some observations on the total and differential leucocyte counts in' adult...

251

SOME OBSERVATIONS ON THE TOTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN' ADULT

MALE EAST AFRICAN NATIVES BY

. Lieut.-Colonel R. M. JOHNSTONE, M.C., M.A., M.B., Ch.B., F.R.C.P·.E.

Royal Army Medical Carp's Adviser in Medicine, Headquarters, East Africa Commarnd

M~DICAL OFFICERS, who are posted to stations where they h~ve to . treat nonEuropean personnel, need to learn what is normal in such patients before they can assess them correctly.' Differences' between European and non-European patients, which may be found on clinical examination, do not really lend themselves to description on paper by one, who is not gifted with the pen of a Heberden or a Paget. but are easily demonstrable at the bedside. On the other hand, the normal and abnormal values of the common clinical pathological investigations may be easily recorded and may thus form a small but useful addition to our knowledge of the biology of man.

The purpose of this paper is to record our findings in respect of one particular clinical pathological investigation made on adult male East African natives during the period April 1949-March 1951 at the Military Hospitals at

, Mackinnon Road and Nairobi .. This investigation was started because it was clear that in the native patients,

undergoing treatment at the Military Hospital at Mackinnon Road, the total and differeptial leucocyte counts differed materially from those usually encountered in European patients in temperate climates.

To avoid overburdening the pathological laboratory no attempt was made to perform total and d~erentialleucocyte counts except on patients, in whom it was considered that the information thus gained would be of value in reaching a diagnosis or in assessing prognosis~ Furthermore, as the original purpose of the investigation was the purely practical one of learning how to interpret the results reported from the laboratory, the counts were carried out by the laboratory technicians. These technicians changed from time to time during the period of the investigations and so subjective sources of error may be randomized. .

The material consisted of askaris from the military units and labourers from the Civil Labour Force between the ages of 20 ,and 45, who were admitted' to hospital for investigation or treatment. A total of 480 leucocyte counts from 480 different patients has been collected. 34 of these patients have been classified

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252 Total and Differential Leucocyte Counts

as apparen~ly healthy. These patients were,sent in for investigation by medical officers who had only recently arrived in East Africa and who were thus unaccustomed to dealing with natives. They were afebrile throughout their stay in hospital; had fifteen negative blood slides taken in the course of n hours; . had no abnormality in their urine; had no parasites or parasitic ova in their stools; and had normal radiographs of their heart and lung~.

The main findings were all established at'Mackinnon Road, but, at a. later date, the investigation was continued at Nairobi for the purpose of deciding whether the findings were of general application or whether they were due to lo~al conditions in Mackinnon Road. THe findings in both hospitals were essentiaily simi.lar so iiis concluded that they are of general application; . The total and differential leucocyte counts in 33 healthy European males, aged 18 to 45, who were serving in East Africa, have also. been recorded as they are considered to have an important bearing on the interpretation of the causation of our results. . . . .

Whitby and Britten [I] give the normal number of leucocytes in the circulat-ing blood as 4,000 to 11,000 per c.mm.; and the normal distribution of the differential count as follows:

Neutrophil polymorphonuclea))s Lymphocytes Monocytes Eosinophil polymorphonuclears Basophil polymorphonuclears

Totai per c.mm. 1,500-7,500 1,000-4,500

0- 800 0- 400 0- 200

per cent 33-75 15--60' 0- 9 0-6 0- 2

In the 34 patients, in whom no evidence of disease could. be found, th~ total leucocyte counts lay between 3,000 and 7,000cetls per c.mm.; the neutrophil polymorph counts lay between 1,000 and 4,000 cells per c,mm.; the lymphocyte counts between 1,000 and 4,500 cells per c.mm.; the monocyte counts between o and 500 cells per c.mm.; the eosinophil counts between 0 and 400 cells per c.mm.; and the basophil counts between 0 and 200 cells per c.mm.; though basophil cells were only seen inS of these patients.

