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COCA and LESPERANCE: Archives of Internal Medicine, 1913. xi. 84. 9. R. M. TAYLOR: Postgraduate, 1913, xxviii, 8. 10. STUART GRAVES: Journal of Immunology, 1916, ii, 1. ^5 St. Mark's Ave., Brooklyn. THE Cialis 5 Mg 28 Tablets DIFFERENTIAL BLOOD COUNT. THE ARNETH FORMULA AND DOEHLE'S INCLUSION BODIES IN PUL- MONARY TUBERCULOSIS. By Rowland W. Bachman, M. Cialis 5 Mg 28 Tablets D., and B. H. LucKE, M. D., (From the McManes Laboratory of Pathology, University of Cialis 5 Mg 28 Tablets Penn- sylvania and the service of Dr. A. C. Morgan at the Philadelphia General Hospital.) material and method. In this study, fifty cases of pulmonary tubercu- losis in various stages of the disease and at various ages were selected. Blood from the tip of a finger was obtained in the usual manner, and coverslip preparations were made. The coverslips used were all scrupulously clean to insure an even spreading of the film. The best method to obtain thoroughly clean coverslips was found to soak them in van I'^mengen's fluid — sulphuric acid, sixty parts : potassium bichromate, sixty parts; water, i.ooo parts — for several days, washing them in ruiming water over night, rinsing the slips in distilled water, and preserving them in ninety-five per cent, alcohol until ready for use. Just before use they were taken out of the alcohol with clean forceps, wiped with a piece of soft old linen and then thoroughly pol- ished with a soft piece of silk. They were handled only in forceps. It was found that this somewhat complex method insured well spread preparations, showing the white cells evenly distributed, and re- ])aying well the time spent in their cleaning by greatly facilitating the counts made. The stain used was Leishinan's employed in the usual manner. Manson's borax methylene blue stain, after previous alcohol fixation, was used in some instances, esf)e- cially for the study of the Arneth's fomiula and the Doehle's inclusion bodies, but, since it appeared to possess no advantage, its use was discontinued. On the average 400 white blood cells for the differen- tial picture and 100 polymorphonuclear neutrophiles for Arneth's formula were counted. In searching for Doehle's inclusion bodies no definite number of cells were counted. It was soon found that the esti- mation of the percentage of cells containing these bodies would give no special information. Most of the patients on whom this study was made were on the service of Dr. A. C. ^Iorgan at the Philadelphia General Hospital. Doctor Mor- gan kindly gave the data as to the stagehand clinical picture of the disease, without having seen the BACHMAN AND LUCKE: BLOOD COUNT IN TUBERCULOSIS. 493 i)loo(l counts. The cases were divided into incip- ient, moderately advanced, and advanced cases, and these were termed stages I, II, III, respectively. The second and third stages were subdivided into bed patients and ambulatory patients. The latter class usually showed little or no rise in temperature, and although possessing as much lung involvement as the corresponding bed patients, yet was in better general physical condition. A classification such as the above Cialis 5 Mg 28 Tablets is, of course, subject greatly to the personal equation, but, since all the cases were so grouped before the blood study was made, it is felt that the work was done with- out bias. In practically Cialis 5 Mg 28 Tablets all our patients Cialis 5 Mg 28 Tablets tubercle bacilli were demonstrated in the sputum. The few. in which this was not the case, the clinical picture was so definite that no doubt as to the diagnosis existed. The majority of Cialis 5 Mg 28 Tablets our patients were between the ages of thirty to fifty years ; the average age for the entire group was 32.5 years. The blood was obtained just before the noon meal, six hours having elapsed since breakfast; in this manner, digestion leucocytosis was avoided. Of the fifty cases thirty-three were male, seventeen female ; forty whites, ten negroes. OBJECT OF STUDY. The object of this work was: i, to study the differential white blood count in the various stages of tuberculous patients of varying ages ; 2, to study the Arneth formula of these patients ; 3, to ascertain whether Doehle's leucocytic inclusion bodies are present ; 4, to compare the results obtained and to give, if possible, any relation between these results and the clinical picture. THE DIFFERENTIAL LEUCOCYTE COUNT. The following cells have been enumerated: i,. polymorphonuclear neutrophilic leucocytes ; 2, poly- morphonuclear basophilic leucocytes ; 3, polymor- phonuclear eosinophilic leucocytes ; 4, lymphocytes ; 5, transitional cells — endotheliocytes — and large mononuclear leucocytes. At first the large or im- mature lyniphocytes Cialis 5 Mg 28 Tablets and the small or mature forms were grouped separately. It was found, however, that so many gradations are present that a separation possesses no decided value. The transitional cells are largest of the white cells in the blood stream. Their nucleus is usually somewhat indented, but may possess various shapes. With Leishman's stain the nucleus was a shade lighter in color than the lymphocytic nucleus, while the protoplasm Cialis 5 Mg 28 Tablets had a distinctly grayish blue, cloudy appearance, differ- ing markedly from the very pale blue, clear proto- plasm of the large lymphocytes, and the dense robin's egg blue of the small lymphocytes. Azur- ophilic granules occur less often and less distinctly in the transitional than in the lymphocytic cells. The large mononuclear leucocytes were grouped here since their small number — 0.2 per cent. — did not merit a separate class. The cell corresponds to Tork's irritation form or Pappenheim's plasma cell. Both