A- '* A “WHY CF THE LEL‘COCYTIC X. 1 ‘1'}. 2210. LI‘REL ZN BRLCELLOSES Thesis {or the Degree of M. S NHCHEGAN STATE C ‘LL‘CE Mjuri'le R. Munger 1939 STUDY OF T33 LSUCOSYTIC PICTUAE II BRYCELLOSIS CV ‘ T ‘7 ”71 ‘\ _‘) --- " I‘I‘x') - L «.3.le no it {gm A lHflfiSlS Su witted to the Graduate School of Hichifan State Collefe of Arriculture and Applied Science in partial ful— filment of the requirements for the defree of ‘.. "—77“ r SLLQMC ‘J Department of fiact-riolofiy 15:37”? / J THES‘S «(.sfrn ACT I I (j. {LLDGE' ii. i "his Opportunity is taken to acknowledre my 'edness to Dr. I. Forest Eucclcson for I *— his cooperation in rekinfi available c. 1 I 19 material for this studf and to Dr. fiaahacl 1°“ncs for his helpful svffestions. ULL .wfwr ' ’. ‘ a- r. (a 5”? '\ ‘L‘ JUL”; OL‘ 5-1V“ _ 74x. #0) . Lilli" XLC‘OU C‘dlli) PH. ;. giira ELCUL CELLS u‘ . ‘ -. r .- W * 1].; . L/Is_):JL‘:/‘di0“r A STUEY LY fnfi LEUCOCTTIC PIC'URE I? BRUCELLCSIS IZIIOLUCTIUH The die nostic tests so far crployed without the tee of corrobora- tive laboratory findinfs frequently are of liritcd value in the detection of active lwr11cellos is. Because of this fact it has :een advisable to investigate certain abnormalities which accompenr truc11llosi as revealed by leborntorv 'ests. It is no>ed thereby to provide additions. useful die wno tic criteria in the dete tien of this disease. An opportu~itv presented itself recently to stnlf certain asgects of the bleed picture in seventy—six acute brucellosis cases from which igjgaill§:::liwensls was recovered. These yetients were located on is were rede from two to d- H O :3 the island of lalta. its blood examine io1r 1Tee;s after the onset of the disease. All re dllood. cell neesurenents and leucocyte differentials mere made from cover slip smears stei ned 1th Hastinys' stuin. Studies have been nade of the blood picture in brucellosis, but generally these stud'es were not nade on a jroup of patients from whom Erucella orjenisns had leen isole ted. _~ Red Blood Cells here have been many reports in the literature tl1ot lrucellosis . . 1 , x —. , . 13 accompanied by a secondary {l}, (2), (9), (U) from a s ifht to 1 . I ,— 7-., . . , . mooerete anen a Ky). arucellcs1s accompanied my an imperfect coafuletion tire and clot retraction time has been resorted by Calder / , . - . ,1. \ . . (n) and assoc1ates. irecge and nerver (la, 11nd fl1at jaundice may ‘ accompany brueellcsis caused by enlarged lynnn modes which occlude A. the common duct. INN Mle I rer res ents the findings from jPZ cases. These cases revealed that there is a marked variation from the normal in the size of the red