TABLE I.-TOTAL AND DIFFERENTIAL LEUCOCYTE.COUN~S IN HEALTHY ADULT MALE EAST

AFRICAN NATIVES

s...;;u Total 1:leutrophil Mono- Eosino-counts polymorphs % Lymphocyles %. nuclea"s . % phils % Basophils . %

, I 3,000 . 1,020 34 1,830 ,61 ISO 5 2 3,200 1,216 38 1,664 52 256 8 64 2 3 3,500 1;575 45 1,785 '51 10 -2 35 I 35 4 3.600 1.296 36 1,944 54 216 6 144 4

: 5, ~,800 1,444 . 38 2,280 60 76 2 6 4,000 2,000 50 1,640 41 160 4 200 5, 7 ,'4,000 2,200 55 1,600 40 120 3 80 2 8 4,200 1,848 44 2:058 49' 168 ' 4 126 3 9 . 4,300 1,720 40 . 20193 51 86 2 301 7

IQ- 4,500 2,l15 . 41 2,250 50 135. 3 " --.11. 4,600. 2,024 - .4.4 ,·VOO ,50 1~1:: 4 9Z 2 -:i"" ~



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'. R. M."/ohnstone c 253'

Total Neutrophil Mono- . Eosino···

"Si':r:ial CO,unt~ polymorphs 01 Lymphocytes % nuclears % phlis % BasophUs % 10

\12 4,800' :.::,:t08 . 46 2,496 52 48 1 48 1

13 5,000 :'::,750 55 :'::,000 40 150 3 100 2 14 5,100 1,9tl9 39 :'::,754 64 153 3 204 4

. 15 5,200 2,080 40 3,1~0 60

16 5,200 2,860 55 1,820 J5 260 5 260 5

17 5,300 2,173 41 2,756 52 212 4 159 3

18 5,400 3,240 60·· 2,160 40

19 5,500. ,2,420 44 2,805 51 110 2 165 3 20 5,500 2',310 42 2,970 54 55 165 3 21 5,600 1,960 35 3,640 ·65 22 5,700 1,995 35 3,135 55 570 10 23 · 5,800 2,030 35 3,654 63 ' 116 2

24 5,900 1,947 33 3,422 58 118 2 413 7

25 6,000 3,000 50 2,700 45· 180 3 120 2

26 6,000 3,840 64 1,920 32 120 2 120 2 27 6,100 1,525 25 4,453 73 122 2 28' 6,200 3,906 63 1,674 27 372 6 248 4:

29 6,400 2,560 40 3,840. 60 30 6,500 2,080 32 4,030 . 62 260 4 130 2

31 6,600 2,442 37 3,960 60 . 66 1 13'2 2

32 · 6,800 2,448 36 3,944 58 408 6 33 · 7,000 2,520 36 4,410 63 70 1 3"4 .... 7,000 2,940 42 3,640 52 210 3 210 3

'Thus the total leucocyte counts in apparently healthy adult male East Afdcan natives are lower than those accepted as normal in Europeans in temperate climates. And the differential leucocyte counts reveal that this difference is chiefly due to the smaller number o£neutroph~ polymorphs in the circulating' blood." . .

,Th!ee practical points arise from these findings: firstly, a total count of more than. 7,500 cells per c.mm., should be regarded as indicating a leucocytosis;

. secondly, it is only when the total count is less than 2,500 cells per c.mm.; that the patient should be considered to exhibit a leucopenia; and thirdly a diffential count which exhibits the normal Europeandistribution is relatively uncommon, and more often than not indicates the presence of disease.

The. commonest and .. most important tropical. disease is malaria. At Mackinnon Road, a large part of the population at risk was made up of the Civil Labour Force, in which it was impossible to enforce the taking of suppressive me£ac~ine. Cases of malignant tertian malaria were, therefore, common and in 74 proven cases total and differential leucocyte counts were perform~. In 6,0 of these patients the total leucocyte coUnts wer« within the norinallimits as we have defined them, for apparently healthy adult male East African natiyes: in 14 patients'a leucocytosis occurred, the highest figure being. 12,000 cells per c.mm. In, 'the 60 patients with normal total counts, the differential counts had a normal European distribution in 19 cases; and in the 14 patients showing a leucocytosis a European distri])lltion occurs in 4 cases. These proportions are slightly higher than were found in the 34 normal cases but the increase is not great en<mgh to



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have' statistical significance. In malignant tertian malaria, therefore, the total and differential counts are usually within normal limits, but a leucocytosis may be expected in about 1 in every 5 cases.

