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
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
3. Frequently the red corpuscles increase as
the disease gets better.
4. In the majority of cases of phthisis there
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
It has also been noted that the leucocytes
in some cases were found to increase on improvement,
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 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
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