blood cells of the brucellosis patient. Calder r (6) has re ported fiequen t instances or nacrocvtic,n hjperchroric tvpe of anemia thile Iis lonne and Janbon (7) cons1der a constant and extrerelr 1tr -ed anemia an habitual S"npton1i:1 certa ain classic descriptions of the disease. Decrease in hencrlobin and red cells are observed i: izli~nan , prolonged and tenacious ferns of undulant fever and in ferns producing hexorrhage but in the usual cases the number of red cells 'enain at about )1, (‘fi‘O ,0’0 per cubic rillireter. lEerd " (h) er d essociat es report that a secondary a11enia usuallv occurred with the heuoglotin and red blood cells both reduced, the amounts of decrease dependine Cirectlv on the severitv and duration of the disease. In the eresent investi re1gion it gas .L revealed in the first thir1;y-t”o cases studied t1a t ’3 1er cent ’ ./ of the patients had an inc rea.sed HUMJCF of red cells 1miich were swaller than norwal and in l? per cent there was a tendency of the cells to be lar"er than normal. The average red blood cell yeasure- went formula was of a 3?: 56:25 ratio instead of the )5: 5h:53 ratio -‘ '). r‘he red wlcod cells of some patients varied in size from three /"N I ‘U to ten ricrons, although the normal varia sion is from six to ten microns. This variation in size is pr M11r e fected b? an accompany- ing splenic and liver pathologr. I.-. {hite Blood Cells 0-.- -* -N There are scattered reports in the literature to the effect that brucellosis is characterized by a leucopenia with a relative lympho- cvtosis (1), (2), or a nenocytosis (3), (h). The determinations of _, —D— the total leuCOC'te counts are for the most part in accord with MLOSe of previous authors. The white blood cell count on the average is lower thann O‘mal1ith a relative and absol11te mon00"tosis. (Tables I, II, III and Chart I). In a leucopenia the lvnphocvtosis at tires is only relative union is made apparent bv the reduction of “r“nuloe" mes, (See Case to. 57, Table II). There is a quantitative increase in the non—f ilamented neutropb ile s. U.fortunate1v rzanv 01 the nor 1-filamented as well as tLe filamented polyxorphonuclear neutrophiles contain "toxic" ranules, that is, there is a basophilic granulation of the neutrophiles. The theory of the leucocvtic response in brucellosis is well demonstrated and explained by haden (9). Our case So. 25 exemplifies his theory. The leucopenia is undoubtedly due to selective toxic effects of the Brucella nelitensis or anisn which prevents normal cell naturation in ”u.».- .n --—. u.