Kerr, Francis Ferguson

2018-01-31T11:46:25Z

2018-01-31T11:46:25Z

1903

1. In the majority of cases of phthisis of all stages the rate of haemoglobin is surprisingly high. Of those examined 85.7 per cent had 70 per cent or more of haemoglobin. In a few cases, however, of both early and advanced. disease it is lowered. The proportion under 70 per cent in my series is 14.3 in the hundred.

If the percentage is low at first it will increase as the patient improves under treatment.

2. The red corpuscles are generally present in good amount, sometimes in abnormally high amount. Thus the cases with red cells numbering 5,000,000 or more make 61.5 per cent in those examined in my series of all stages, while those with red cells below 5,000,000 number 38.5 per cent of the whole.

It is to be noted that these numbers are attained by the production of many immature and ill - formed corpuscles, as has been noted by Cabot. I did not find poikilocytotic forms present,or nucleated red cells.

3. Frequently the red corpuscles increase as the disease gets better.

4. In the majority of cases of phthisis there is present at some stage of their history a variable increase in the leucocytes. This leucocytosis I believe to be of two kinds - (a) A polymorphonuclear increase where the entrance of septic organisms calls forth resistance. (b) A basophile increase accompanying improvement under appropriate treatment, with plentiful nitrogenous diet and hygienic surroundings. Both forms of leucocytosis are desirable. The first because it shows that the system is resisting the mixed infection. The second, because it indicates that the blood and the body generally are responding to treatment. The first form is usually the higher in numbers. I believe, further, that these two forms of leucocytosis may co -exist or follow one another; that is the basophile increase follow a polymorphonuclear increase.

It has been pointed out that the polymorphonuclear cells decrease in favour of the basophile in certain of the cases showing improvement. In such cases I believe that this change from a polymorph. leucocytosis to a basophile leucocytosis was taking place.

It has also been noted that the leucocytes in some cases were found to increase on improvement, and and in others to decrease.

On looking into the two groups of cases we find that when the leucocytes increased after a period of treatment the initial count, in the majority, was not very high. On the other hand, in those cases where the leucocytosis diminished, the first count was fairly high in every case. One is therefore led to conclude that the leucocytes increase when their aid is needed, and gradually diminish when the demand is less urgent.

No doubt the change from a polymorphonuclear increase, which is fairly high, to one of basophiles, which is not quite so high, accounts in part for the fall. This may also explain why certain observers have recorded an increase in leucocytosis, and others a decrease under treatment with improvement.

Of the cases. examined immediately on admission, 69.2 per cent showed no basophilia, while those showing basophilia numbered 30.8 per cent.

Of those examined after varying periods of treatment, 40 per cent showed some degree of basophilia.

In addition to this number many showed an increase in basophile cells not marked enough to be classified with the last -named 40 per cent. In this category must be placed many of those cases which showed showed a normal or increased number of polymorphonuclear forms at first, due to septic infection, and which were found to have a diminished number of polymorphs. when the patient. had been improving some time. The overcoming of the mixed infection, no doubt, largely contributing to the general progress.

Of the cases which showed a basophile reaction after treatment and were: resident in hospital long enough for an opinion of their progress to be formed; 81.2 per cent .made good progress, while 18.8 per cent were doubtfully improved.

From these facts I conclude that a basophile reaction is of good prognostic importance.

5. Myelocytes were found in small numbers in 9.4 per cent of the cases examined.

6. In certain cases the coarsely granular eosinophiles increase as the patient progresses.

7. It must be remembered that the concentration of the blood, which is probably present in the greater number of cases of phthisis at all extensive or old standing, must exercise a decided influence in producing the apparently high number of corpuscles and haemoglobin which are found in so many cases,and must thus make the leucocytosis appear larger than it is.

Finally, I should like to add that the variations in any given class of case are very wide and make conclusions difficult to draw. For this reason I have thought it better to confine myself to general conclusions, and not to attempt to lay down definite laws for the different classes of the disease, further than has been done as each section was discussed.

http://hdl.handle.net/1842/28350

The University of Edinburgh

Annexe Thesis Digitisation Project 2017 Block 16

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The treatment of nineteen cases of an epidemic of diphtheria of two months

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MD Doctor of Medicine