Abstract
It is well recognized that the leucocyte count in lobar pneumonia may vary within wide limits. The majority of the cases which end fatally show either a very high or relatively low count, while those with favorable outcome most often have counts between these extremes.
For the low leucocyte count, at least two explanations have been suggested: (1) the bone marrow fails to react, either as the result of some previous injury (chronic alcoholism, for example), or on account of a paralysis of the blood-forming elements from overstimulation by the pneumococcus infection itself; (2) a rapid spread of the pneumonic process takes the leucocytes out of the blood faster than they are thrown into the circulation from the bone-marrow, therefore, the number of circulating leucocytes may be normal or slightly increased, even though the output of the bone-marrow factory may be far above normal. Still another possibility must be conceived, namely, that leucocytes may be formed in some other organ than the bone marrow, for example, the spleen. Dr. F. A. Evans, working in our laboratory, pointed out several years ago that the gray, acute splenic tumor of lobar pneumonia contained large numbers of cells of the myeloid series, as indicated by the oxydase reaction, and suggested that the spleen might be the source of certain of the cells of the pneumonic exudate.
In the present study, an attempt has been made to correlate the bone-marrow changes and the blood picture in twenty fatal cases of lobar pneumonia, which have come to autopsy. In nearly all of the cases, several leucocyte counts were made. In the majority, there was a record of a count on the last day of the patient's life.
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