 per 

 cent, or more. 



The chief reliance is to be placed on the haemoglobin. It 

 should be normal or slightly reduced at the end of pregnancy, 

 fall in proportion to the haemorrhage at parturition and for a day 

 or two after, and then be rapidly regenerated. Under normal 

 circumstances it should not be much below 70 per cent. , nor the 

 red corpuscles much below 4,000,000. Figures much below these 

 (unless there has been great haemorrhage, or unless it has been 

 repeated) raise suspicions of sepsis, whilst an observed fall is 

 almost definite proof. This has also much value in prognosis 

 (see p. 223). 



Perimetritis, Parametritis, etc. — Here the usual relations 

 hold good. There is a moderate leucocytosis in a non-suppurative 

 lesion, a high one when suppuration occurs. The figures are 

 usually somewhat lower than in other parts of the body, and 

 18,000 may be taken as fairly definite evidence of pus, provided 

 other sources of leucocytosis can be excluded. 



Other Pelvic Swellings. — The blood-counts in these cases 

 have to be interpreted with much caution, and are often very 

 equivocal. Thus, pyosalpinx is usually associated with the ordinary 

 signs of pus, but the cases are frequently tuberculous, when there 

 is no leucocytosis, or gonorrhceal, when there is only leucocytosis 