-- —1 the bone marrow of the neutrophiles. Such cells as released Show 3 evidence C1 anage bv tn presence of his ophilic granulation in the To a . ’q 4. ‘ . ‘P o o a H H '- ~’An cvtOplssr. naden (j) believes that s;ese neutroohiles CORtfllany 1o-1c ~J granules are of little value in their normal function of defense. 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IIL -, ll 14 ATnllévil. :10: 4.1 - Tll‘i‘nllnllntl. +m . o w o m w W :H mH NH mm o o " ogc.4 mw . . * m . w _ “ Lr » - H .r r lull < \ IIYOIlln'- In! .VQI- l IH l . l d! .JHI’IVV ‘ J.\ IIJ . +N 9 H H w c cm H cw mH mm H o o “ 05H.g :u N u . . v H H w M . .H 91...... .1... H . . 4, - , tn..1lx+ol.-..\l..1ul filalliw ‘ .-.,z. > I . +m H w m m ” HH mm mm a _ Na 0 c H 00¢.u m, _ . . . w m . _ _ . . . . ll, - 0| '1.in Old- w 'II. I q H . .. JJ 11 J I n on N L “H. +0 , H . o n m “ D a bH _. cm 40 :H . c o " 00Lq ._ mo . o a , w N _ w _ _ _. W [1 Ir [ . w . H L y .I it . . .c J 4 x 11 .--..il. l1 4f. ....| 1 . u - +m * H . o a _ m . NH mm NH _ mm H o o H ogH.c Hw _ w H . _ M a — H . * _ . LI H u u t. _ l 1:...” {:1 41 -..-.4. to 4. .3 H: H, Fl u-l»134\xeLrltIW.c . +H ._ H a C ._ N H in 5H CH n 0C _ L H H L 0 L Ox “ m _ . M W m I o -, Hi 2.1.2. . J I if? ...a! ,4 I N 1 4 l 1.9. .uon 1%-... $1!.1¥.fl..-+.¢.ol $3.14-.. (Ape ..0; ..U: m >6er « rm 0 , p. .H L I? erH o I .mfiHEI ILAW1¢ r mO,. ... L U . 0:. w N HHHHgmmHHHHa omwo ophooflmprmH HHm....H.w LnHm WOHHHH “$14.0: for». mam-.1. .HU ...-.OHQCH ,WHHUcHE .HO 0.0%....00 I + 0P..HOO.rMHw-M.;L.r.-H @FthaH \rH1H mHHS szmu mng Ho COHLMHSfldLa OHHHJnondH u me mHHAQOLuzmc LdOHoafioJmLoflhHom copcmfidHHh 1 nu : )4 "J L. Q\ ’2 r r'i 14 ll 31 P) (D H :-1 ._4 r‘1 I- 4 .._.,-..o.-H-: mm La mHos-Lorm .Hon..-HoH. Hum-Lam. -cHH.HIH._-.oq -..!” Hr.>n 11 wophoommth mszwA m.LsA u WHHH mHHCQOmwn n 7 HHmo meomHopc mofi mSoHpoonH u LH oHmeoLHmou 1 .mo. ophoomog u on #5500 voon mwflflfi u .o.n.; mHOLfihm ow Amg * I’ll. '1. '-."I‘-'ull-'.l- III. ...-1.1.- II.-"I.A‘O ".‘J-'1I"v’ 1'. 31-.....I- -.. I'.‘I§II‘1"‘-‘ 0'. --.- "lu'---.ll|.--ll.l""-l. 1' 0" 0|- 'I..Ial-- I---‘ I'-‘ ‘I-!'-I o 1.0 o- \o. o. _ 0.1 o \\\c _ ......x. ) 4.4\ H ...-N 0 H M Q flw . fl-IL «IN m Mm \L * my... I H M O Nun“ H 0. ON“ * H MJ ” | WN * mop ...:l... “ main Q0) Ck? _ . L L . H L . ~ H . . . . . . . . P . . . . . . 1"'.1.4 '1' - '. '- - .1 - '1’ '4'1'- ' .I .A.-. 'I“- 't- ' ' ' -. ‘ 'u' -. ' I.L - ’. ' - I. I - . ‘1. +u'lll- -.q 4'1- I1 ‘I . -.t'11t'.'l'll.. ' - 'u ....... uwdeLQ-Lcfi J +H . . c NH pm H OH H mm o . m . . ii",'l-1 '. ‘10 '\- '1’! ' V' ”-,.n ' - C J. . L :10 . . w M m w . . a N H . . H . . In- -.-. I'm. 0‘0. '0. -..-”.4-“ -.vl‘! r- ..l.0 \I’...‘ .II '1‘ '. A? "IIOIu-..'.I.1. 5.1.0...