Abstract

Since Dbhle's first article on Leukocytic Inclusions in Scarlet Fever, a number of workers have investigated the occurrence, significance, and nature of such inclusions but the conclusions derived from these investigations differ very much. D6hle' examined smears of blood fixed by alcohol from 30 cases of scarlet fever and from numerous other diseases, which he does not specify. The smears were stained either with a mixture of Hoppe-Seyler's reagent, water and Michaelis' azure blue, or with an acid solution of orseiles mixed with acid hematoxylin. He also used Pappenheim's stain. By these methods he observed inclusions in the cytoplasm of nearly all neutrophiles almost invariably in scarlet fever. These bodies stained blue with the two first-mentioned stains, and took a pale red with Pappenheim's mixture. Their size and shape varied greatly, some being as large as one-sixth the size of the nucleus, and round or rod-shaped, or oval with one pointed end. The number of bodies per cell varied from one to six. The only cases of scarlet fever in which such bodies did not occur were two examined late in the disease. Only in cases of two other diseases were similar bodies found; viz., two cases of carcinoma and one of pneumonia, in which there was a history of syphilis (the author stating that in this particular instance his slides might have become mixed with those of scarlet fever). D6hle holds that because the bodies stain red with Pappenheim's stain they need not be confused with nuclear fragments; he also finds similar bodies free in the blood. In a more recent article D6hle2 describes spiral forms in the cytoplasm of leukocytes, and also in the blood of two cases of scarlet fever. These he believes are spirochaetes and he names them Spirochaeta scarlatinae. The bodies which he described in the leukocytes he holds to be fragments of the parasites of both diagnostic and prognostic significance. Stimulated by D6hle's work, Kretschmer3 studied some 30 cases of scarlet fever and about 70 controls. At first he used D6hle's method, but soon changed to fixation by methyl alcohol and staining with Manson's stain, because this technic is equally efficient and much simpler. He also tried Giemsa's stain. Kretschmer verified Dbhle's results in regard to scarlet fever, finding bodies in all early cases; they usually disappeared by the 8th-ioth day, occasionally somewhat later. D6hle and Kretschmer both failed to find such bodies in animals; the latter failed to find any relation between the temperature and the occurrence of the bodies. The other diseases in which he found the bodies, but by no means constantly, were diphtheria, tuberculosis, and pneumonia. They were not found in leukocytes from normal persons or in cases of measles. Nicoll and Williams4 used Kretschmer's technic, and also Giemsa's stain over night. In 51 cases of scarlet fever in which the patients had been sick more than eight days the bodies were present in all except six cases. Bodies were also found

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