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#Clinical Features.# In pharyngeal diphtheria, on the first or second day of the disease, redness and swelling of the mucous membrane of the pharynx, tonsils, and palate are well marked, and small, circular greenish or grey patches of false membrane, composed of necrosed epithelium, fibrin, leucocytes, and red blood corpuscles, begin to appear.
Capillary loops grow into the coagulum, and migrated leucocytes from the adjacent blood vessels destroy the red corpuscles, and are in turn disposed of by the developing fibroblasts, which by their growth and proliferation fill up the gap with young connective tissue. It will be evident that this process only differs from healing by primary union in the amount of blood-clot that is present.
On removing the packing on the fifth or sixth day, the surface is found to be covered with minute, red, papillary granulations, which are beginning to fill up the cavity. At the edges the epithelium has proliferated and is covering over the newly formed granulation tissue. As lymph and leucocytes escape from the exposed surface there is a certain amount of serous or sero-purulent discharge.
When this has happened, in the language of the old surgeon-philosophers, "suppuration is established," and the patient is saved. Or if, as often happens, an antitoxin is formed, which protects the whole body, this is largely built out of substances set free from the bodies of slain leucocytes.
In interpreting the "blood count," it is to be kept in mind that a physiological leucocytosis occurs within three or four hours of taking a meal, especially one rich in proteins, from 1500 to 2000 being added to the normal number. In this digestion leucocytosis the increase is chiefly in the polynuclear neutrophile leucocytes.
Borne in countless numbers in its ever-ebbing and returning streams are little disks, flattened, bi-concave, not larger in man than one-three-thousandth of an inch in diameter, called red corpuscles, whose part it is to carry from the lungs to the tissues pure oxygen, without which the fire called life cannot be sustained, and back from the tissues to the lungs carbonic acid, one of the products of that fire; and larger, yet marvelously small, bodies called leucocytes or white corpuscles, whose precise origin and use to this day, in spite of all the labor that has been spent upon their study, remain unknown.
To see the micro-organism move, evolve and revolve in the midst of normal cells, uncoil and undulate in the fluids which they inhabit, to see them play hide and seek with the blood corpuscles and clumps of fibrin, turn, twist, and rotate as if in a cage, to see these deadly little trypanosomes moving back and forth in every direction displaying their delicate undulating membranes and shoving aside the blood cells that are in their way while by their side the leucocytes, or white corpuscles, lazily extend or retract their pseudopods of protoplasm.
It results in an increase in the reactive changes around the tuberculous focus, an increase in the immigration of leucocytes, and infiltration with the lymphocytes.
In estimating the clinical importance of a leucocytosis, it is not sufficient merely to count the aggregate number of leucocytes present. A differential count must be made to determine which variety of cells is in excess.
#Leucocytosis.# Most bacterial diseases, as well as certain other pathological conditions, are associated with an increase in the number of leucocytes in the blood throughout the circulatory system. This condition of the blood, which is known as leucocytosis, is believed to be due to an excessive output and rapid formation of leucocytes by the bone marrow, and it probably has as its object the arrest and destruction of the invading organisms or toxins. To increase the resisting power of the system to pathogenic organisms, an artificial leucocytosis may be induced by subcutaneous injection of a solution of nucleinate of soda (16
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