- '- L. "t- Ov-"Imtav- .0- ’1’.1.|'l.1'.- .1... 'I‘l. ' 0...-.. '1... '0... .].;i . . . a w w m . I .-.—o- — o- L-“‘-H—.— -4 us... o—c .— 4. _\.. \ vJ 1. . u “a: . +H H n m m m «H aw H .o “ aH . o M H “ LLL H“ Hm . . _ M . . _ .. n m _ H u u . n . . _ . .I-‘ 3"1’,’ ,9- ’1--’:’-' - ' -M- ’- I -1'31%-" .I .... 'H'I. -.- - I .r'.". '1 - .. ’n. 'u‘ .L‘ " 'I-..l.. +- ..l...'.l- t’lr'l'.“ ’Fv"! - 01"...‘1 '1‘! "1I-. \zqqlr'i l u . . . x . +m . o H o u a L L mH . wm . H“ . mm _ o . H H One N" ow ~ . . v w . . a H H . . + . . . . n . . . . . . _ p L L L n . . . . . II! o b. 14 .4 \J 1* \‘nlull 1” .1 I J \1 ”>41 1‘111.‘ 411 _, I, h J 1 \ 11L " +m m H a m L 0 u w v C ” >4 . mm H Ur m 0 , O H Lap 0. 00 H w M u _ H L . ~ . . . . . a . a . w . . H m . . _ .- 11.1-.. 11 . .- - _ -..-1 L 1.1.11...- 1 ..a 1. - L - . .... 1 1-141131111331-11 1.11.1 m HAUL-cm H Luca..- ” H-H w :H H w -L- n o: a Ler 1”» t L L 1-,,- “ mi..- .r rm H ..uOHLL ... L, L.- ..L n 0:- .-....-0-111. 11.11 14"-uc1-u.«1.1.rq..to.v .......... 1 unit-:coo .. 11. I 1 21111111 -r 1%: *- r 1 n 1 .2 L :1- numb-.1 -. 1-- I ..-.1111..--.1111 Vtwmhox meLH3100 HM oHHda IMHI " OTTIIl A. A ‘. 1-0 .1. '4 09110313 with 1 x i 1 1‘1- .L 1n Leucocytes Covnarison of -1 1 w ...-1J- . L 1-.- _ 2-1.” M m1 . H M n w H W M w nW-U. - a o . m w 2/. . n:— 5.” 5" 1L . O. . r _ . 11. ;. . w .1: 7: . . w c v 1-. .0 O. O. ‘- 0.. O. O ~m. r C O.“ m: J” AIM/NJ. 1-1+ nCw mvm . . C r, «I . .qux .2 p... . m . m “ fl 1.. l. L L. . . 111-. 11 . .. M lit-4.1 . 111 .I-I-tf1.1lf.11 . .- .1 . 9.1.1 1. M: L 9 m L a 4- ,“ L r, . mm . w u N . u _ L .M._ Mm * n/ 9.. \- . 7 ~ .- L.“ . I“ )L. (V 3. rU h? /Q~ 1‘ fl %9 u .1” n; w?" m9. 13 W1 2: O: . I. x . n ”I“. K. B. 6.49% 1-. Tu. W n L m M u M M H w ..L . _, . m w . . L H4 g .. .. . tom-1.0.1.1110...- I. 1+--- . — . _ W4 ”‘ H . w o g — . u * H “ ~ . H . n M m . 49. .. . . _ . a L m . . 09 L nu ” rq/. n99. an.” nuuL nu . .L»/. 14. “ C H o o. o o. ... o" o. o. 1; n9 ,0 0x fl? n9. 1H“ AL" . r “ xo- . n;- F: . L . u . u _ H . . T- ...M. --.-9-.-. H - --.-1m - -J . . _ L . . N _ m L m . TL n9 L 09 1 01 mi 0: m9 0; fl: .- . ~ ‘0 L 0:. 1u+ 9-9. C _ 14..-. fl}. . /U ..rL . 20.. n w L / .M m.“ 3" L ..... . ...-.... . . 11.. . ” F. u _ _ L“ L m a . L H .-.-141+ .- m u 4. _ .-. ...- 4. . a . l _ ~ 1 fl “ 3 . u r « r .. M a 1 . Hi. 1 w L w- ... —. LL 8 . .--. P 1 1 , 0 R C ”Hut.“ D.- .. _l~ H c L“ S .T-Ar m... 1.1 1 - - - L1-.. - -..-..- - .. -.