\~!$--,: -

TABLE n.-TOTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN ADULT MALE EAST AFRICAN

NATIVES SUFFERING FROM PROVEN M.T. MALARIA

Total Neutrophil Lympho- Mono- Eosino-Serial .co'unts .polymorphs % cytes % cytes % phi/s % Basophils %.

1 2,500 1,000 40 1,200 48 250 10 50 2

2 2,800 1,792 64 840 30 56 2 112 4

3 2,900 1,450 50 1,160 40 290 10

4- 3,000 1,050· 35 1,500 50 450 15

5 3,200 1,184 37 1,920 60 96 3

6 3,400 1,190 35 2,210 65 7 .3,500 1,400 40 .1,990 57 105 3 8 3,600 1,440 35 2,540 65 9 3,800 1,178 31 2,880 60 76 2 266 7

10 3,800 1,710 45 2,090 55 11 3,800 950 25 2,850 75 12 3,900 1,833 47 1,950 50 117 3 13 3,900 2,847 73 975 25 39 1 - 39 14 4,000 2,000 50 1,600 40 120 3 280 7 15 4,000 1,600 40 2,400 60 16 4,000 1,760 44 1,800 45 120 3 320 8

17 4,200 2,310 55 1,680 40 126 3 84 2 18 . 4,200 1,806 48 2,3J.0 55 42 1 42 19 4,500 2,025 45 2,475 55 20 4,500 630 14 3,825 85 45 21 4,600 1,978 43 2,300 50 138 3 184 4 22 4,600 1,932 42 2,530 55 138 3 23 4,700 2,209 47 2,021 43 94 2 376 8 24 4,800 2,400 50 2,304 48 96 2 25 4,800 2,784 58 1,872 39 96 2 48 26 4,800 1,920 40 2,880 60 27 5,000 2,200 44 2,500 50 300 6 28 5,000 2,050 41 2,800 56 150 3 29 5,100 3,315 65 1,530 30 153 3 102 2 30 5,200 2,236 42 2,860 55 104 2 31 5,300 2,120 40 3,180 60 32 5,400 1,998 37 3,348 62 54 -33 5,500 2,145 39 3,355 61 34 5,500 3,190 58· 2,200 40 110 2 35 5,500 2,420 44 2,530 46 330 6 220 4 36 5,500 2,915 53 2,200 40 110 2 275 5 37 5,600 3',360 60 2,184 39 56 1 38 5,600 3,304 59 1,~60 35 224 4 112 2 39 5,700 2,565 45 3,135 55 , 40 5;800 2,552 44 2,900 50 232 4 116 2 41 5,900 2,596 44 2,950 50 118 2 59 1 177 . 3 42 6,000 3,540 59 2,400 40 60 1 43 6,000 1,980 33 3,600 60 180 3 240 4 -44 6,000 3,900 65 1,800 30 180 3 120 2 45 6,100 1,830 30 3;904 64 61 1 305 5



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R. M. Johnst~ne 255

Total . Neutrophil Lympho- Mono- Easino-Serial ~ounts polymorph. % cytes % eyles % phils % Basophils %

46 6,200 4,650 75 1,550 25 47 6,200 2,170 35 3,968 64 62 1 48 6,400 2,176 34 3,968 62 128 2 128 2 49 6,500 3,900 60 2,210 34 195 3 195 3 50 6,500 3,900 60 1,950 30 650 10 51 6,500 3,250 50 3,250 50 52 6,500 2,600 40 3,575 55 260 4 65 I 53 6,500 3,445 53 2,600 40 195 3 65 I 195 3 54 6,600 4,290 65 1,980 30 66 1 132 2 132 .2 55 6,800 4,216 62 2,312 34 136 2 136 2 56 6,900 3,864 56 2,760 40 276 4 57 7,000 2,800 40 3,710 53 140 2 350 5 58 7,000 3,010 43 3,710 53 280 4 59 7,000 2,030 29 4,900 70 70 1 60 7,500 4,350 58 2,850 38 300 4 61 7,800 3,900 50 3,822 49 718 1 62 8,000 2,560 32 5,200 65 240 3 63 9,000 3,510 39 4,050 45 720 8 720 8 64 9,200 ·4,140 45 5,060 55 65 9,300 4,092 44 5,208 56 66 9,500 5,700 60 3,420 36 190 2 190 2 67 lO,flOO . 3,800 38 4,800 48 1,000 10 400 4 68 10,000 4,800 48 5,200 52 69 10,500 4,725 45 5,250 50 315 3 210 2 70 10,500 4,500 43 5,775 55 225 2 71 10,500 9,345 89 1,050 10 105 I 72 11,000 8,140 74 2,200 20 440 4 270 2 73 11,000 5,390 49 5,500 50 no 1 74- 12,000 7,800 65 3,000 25 720 6 480 4

