1907.] Fatty Degeneration of the Blood. 433 



The fineness of the fatty points, their varying number in different cells in 

 the same film, and the fact that they occur in abundance in cases where the 

 condition of the patient excludes the possibility of so large an amount of fat 

 being merely ingested from the blood by the circulating leucocytes, all point 

 to this conclusion. Thus in the three cases of acute pneumonia the blood was 

 taken, in one, on the sixth day, two hours after the crisis ; in another, on the 

 fifth or sixth day, before the crisis ; and in the third, five hours after the 

 crisis. Furthermore, the fact that in such an acute disease fatty degeneration 

 actually does occur in the renal epithelium and cardiac muscle proves the 

 ability of the toxins to effect such damage also upon the circulating 

 leucocytes. 



That the degeneration of the leucocytes has occurred in the blood and not 

 in the bone-marrow may be held as almost certain, since had so marked a 

 change taken place whilst the cells were still in the marrow, it is unlikely 

 that they would have entered the vessels ; they would have remained in situ. 

 Upon the actual condition of the bone-marrow we have, with one exception, 

 no observations. 



When, as in myelsemia, the fat occurs likewise in myelocytes in the blood, 

 we should think, similarly, that the change occurred in the cells after they 

 had reached the blood-stream. 



The leucocytes most degenerated probably die, and might by their 

 disintegration furnish a certain amount of free fat in the plasma. 



Not that this is the sole source of the free fat in the blood which was 

 present in some of the cases, for its amount is too great for such an explanation. 

 Most of the free fat must be regarded as derived from the intestine, or as 

 transferred from the common connective tissue to the blood plasma for the 

 use of the more important organs. The fat in some of the leucocytes under 

 these circumstances is doubtless ingested, but the fact that in some of the 

 cases where the fat in the leucocytes was well pronounced no free fat was 

 present in the plasma shows that this cannot be advanced as the sole 

 explanation. 



The presence of fat in some of the myelocytes of the blood film in 

 myelsemia, again, cannot be due to ingestion, since these cells have no 

 phagocytic powers. It might have been thought, a priori, that the presence 

 of fat in the finely granular polymorphonuclear leucocytes would be a sign 

 of grave significance as indicating not only a high degree of toxaemia but an 

 interference with the function of cells, the phagocytic integrity of which is of 

 such importance in the cure of a disease like pneumonia. For the leucocytes 

 so altered must have lost for the time their physiological capacities. They 

 would be much in the same condition as the pus cells in an acute abscess, 