- I - 1. - .1; Chart I. * ACCOfipanies CHART I .1h. The results of the author's investifistion of the eosinophile and basophile values are in accord with those of Lerdv (L) in that they did not show any esser tial cLenfe from.the normal. beldridee (10) and his associates leve deseril led and illustrated the tvpe of taco- phile observed in these cases. This cell is larrer, and the franules are more nunereus than those of the ordinary besop}:ile. Since there seen.to be vs rv1n~ opinions referCinf the steinin: aff'nit ies of the prol'irmoc*te and raters lvmphoc"te cytoplasm (6), (ll), (12) it has t:een found advisable to rely on the nuclee structure for the *“rorve of eeten mi inc ‘he see of lymptocrtes. I? there was I ' ‘ evidence of nucleoli, and Lne cell'wes larger than normal with an eounoanee of shoeilasm but not too besophilic, 3he cell *.ss classifies as a normal lerje l'rrqoevto. It was found, according to the 1eta.1n Chart I, that the "reetest increase ooth _uentitativelf and qualitatively took place in the case of tiese cells. “n actual qualitative decrease from toe normal was found in the case of the small lymphocvtes. Atout 10 per cent of the patients studied revealed the presence of plasma cells. Since the presence of there cells usually indicates a disturbs new of ltmph elands, t} 1ei.r 9‘1eere ce provides further evidence of the lfmphoc“to enic effect of EZIEZEEa infection. Clinicians enc hematolOfiists are qlJite‘."ell£ “re d in considerinfi a .1re'oneerexce of lymphocytes in trucellosis, men? of wnicn are forms not commonly seen in the blood 01 normal incivicnels (L), (5}. One interestinf noint encountered in.ifl is Lgestiretion which has not been not ed before in the literature, is that many of true nature smell lj7rplr1o- oftes are much larger than normal. This cell is similar to a t*pe of 1 ___-_-._._..__.._—_..___ '_'_‘_‘.__ '__.-_’._..Il_ '_ ...- 1.! .- . ‘ . ,,, T}. , .‘r . ‘1‘. f ulOUS rowcrnc13051s l'r11oc7te. In SJHC.&MLHCFS tgese nave I ‘r :3 r' ‘ ' i ‘ wv‘:' ‘ " " - 7‘. v . ~ ‘1‘ ' 'bee; 'ter.£3- L;~,Iolc> ic l.c1‘1(xr es"arw1 celecrs :rnma HETWNI olmrn H - H ,1- , , I- 1 1.. , ...‘ , , , laree no vre lvm hOC’LeS . lLHSC cells rare all uhC a.»erence l ._ ,. ~ _ _“ - f. _.:. .I. Z A - .. 7‘ J 1’ ‘ ‘I ~ ' ‘ .1- - . _: r“ Cl 3.;{1l1 1-7510": 2,83, big rf‘ttlo Cl .Vhe m_.cl(21,_s to Cfooniz’LSXl 061..“ nuclxnrs afijumyi to tma of a nmnfla nCMOffrnmns strucinune :Len cumiinarilg' seen in re ure 1ffibhecytes but tLe“e was no e idence oi nucleoli. -' ‘ '4»"‘ v1 'J' ~ ‘v‘ ~r‘ “ ‘J‘ P’ :‘ ‘u '. O .‘W . T" ' :1sse le1_1;.;asnre l 7.,hoc 4 e.s are e 111V 1; to 31,3:1c10ns 111<3u1.eter. The nornal small 1frghocftes usually measure from 8 to 10 nicrons in " - - ‘ fl~ \ P‘ f, \ x '- J- Wfl‘ 7-1— ~- Iniavwate1‘. 11“ I uraf €13 ,, t 10 1161' cr31 o: 1.51 1‘ 1%10C* yes: a u>esufe<1 ..