Another tropical disease that is. common in East Africa is schistosomiasis. Total and differential leucocyte counts were performed on 38.patients suffering from this disease. In 25 patients, the. total and differential counts were within. normal limits. In lO patients there was a leucocytosis associated with an increase of neutrophil polymorphs in the circulating blood and probably due to the presence of secondary infection in the bladder or bowel. In 3 patients there was a leucocytosis associated with a marked eosinophilia. Eosinophilia was observed. in only 9 out of the 38 patients and was found to be of small diagnostic or prog-nostic value. In schistosomiasis, therefore, the total and differential leucocyte counts are usually within normal limits unless .a marked eosinophilia or the presence of secondary infection leads to a leucocytosis.

TABLE IlL-TOTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN ADULT MALE EAST AFRICAN

NATIVES SUFFERING FROM SCHISTOSOMIASIS

Total Neutrophil. Lympho- Mono- Eosino-Serial counts polymorph. . % cytes % cytes % phils % Basophils %

1 2,500 . 1,125 45 1,125 45 250 10 2 3,000 1,410 47 1,410 47 90 3 90 3 3 3,500 2,275 65 1,225 35 4 3,600 1.,908 53 1,584. 44 108 3



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256

Serial

5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35: 36 37 38

Total counts

3,800 4,000 5,200 5,400 5,600 5,900 6,000 6,000 6,000 6,200 6,300 6,400 0,500

.6,600 6,800 6,900 7,000 .7,000 7,400 7,500 7,500 7,600 7,700 7,800 8,000 8,200 8,500 8,600 9,000 9,000

. 9,000 . 10,000 13,000 13,000

Total and Differential Leucocyte Counts

Neutrophil po[ymorphs

1,900 2,520 2,496 1,728 2,Z44 3,953 4,260 2,440 3,420 2,604 3,654 2,560 4,810 c2,772 1,700 3,105 3,290 .

'3,990 3;848 3,975 3,825 3,724 3,157 4,446 5,760 5,412 3,995 3,526 5,760 5,850 7,850

. 6,200 6,630 6,1l0

% 50 63 48 32 49 67 71 49 57 42 58 40 74 42 25 45 47 57 52 53. 51 49 41 57 72 66 47 41 64 65 85 62 51 47

Lymphocytes

1,710 800

1,872 3,564 2,464 1,534 1,500 2,760 2,160 3,100 3,394 2,560 1,235 3,630 4,964 3,312 3',150 1,890

. 2,220 2,850 2,700 3,496 4,004 3;120 2,160 2,132 4,250 3,182 2,970 3,060 1,350 3,400 4,550 3,900

% 45 20 36 66 44 26 25 46 36 50 38 40 19 55 73 48 45 27 30 .38 36 46 52 40 27 26 50 37 33 34 15 34 35 30

Mono-cytes %

76 2 80 2

520 10 108 2 224 4 295 5 180 3 180 3 240 4 310 5

63 I 192 3 325 5 66 1

483 7

420 6 444 6 375 5. 150 2 228 3 231 3 78 I

410 5

86 1 270 3'

