10 



ASHBUUN AND CRAIG. 



haemoglobin is reduced proportionately, and he also states that leucopenia 

 obtains. He had not made differential counts of white cells. We were 

 disappointed in not having apparatus for making blood counts and 

 were forced to content ourselves with examinations of fresh and stained 

 films. Prom such examinations we judge that the red cells are not 

 deformed, that they stain normally, and that the differential white cell 

 count is probably not of much assistance in diagnosis. There is appar- 

 ently a well-marked leucopenia. 



The number of cases examined by us is too small to enable us to 

 draw any general conclusion as to the value of differential counts in 

 the prognosis, but if they indicate anything, it is that they have such 

 value. 



It will be noticed that Case 4, discharged recovered, and Case 5, 

 suffering from a third attack and apparently not very sick, both had low 

 polymorphonuclear and high lymphocyte counts ; while Cases 1 and 2, 

 both ending fatally, and 3 and 6, both serious, if not fatal, did not show 

 either. So far, then, as a general deduction might be drawn from the 

 consideration of differential counts on six cases, it would appear that 

 a relative decrease of polymorphonuclear and increase of mononuclear 

 cells, particularly of lymphocytes, constitute a favorable prognostic omen. 

 We were unable to recognize parasites in either fresh or stained specimens 

 of blood, except one body in a fresh film from Case 6. The body was 

 intracellular, amoeboid, unpigmented and about 1/x in diameter. We 

 believed it to be a young tertian jDarasite. (Malaria is common in the 

 district. ) 



The following table shows the results of our differential counts. They 

 are all made on blood drawn August 2, and in each case at least 400 

 white cells were counted. 



Table I. — Differential blood count* in tsutsugamushi disease. 



Small lymphocytes 



Large lymphocytes 



Polymorphonuclears 



Transitional and large mononuclears.. 

 Eosinophiles 



In spotted fever, as in tsutsugamiisTii disease, the blood condition has 

 not been studied sufficiently to permit the drawing of general deductions. 

 Wilson and Chowning and Anderson agreed that the red cell counts 

 were reduced about 20 per cent; the haemoglobin somewhat more; while 

 the leucocytes were increased. In one fatal case, in a pregnant woman, 

 Ashburn found a leucocyte count of 15,600. Not enough differential 