- 1 '- ‘, .J- "' 1- .- 1- 1,. ' .1..°- as this t'Le 01 cell in 1 09b )C per cent 01 1-0 gztce11031s aulOULS s‘t‘1r;1~3(_.. Other cytolOfical similarities to the infectious nlnonucleosis cells were otserved. A lfmnm ocvte Wit} an indented nucleus mes ice as an inrections m nonucleosis type of cell. l‘e tatulated date. in ’La‘nl, I 32:1 an. averame of 1.135 1:70phocytes with indentee nnclei'which corres on“ t file in eccions ronooxwol osis cells . ~ ~ '1 a - ~ - _ o of Twn1e I]. Lrfinnocvees were 0‘? :erved snowin“ con1ensation 01 Dr L L _. he I O ‘ ‘ V I l . ‘! a Q- 1 ’5 V . chromaticn in tre nucleus. Lris C"Ue 0: cell rice up snout no yer o A u. cent of “Le circrlatinf 1?“ectiors nononucleosis cells. A feed illust :1pion or the latter cell has been demonstrated by fialdridfe f‘\ H O \J ’23 ' 4 y.) :3 L) C) O O H. r: (..- 0 C0 0 O O . x . _ ,_ - . -.. 1. , Lsrood (19) chereciserizes nice i us mononucle031s by one '1-w00r; ‘ a I‘ lwn'mx’: .n-r—p ‘ 'l‘-.' van lap-n fowywr-“rc: 3. O", [ wpcw‘r'32‘1M 'fo )4; \l n) v.1. \J O; -.- .'-LCU' UVS I..L'J-_ AJxl -1 v 1%). V‘A Ix) kl L‘. J.‘ --. XL .1 ’4. x.‘ .LLLL‘ J ‘ -'__.r‘ ‘-, . 2...- ,,. L ._..1- J- u, 1.x -v 'Iaole II fenes 1, 21,1 11 1:1 o.,;11_2r'..1se I101“_‘.E‘.1 lj-‘rr1_-.:ocjroes were o.,ser¢ed. (1" The siénificance of tie nuclear ‘enes reimel lymnhocytes is yet to be cetennined. akin (It) by suocrvioal stainini has found, in cases 0 trucellosis, an increase in the type of nonocyte which is similar norphologically to the type of monocytes associated with various forms of hepatic involvemen (ll). ”hese avg“ to be similar to the atwpical m.nocytes found in catarrhal ianndice. (lb). In disease assoc1iate d with liver pathOIOSy, cell averajing 15 by 13 microns, witn an oval nucleus, 'ather dense chromat in (11!‘1 d in character), foamy blue—staining cytoplasm (nonocytoid), but'with absence of the minute, red stainine granules of the nonocyte. There is no perinuclear cl ar zone, as in the lymphocyte. Occasional inclusion granules are found in the crtoplas . The marfin is wavy. ihe "liver daxafe cell" rore recentlv na.ned "liver endothial cell” of Is e.a cs was .resent consis wntl" in ne arl" all cu' the cases of erestinfi point that has seen note ed ane previously Let in rucoiln r"elmei is infection —-. o v-(' _‘ r l_‘ 1/3 a I ‘ _ _ —-.‘n I: I ~V- a ..- l. ': A 0 there is a snihed Lasopnilia of the gianules oI the neLtloghiles. In tiis couner brucellosis patients navine t} ;e ielitensis tyne of infection have beun encountered ".nose neutroohiles aid not posseks the basophilic franulation. These :re nul.s are sirilar in size the Frucelle tacteriu and stain similarly. It is surfGSIe ed that a A control slain swear alwavs be raee without siie bacteria when a phafocytosis test is perforred. A toluidin blue stairire technique -- 1" nvx 2‘ ("$va ~(3‘u Tr 9' 17“ I :1 \c J' ‘ +<"~‘3 o4— : ~;y\ ‘ fa“ y-L‘rx ,. 