200 2 390 3 910 7

Eosino-phils %

76 2 600 IS 312 6

. 168 3 118 2 60 1

120 2 120 2 186 3 189 3

1;152 18 130 2 66 1

132 2

560 8 '700 10 888 12 225 3 750 10 152 2 308 4 156 2 80 1

246 3 255 3

1,806 21

90

200 '2 1,430 11 2,080 16

Basophils %

38

601

66

75 I 75 I

"The greater part of milita,ry medical practice in East Africa, however, is concerned not with the specific tropical diseases but with the common diseases of the respir.atory tract, to which the natives are particularly susceptible. ,

TotaLa.n'd differential leucocyte counts were performed on 110 patients suffering frombronch.itis, Qn 43 patients sufferingfrom bronchopneumonia, and on 58 patients suffering from lobar pneumonia. In all these groups of patients there was a tendency for leucocytosis, associated with an increase in the number of neutrophil polymorphs in the ci~cu~ating b~ood, to. occyr, and . thj~ ten,de~~y~ paralleled the severity of the infection. Thus of 110 patients with bronchitis, 46 (or 42 per cent) showed a leucocytosis; of43 patients ~ith bronchppneumonia 27 (ej'r 63 per cent) showed a leucocytosis; and of 58 patie~ts with lopar pneumonia, 40 (of. 70 per cent) showed a .leucocytosis. Moreover in these three groups of patients a normal European distribution in the differential count was absent in only 10 cases (0'47'5 per cent)., Consequently we .came t6'tegard any



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R. M. johnstone 257

differential count with a normall European distribution as indicative of a res~ piratoryinfection until it was proved otherwise, unless, of course, some other. ~ obvious cause such as 'tonsillitis or forunculosis was present. This rule was proved most useful in practice.

TABLE IV.-TOTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN ADULT MALE EAST AFRICAN

NATIVES SUFFERING FROM BRONCHITIS

Total Neutrophil Lympho- Mono.:. Eosino-Serial counts polymor,phs % cytes % cytes % ·phils % Basophils %

1 3,000 2,190 73 750 25 30 1 30 1 2 3,500 700 20 2,450 70 70 2 210 6 70 2 3 3,500 2,100 60 1,155 33 245 7 4 4,000 2,000 50 1,800 45 120 3 80 2 5 4,000 1,960 49 1,840 46 120 3 80 2 6 4,000 1,640 41 2,000 50 200 5 160 4 7 4,000 2,000 50 1,720 43 200 5 80 2 8 4,500 2,070 46 2,070 46 180 4 180 4 9 5,000 2,600 52 2,000 40 200 4 200 4

10 5,000 2,500 50 2,350 47 150 3 11 5,000 2,750 55 1,500 30 600 12 150 3 12 5,000 3,250 65 1,500 30 200 4 50 I 13 5,000 3,500 70 1,200 24 100 2 200 4 14 5,000 3,250 65 1,500 30 ISO 3 100 2 15 5,000 2,550 51 2,200 44 200 4 50 1 16 5,000 2,500 50 2,200 44 150 3 150 3 17. 5,000 2,550 51 2,300 46 100 2 50 1 18 5,200 4,056 78 1,040 20 104 2 19 5,200 2,496 48 2,392 46 104 2 208 4 20 5,200 3,536 68 1,300 25 52 I 312 6 21 5,200 3,536 68 1,248 24 104 2 312 6 22 5,200 2,704 52 2,080 40 312 6 104 2 23 5,300 3,551 67 1,590 30 106 2 53 1 24 5,400 3,078 57 2,160 40 162 3 25 5,500 3,135 . 57 2,200 40 165 3 26 5,500 2,805 51 2,420 44 110 2 165 3 27 5,600 3,248 58 2,016 36 168 3 168 3 28 5,700 3,477 61 1,824 32 228 4 171 3 29 5,800 3,422 59 1,798 31 290 5 290 5 30 5,900 3,599 61 2,065 35 118 2 118 2 31 5,900 2,655 45 2,950 50 177 3 118 2 32 6,000' 3,960 66 1,680 28 180 3 180 3 33 6,000 3,000 50 2,520 42 240 4 240 4 34 6,000 3,660 61 1,980 33 180 3 180 3 35 6,000 3,180 53 2,400 40 '240 4 180 3 36 6,000 2,280 38 3,600 60 ' 120 2 37 ,6,000 3,180 53 2,400 40 300 5 120 2 38 6,000 3,120 52 2,640 44 60 1 60 1 39 6,100 3,294 54 2,440 40 61 1 305 5 40 6,100 3,904 64 1,830 30 244 4 122 2 41 6,200 4,154 67 1,860 '30 124 2 62 1 42 6,400 3,584 56 2,560 40 192 3 64 1 43 6,600 4,092 62 2,112 32 264 4 132 2 44 7,000 4,690 67 2,100 30 70 1 140 2

