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Observations on the leucocytosis of pneumonia : being an essay specially written for the Goodsir Memorial Scholarship & Gunning Victoria Jubilee Prize (Practice of Physic)

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Date
1897
Author
Forbes, John
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Abstract
 
 
It is difficult in the midst of confusing and more or less contradictory theories and experiments to arrive at any definite conclusion regarding this matter.
 
In considering the subject it is necessary to bear in mind two essential features of the affection.
 
1. Febrile symptoms due to the specific action of the pneumotoxin or pneumotoxins.
 
2. Inflammatory exudation.
 
To this last hypothesis certain of my observations in pneumonia would appear to lend support and with the aid of this hypothesis the events taking place in pneumonia can be best explained.
 
1. The relative low percentage of the polynuclear leucocytes in the first stage as compared with Stage 2, is firstly due to the fact that they are being rapidly lost from the blood; secondly that they are in the process of development
 
2.) The relative high percentage of the mononuclear cells in Stage 1, notwithstanding that they are also thought to a less extent, lost from the "blood, is diie to increased state of development from the lymphocytic condition.
 
3. In stage 2 the process of exudation is over, or if not, the production of the luucocytes is proportional to the loss,' the large cells are often relatively diminished as compared with Stage 1, "because they have developed into fully formed polynuclear cells.
 
4. At the crisis the agents which are the cause of this increased rate of development are antagonised , and a sudden arrest takes place of the progress. This is evidenced first by increase in the number of large mononuclear cells, an arrest of their process of development into the polynuclear fi'rst taking place, later by a greater relative increase of the lymphocytes due to a further arrest of development, the conversion of the lymphocyte into the hyaline cells being apparently a simpler and more quickly accomplished process, than the other.
 
On no other theory than this can I explain absolute increase in the number of the mononuclear cells which is often seen at the crisis.
 
5. A quick decided fall of the luucocyte count during the acute attack is to be explained as due to a sudden increased exudation into the lung, which the haemic leucocytosis is not capable of meeting.
 
6. Cases occurring without leucocytosis may be explained by (1) very rapidly extending inflammatory exudation, (S) failure in the production of leucocytes either due to extreme virulence of the poison, or a want of proper blood supply to the leucocyte producing centres. In such cases most of the polynuclear cells disappear from the blood. They are probably not destroyed; their loss may be accounted for by emigration. The cells which remain in the blood are mostly cells in a transitional stage between the large mononuclear and polynuclear forms. In these cases, even the largest hyaline share in the process of rapid development, and the result of this is the production of polynuclear cells of a larger size than normal.
 
URI
http://hdl.handle.net/1842/28035
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