REVIEW — TROPICAL MEDICINE, ETC. 23 



movement, c. Bodies of indefinite shape, dumb-bells, rods, knobbed at one end, like a Blood- 

 tadpole, etc., with slow movements, d. Small, round, vesicular, highly refractile bodies with continued 

 a central ruby-coloured spot. These are usually quiescent, but may move slowly, e. Small, 

 very rapidly moving, highly refractile micrococcal forms. Attempts at staining and 

 cultivation failed. Porter believes that some are escaped nuclei of leucocytes, some escaped 

 granules of leucocytes, others portions of disintegrated red cells, and that all are produced by 

 some change in the blood constituents. 



Nuttall and Graham-Smith' describe very similar forms, and state that they are liable 

 to be mistaken for free forms of piroplasmata. In a later paper^ they describe and figure 

 the curious changes red corpuscles undergo in blood films, bodies being produced which 

 might deceive the very elect. No one who has done much blood work but has encountered 

 and probably been puzzled and deceived by some of these bodies. In my own experience 

 the small, colourless, spherical forms have proved most troublesome, especially when working 

 with fowl's blood. They are probably the free granules of leucocytes, but it is curious that 

 they cannot be stained : — 



One of the most useful and practical papers which has recently appeared is that by 

 Sutherland on " The Differential Diagnosis of Tropical Fevers." It occurs as an appendix 

 to Chapter III. of Eoberts'^ admirable work on Enteric Fever in India. Here we need only 

 note some of the remarks on leucocytes : — 



" A leucocytosis or relative increase of the lymphocytes or of the polymorphonuclears in the circulation, 

 with absence of parasites in the peripheral blood, spleen or lymph, is always suggestive. A lymphocytosis 

 points to tuberculosis or to a bowel infection by one of the typhoid or allied groups, and a polymorphonuclear 

 cytosis to a local septic infection. A lymphocyte increase is of less value in diagnosing local infections than 

 an increase of the polymorphonuclears, and calls for the diazo reaction, the agglutination and sedimentation 

 tests and the search for tubercles in the choroid with the ophthalmoscope to clear up the issues. Increase of 

 the polymorphonuclears, on the other hand, is distinctive, for it means local septic infection somewhere." 



A long list of what has to be looked for follows, in which one specially notes oral sepsis, sore 

 throat, appendicitis and liver abscess. 



One may add to these notes as the result of the work of Stitt, Vedder, Ashburn and 

 Craig, and to a less extent from personal observation, that a decrease in the 

 polymorphonuclears and a marked increase in the small lymphocytes points to dengue fever, 

 especially if there is an accompanying leucopenia. This will be considered later. A useful 

 paper on the conditions producing eosinopliilia is that by Fearnsides,'' who in a summary 

 states that the condition is usually associated with the presence of Hchistosomum Tiiematohium, 

 Trichmella spiralis, Ankylostoma diiodenale, the various species of Filarial and Echinococcus 

 cysts. It may also occur associated with the presence of any one of the Helminthidx, but is 

 rare in cases infected with Dihothriocephalus latus, and not common in infections with 

 Trichocephalus trichiurus. He further points out that the changes in the leucocytes are to be 

 regarded as due to toxic agents produced by the worms, and in the nature of a reaction for 

 the good of the host. 



Emery,* in his useful clinical work, gives an easy method of recording the differential 

 leucocyte count, which does not seem to be very generally known and certainly saves much 

 time. " The simplest way of noting down the leucocytes," he says, " is to assign letters to 

 each variety, P for polynuclear, E for eosinophile, etc., and to put these down in blocks of 

 five each, thus : — 



P P P L E 



P P L L H 



L P P P P 



P L L P L 



P P P L P" 



In this way you can tell at any time how many leucocytes you have counted. I should 

 think that anyone who has made differential counts in the heat of the Sudan by the ordinary 

 method of headings and columns will appreciate this simplified and rational procedure. 



' Nuttall, Q. H. P., and Qraham-Smith, Q. S. (October, 1906), " Canine Piroplasmosis." Journal of Hygiene, 

 p. 586. 



'^ Nuttall, G. H. F., and Qraham-Smith, Q. S. (April, 1907), " Canine Piroplasmosis." Journal of Hygiene, p. 586. 



■' Roberts, E., " Enteric Fever in India, etc., etc." Loudon, 1906. 



•• Fearnsides, E. G. (March, 1906), " The Effects of Metazoan Parasites on their Hosts." Journal of 

 Economic Biology, p. 41, Vol. I. 



^ Emery, W., " Clinical Bacteriology and Hematology." 2nd Ed. London, 1906. 