18



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258 Total and Differential Leucocyte' Counts

Total Neutrophil Lympho- Mono- Eo~ino-

Serial counts polymorphs % cytes % cytes % phils % BasophilB %

45 7,000 3,850 55 2,800 40 210 3' 140 2

46 7,000 3',500 50 . 3,010 43 280 4 210 3

47 7,000 4,480 64 2,100 30 280 4 140 2 48 7,000 3,990 57 . 2,450 35 350 5 210 3 49 7,000 2,520 36 4,200 60 210 3 70 1 50 7,000 3,780 54 3,150 45 70

51 7,300 3,358 46 3,212 44 438 6 219 3

52 7,400 6,512 88 814 11 74 1 53 7,500 3)50 50 3,000 40 300 4 450 6 54 7,500 4,425 59 2,625 35 300 ' 4 150 2 55 7,500 4,575 61 2,700 36 75 1 150 2 56 7,500 .3,675 49 3,150 42 225 3 450 6 57 7,600 5,168 68 1,900 25 304 4 228 3 58 7,800 4,524 58 2,808 36 78 1 390 5

59 7,800 4,212 54 3,120 40 312 4 156 2

60 . 7,900 4,503 57 3,002 38 237 3 158 2 61 8,000 4,080 51 3,200 40 480 6 240 3 62 8,000 4,480 56 2,800 35 480 6 240 3 63 8,000 4,000 50 3,600 45 240 3 160 2 64 8,000 4,560 57 2,800 35 400 5 240 3 65 8;000 4,640 58 2,400 30 480 6 480 6 66 8,000 5,200 65 2,400 30 240 3 160 2

67 8,000 4,480 56 3,200 40 240 3 80 1 68 8,000 4,560 57 3,200 40 160 2 80 1 69 8,000 5,360 .67 2,400 30 160 2 80 1 70 8,000 2,480 31 5,200 65 320 4 71 8,000 4,560 57 3,120 39 240 3 80 1 72 8,200 4,510 55 2,870 35 492 6 328 4 73 8,400 5,460 65 2,868 27 252 3 420 5 -, 74 8,500 5,440 64 2,550 30 255 3 255 3 75 8,500 5,950 70 2,380 28 85 1 85 1 76 8,600 6,278 73 2,150 25 172 2 77 8,800 6,688 76 1,760 20 352 .4 78 9,000 6,120 68 2,700 30 180 2 79 9,000 6,570 73 1,890 21 180 2 360 4 80 9,000 5,670 63 2,700 30 360 4' 270 3 81 9,000 6,120 68 .2,430 27 270 3 180 2 82 9,000 5,850 65 2,700 30 270 3 180 2 83 9,000 5,670 63 2,970 33 180 2 180 2 84 9,000 5,940 66 2,700 30 180 2 180 2 85 9,200 5;060 55 3,220 35 552 6 368 4 86 , 9,400 6,768 n 2,162 23 282 3. 188 2 87 9,500 4,940 52 4,275 45 190 2 95 1 88 9,600 6,528 68 2,592 27 288 3 192 2 89 9,600 4,800 50 4,128 43 192 2 480 5 90 10,000 7,400 74 2,100 21 300 3 200 2 91 10,000 7,300 73 2,200 22 300 3 200 2 92 10,000 6,600 66 2,900 29 300 3' 200 2 93 10,000 7,300 73 2,300 23 200 2 200 2 94 10,000 7,200 72 2,100 21 400 4 300 3 95 10,000 6,900 69 2,200 22 500 5 400 5 96 10,000 .6,900 69 1,700 17 400 4 1,000 110



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Total _ . , Neutrophil Lympho- Mono- Eosmo_ Serial counts polymorphs o/n cytes % cytes % phils % Basoph/h %