17" a: (V C“ ,- 12.8. “e'_/ A -1::. ... QC U~’C. I. ....L' («C‘ (3 OCT]. ... OI J‘L‘I U 318.-L1’1..__- ()._ .)1_\‘:. OC"' '10s)..- I.) n).;’1\:78.rs Cl) .--—--..- do not tskc the tolu1dln blvc ”tail. 5.11531 .581 CI? There fins crest (1-110U1F" in cla_siff1nf the Because cl th fact that all ‘radaticqs frc" 'nc s cvfie to tLa "liver Chdo+hlwl cell" and the varicvs 1" nucleosis cells re :rcsent. J 4‘) 0. _~‘ J-." ldeJ I" O abnormal cell hlcod of Mrtccllos ' °' " beliovad thn* i a c funcblcn, lowevcx, 13 o . s v c Prcdrcec to ccrkat an? 3‘901110 condW"1 I found Ill" in r'W‘ ., ' J- ‘ _ 1. ,fi .. _, ‘ 13- '2' '- / ,." ,,2,, «-_. ' ... ‘ .:.1. , lac “T1 er cocs n0c -Hrce J1.“ lurk \lJ)I»nO IClleGS bud 11* .02 1 "00- 1')" "‘0“ '1‘ _) 1 l 9 0‘7"‘: 1‘1 l‘ 7‘\1‘:‘ :, ll. 0‘)..qlqo t; “J\/-L ‘J... Ll 00L UUI D8._5- UO roi/ #08 rhicL a c noL avoilalle for +hc ‘1006 because oi tcfiporrrv exlm 01 the Fons narICW'.1t present the "“fllelC cau e for e entrazcc cf al“ormsl l" DLOC" ,s lnto chc hljoc stream or decrees i“ 1“c nur‘cl of Cl"CUlatiN‘ nevtrochilss i l ' .3 ' , \\ J, ', ’I - . nos known. It is (cle1Lcl" 'now“ \lb/ c29. some 01 t%a I U '_ _o 'I“ V": r‘,‘ v‘ I 0 lrnf‘ccvtns or1~1nacc in -hs l'chvlflSth , I. '. ~ g C h C‘lcr.‘4 w-vo r~ 3‘. " .‘h o n awro u n 71 '0 w "x a D v Y‘. A. 1 O L. L.LJ AOU C’ Kit.) ~41 V ( O-‘- 1 (JA é L k)‘ OJ- C.“- q_ ‘ o “ -,_t a [71-:‘ I ‘ -I': .L‘ cruccllcs:s s‘qclcc. luls is an accovr'ficc wlss 5:“ n'mj nnfl- :r "Jar! ) "fi1‘\‘\ r“!— 7 :HI" . infl‘l‘l I) ~1.( lj(/C.L ‘uvoo i1“, LL54 .'L‘_ L’LUC(I (llAva 111 if). .i e .., J . , _ - .. -- ° , 1 DlU'.OI‘ o; : CHLUC ’uOS .25 I_Oq rcn1clxr 1.x:rcx1sc * 0*r3r and sis w} Oy‘(’(/"UOSin .' {AT tin/11 t Cbnormcl cells 11‘.“ J...‘ l 1 r . I; 8. '_.”(‘5~l l “‘2 f" 2.. U. .. o ".f 8 these cells are not ".931 C(Ifirtes v". :4 . J J, U- E7 Book 8 I“ O "r“ W. (1:3) :2 CC ”1‘1" Lnn 7 .». .338. I I - J. write 1‘ '13 -15" \J n br1.ce]los 0 al. “18 mlcrr.al J she o 13 Iazr_nl 4- Ci. u a \ Ha brucellosis. S austion ‘ Lv a $ J- .r 1 " , .P J- ‘- r. ‘ . .. l '1 '._ ' ll :93 ionnm in tfifi SUIT] oi lyncelli LCllVCUSI ...--.. -- — ‘— . «- I I q “ " Iv~ '1 *a ‘l ;_ ‘ 1 ‘ _O .-. 4.-.}- lLClVthSLS Cut; “he bloom ingUIG rexeals a leucctenia lluh a .2- . ".1- : L) 2-0I10C lb SL3. lke red blcli wells tend to be slivhtly smaller than mortal; maul- ,,- -' .1- ,. ? -"; 4“ l . ..'