. The diseases of infancy and childhood. cases or verysevere infections with little or no reaction. The increase begins shortlyafter the onset and continues during the stage of exudation, generallyreaching its maximum shortly before the crisis, when it declines usual number of white cells in an average case of pneumonia ina young child is from 25,000 to 40,000, but it is not rare for the countto run up to 50,000 or even 60,000. We have seen it over 100,000 severaltimes. The absence of leucocytosis in a strong child who is acutely illis always strong presumptive evidence against pne
. The diseases of infancy and childhood. cases or verysevere infections with little or no reaction. The increase begins shortlyafter the onset and continues during the stage of exudation, generallyreaching its maximum shortly before the crisis, when it declines usual number of white cells in an average case of pneumonia ina young child is from 25,000 to 40,000, but it is not rare for the countto run up to 50,000 or even 60,000. We have seen it over 100,000 severaltimes. The absence of leucocytosis in a strong child who is acutely illis always strong presumptive evidence against pneumonia. A well-marked leucocytosis is of much value in differentiating pneumonia fromtyphoid fever. Positive blood cultures were obtained in the Babies Hos-pital in 14 per cent, of 108 cases studied. Otten found almost exactlythe same proportion in a study of 70 cases. These observations indicatethat positive cultures are much less frequent than in the pneumonia of adults. Physical Signs.—The earliest signs in pneumonia are due to the. Fig. 68.—First Stage. Congestion of leftlower lobe, with crepitant rales. Feeblebreathing of a rude character, with slightdulness. Fig. 69.—In the center of the area, a smallspot of pure bronchial breathing and voice;surrounding this an occasional crepitantrale, with bronchovesicular breathing andslight dulness.
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