97 10,000 6,800 68 2,800 28 400 4 98 10,200 8,364 82 1,530 15 204 2 102 99 10,200 7,242 71 2,754 27 204 2

·100 10,400 7,800 75 2,392 23 208 2 101 10,600 7,632 72 2,226 21 106 1 636 6 102 1I,000 5,120 52 4,180 38 660 6 440 4 103 11,000 6,600 60 3,300 33 440 4 330 3 104 11,000 8,250 75 2,200 20 440 4 110 105 11,500 9,430 82 2,070 18 106 11,800 8,260 70 3,304 28 236 2 107 13,000 9,750 75 2,340 18 650 5 260 2 108 14,000 9,660 69 3,220 23 840 6 280 2 109 14,000 10,920 78 2,100 15 560 4 420 3 110 14,500 10,440 12 2,900 20 580 4 580 4

TABLE V.-TOTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN ADULT l\'lALE EAST AFRICAN

NATIVES SUFFERING FROM BRONCHOPNEUMONIA

Total Neutrophil Lympho- Mono~ Eosino-Serial counts polymorphs % cytes ' % cytes % phils % Basophils %

1 4,000 2,080 52 1,780 42 240 6 2 4,500 2,565 57 1,800 40 90 2 45 3 5,000 2,950 59 1,750 35 300 6 4 5,200 2,080 40 2,028 39 416 8 676 13 5 5,400 2,970 55 2,160 4{) 270 5 6 5,500 4,070 74 1,100 20 165 3 165 3 7 5,600 2,968 53 2,520 45 112 2 8 6,000 3,600 60 2,040 34 i20 2 240 4 9 6,000 3,900 65 1,500 25 480 8 120 2

10 6,300 3,465 55 2,520 40 252 4 63' 1 II 6,500 3,770 58 2,990 46 130 2 260 4 12 6,800 3,876 57 2,320 35 340 5 204 3 13 7,000 3,290-- 47 3,500, 50 280' 3 -14 7,000 3,150 45 3,150 45 700 10 15 7,200 3,960 55 3,096 43 72 I 72 1 16 7,500 4,875 65 2,250 30 150 2 225 3 17 8,000 4,80() 60 2,800 35 240 3 160 2 18 8,000 4,320 54 3,200 40 240 3 240 3 19 8,200 6,232 76 1,640 20 2;1-6 3 82 I 20 8,400 4,872 58 3,360 40 82 I 82 1 21 8,500 4,250 50 4,080 48 170 2 22 8,600 4,988 58 3,010 35 258 3 344 4 23 . 8,700 6,003 69 2,175 2$ 522 6 24 8,800 5,632 64 2,640 30 352 "4 176 2 25 8,900 5,696 64 2,848 32 1718 2 178 2 26 9,000 4,320 48 3,600 40 8ID 9 270 3 27 9,000 5,850 65 2,250 25 720 8 180 2 28 10,000 7,700 77 1,800 18 300 3 200 2 29 10,000 7,600 76 2,000 20 300 3 100 1 30 10,000 6,800 68 2,900 29 200 2 100 1 31 10,000 7,600 76 2,000 20 200 2 200 2 32 ID,OOO 7,200 72 2,400 24 300 3 100 1 33 ID,OOO 6,000 60 2,800 28 400 4 800 8 34- 10,500 7,560 72 2,520 24 420 4



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Total Neutrophil Lympho- Mono- Eosino-Serial counts polymorphs % cytes % cytes % phllS % Basophils %

3'5 10,600 8,056 76 2,120 20 212 2 212 2

36 10,800 7,128 66 2,700 25 - 540 5 432 4

37 11,000 8;910 81 1,760 16 330 3

38 12,000 8,400 70 3,000 25 360 3 240 2

39 13,000 8,840 68 2,990 23 910 7 260 2 40 15,000 11,100 74 3,750 25 150 41 15,000 12,000 80 2,400 16 450 3 150 42 16,000 11,840 74 3,520 22 640 4 43 17,000 13,940 82 2,550 15 340 2 170

TABLE VI.-TOTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN ADULT MALE EAST AFRICAN