_ ' :mnxrzer, SObo natiends )awe ewimehco oi KflCFOCYLOSlS. I2 .1, - ~ f- ~27. {"1 ,q ..'- V F .1- ..n-l- . 1L9?9‘JQS an incrgase Ol “go non-ii auenued reap? {L1 as over the normal value. U .l, ‘ H -,. f _ ~ , . ‘_ ' _ ‘_. 3 ~_~‘_ " ° ., ' 5“ ' lhe grogegce 01 an 9010510 léngnoc yes 13 Au Jer cent of tie brucellosis ca3qs is siflnificent. "Liver endothial cells" Finally varvinf do “e;s of "basonhilic granulation of the A. neu“rophiles was Young in all cases of brucellosis studied. "“s -1 -4,- l .31 \‘ 1‘)u‘l‘." "\ ie. .54. 4.JA~L‘A-\J.—J l. Lracke, Roy k., and H. E. larver. Diseases of the blood ll.) 1- (D ‘ t :3 Li O [._.I O and Atlas C“ ,Fhilafielphie, J. E. Lipdin- cott 00., p. la. Ibid. p. 127 1b. lbid. n. 130 2. PBDPOP, C. V and Levii L. Parley. Practical Iewetolosical Digewosis, P¢11._ ~‘lv 'r " -‘ - ‘, A (“.1 —\ 1.13.} lOl l". 1,01. 1, PL). //“_,I-;“/"\/). 1’.’/‘l.. ~ - 1 / a ’ / 11a. IUlQ. p. 019-910 f‘ ‘ .'_' , . ‘: '— Iv ‘, A ‘r' -.-'-r‘ » 0 ~13 ‘1- — u o . o -, ;—’ . 7,1,7 a. hlseflan, L. L. coucnsl oi ongor1;encal Leoiclne, J4. “,1, fi "1’ .- ~~ \ -' . ~ 2 7 ‘ ~ ' "4 ‘. _y 'w‘ P _- ._. T“ 0" _' *_ l) . US'OO(1, JJC‘IIlT/l J.IJ. lJI‘C.‘C 08(ll-1 S Oi L‘ilc U00 -1. {Zulu} for .";-’CPGI’1..‘.CJ&J31 -' -‘ " 1: '7. --. r F; r- ’\ gr- nioleV at: .eolCige, )2, y). Llo-ela. 13/ . .. ll. "shin, r.3. Studies c! Livinfi Fumen Blood C (D }_s H 0) P a? {2. H O c I 5... o ..3 T _ 1". ‘N 0 7“ ‘ :‘l_ ‘r'l‘ "r7 ' 7' uohns :oykins Mosulbal Jn: L/7. lygh. :hael. fic‘sonol communication. Q N 1n. Turk, h.l. beotische Erxrankun en oei Verkumnerunf Ces Grunulozrtensysters, Lien. 31in. hchnschr. EC: 1Q7 1907. 17. RosentLal, Lethan and hurolo A. Abel. Ene 5i~nific nce of the Tenocrtes in A*ranulocytosis 'Leuhouenic Inlectious LOTIOCI'Z'DOSlS). farierican Journal of Clinical PathOlOff, Vol. 6, LO. 5, on. CUE-230. 1?}6. .- l 13. Bock, H. E., and I. Biode. Ueber Agranulozytose Aleukie, neerozrtotoxicosen, Celia 19. lanter, Iyrtle and 1. Forest fiuddleson. A Preliminary -eport of . -\_ r“! Llood Picture in Erucellosis. lhe Journal of Laboratory and -. . . - . . .‘7 ,31 -- ,' ,_ ' ,. ...,, LllfllCQI .ediCJne, :01. L3, 10. 6, pp. 91/-ulg, 1);}, mm USE ONLX. ,0! . ~v’U .5 Apr2£ ’2- . \l . . .1. fig}! “z’ri‘. 553;: . . . .. . . ...; ..xII.. . . ‘92...." ......3’..... ...: ._-, fr’l',.' - . ‘53: . 3. ...-g...” m, ,u4l‘d uijfi'J-Qfl" »¥~,‘_ ‘2’ . I“ ‘ ”A ;"'¥‘H ‘3. ' " ‘ I. ‘a v' _ 2.35 ‘. ‘ ' ‘ , ' I u . . ‘4 i ANT '1? . {It '4 {31% ,f» H.111}. “(grfic‘é ’. ‘ZK ‘3 . V .4 ! Q ,fo -'. . ._I .. in ‘3‘; i "U c .I V % .9 D ' - o H» .\ _ c'. '. vi 1 . .. . 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