The microscopic changes in the blood during pregnancy and the puerperium with special reference to leucocytosis
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In attempting to make a brief summary of the results of this investigation, I must repeat that the main object in view, was the determination of the leucocyte curves in the normal puerperium. The uniformity of the results obtained leads one to the conclusion that there is a distinct leucocytosis during pregnancy in primipara and also, but to a smaller extent, in multipara, and that it reaches its maximum at term. Besides this, we see that a standard leucocyte curve during the puerperium does exist, and in this curve we appear to have a record of the patient's progress towards recovery, approximating to the information obtained from the examination of the pulse and more regular than the corresponding temperature chart.The striking fact in the leucocyte curve of the puerperium, is the rapid and regular fall in the first four days of the puerperium, from the comparatively high count existing at term, and as it is during this time that manifestations of septic complications generally show themselves, we should regard with suspicion any case in which the leucocyte count remains high or rises above this normal standard. And we must remember, of course, that a leucocytosis may be due to other causes than puerperal sepsis. The presence of an inflammatory focus in the body, apart from the pelvis, may produce a similar rise.Hibbard and White, for instance, have shown that a simple mastitis may give rise, to an independent leucocytosis, a pneumonia of course, and appar- ently, a Uraemic condition also will produce the same effect. But in the absence of such conditions, and they can generally can be excluded, a leucocytosis higher than that normally present must put us on our guard and make us use every means in our power to eliminate the possibility of puerperal sepsis. It will not be surprising, and indeed, will only be in accord with what has been found in other conditions if such a leucocytosis should sometimes prove the first warning that puerperal infection has occurred. The evidence we obtain, however, from the estimation of the leucocytes, must always be considered in conjunction with the evidence obtained from other sources. It can never take the place of careful clinical examination. Incident- ally, in the investigation also, we have confirmed the observation that the leucocytosis is essentially a polymorphonuclear leucocytosis, and would beg to again direct attention to the suggestion that the leucocytosis of pregnancy is essentially toxic in origin and that it indicates in some way, a reaction on the part of the mother to toxic substances of metabolic origin set free from the altered physiological processes dependent on the presence of the foetus in the uterus. Naturally, in a series of observations such as the present, one did not expect to find many examples of puerperal sepsis, and consequently, I am unable to give examples of puerperal complications to contrast with the foregoing normal cases. It will be my endeavour, however, in the future as occasion offers, to extend my observations in the direction of abnormal cases. When a larger number of those cases have been placed on record, it may be found possible to determine the precise value of an examination of the blood in the puerperium. There can be little doubt, however, from what has been found in other branches of medicine and in other diseases, that the estimation of the leucocytes will form a valuable addition to the means at our disposal for the diagnosis of puerperal disease.