'NATIVES SUFFERING FROM LOBAR PNEUMONIA

-Total Neutrophil Lympho- Mono- Eosino-Serial counts polymorphs % eytes % cytes % phils % BasovhUs %

1 3,000 1,170 39 1,500 50 300 10 30 1 2 4,500 ,3,600 80 900 20 3 5,000 2,800 56 2,050 41 '150 3

4 5,200 3,224 62 1,820 3'5 104 2 52 5 5,500 2,640 48 2,530 . 46 165 3' 110 2 55 6 6,000 2,940 49 2,700 45 180 3 120 2 60 7 6,000 4,740 79 900 15 300 5 60 1 8 6,200 3,410 55 2,790 45 9 6,500 3,702 57 2,470 38 130 2 195 3

10 6,600 4,290 65 -1,980 30 66 1 66 1 198 3 11 7,000 3,710 53 3,010 43 140 2 140 2 12 7,000 3,710 53 3,080 44 70 1 140 2 13 7,000 4,410 63 2,100 30 350 5 140 2 14 7,000 3,990 57 2,800 40 140 2 70 1 15 7,200 3,528 49 3,456 48 216 3 16 7,500 5,400 , 72 1,875 25 225 3 17 71600 6,004 79 1,520 20 76 1 18 7,800 4,446 57 2,964 \ ,18 312 4 78 19 8,000 6,640 83 1,200 - IS 160 2 20 8,000 5.040 63 2,800 35 160 2 21 8,000 6,800 85 1,200 15 22 8,000 3,920 49 3,600 45 320 4 160 2 23 8,000 4,800 60 2,800 35 240 3 160 2 24 8,500 6,630 78 1,700 20 190 2 25 9,000 8,460 94 540 6 26 9,200 7,636 83 1,012 11 276 3 276 3 27 9,500 6,93'5 73 2,375 25 95 1 95 1 28 9,600 7,200 75 2,112 22 288 3 29 10,000 5,700 57 3,500 35 800 8 30 10,000 7,300 73 2,200 22 400 4 100 31 10,000 7,000 70 3,000 30 32 10,000 8,000 80 1,900 19 100 1 33 10,800 5,400 50 3,780 35 540 5 756 7 324 3 34 10,800 6,048 56 3,564 33 432 4 756 7 35 10,800 7,884 73 2,268 21 432 4 216 2 36 '11,000 7,810 71 2,420 22 660 6 110 1 37 11,200 6,608 59 3,808 34 784 7 38 1l,400 8,208 72 ,2,736 24 342 3 114 -1



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Total Neutrophil Lympho- Mono- Eosino-Serial counts polymorphs % cytes % cytes % phils' % Basophtl. %

39 11,500 9,890 86 1,380 12 230 2 40 11,800 8,496 72 2,360 20 590 5 354 3 41 13,000 10,920 84 1,950 15 130 I 42 13,000 8,450 65 3,250 25 520 4 780 6 43 14,000 10,500 75 2,800 20 280 2 420 3 44 14,000 11,200 80 2,240 16 280 2 280 2 45 14,000 11,200 80 2,380 17 280, 2 140 I 46 15,000 11,400 76 2,300 22 300 2 47 15,000 10,500 70 4,500 30 48 15,200 12,008 79 3,040 20 152 1 49 15,800 10,744 . 68 3,950 25 632 4 474 3 50 16,000 12,480 78 3,200 20 320 2 51 16,000 9,120 57 6,400 40 160 I 320 2 52 16,000 '12,800 80 2,720 17 480 3 53 16,800 14,112 84 2.520 15 168 I 54 17,000 13,940 82 2,550 15 510 3 55 17,000 13,430 79 2,550 15 680 4' 340 2 56 19,000 13,490 71 2,090 11 3,420 18 57 19,000 13,300 70 3,800 20 1,710 9 190 58 19,200 13,440 70 5,184 27 384 2 192

In addition to the pyogenic infections of the respiratory tract, the East African native is highly susceptible to infection with the tubercle bacillus. Total and differential leucocyte counts were performed in 31 patients so infected. A

'leucocytosis, associated with an increase in the number of neutrophil tJoly-morphs in the circulating blood, was present in 9 cases and in the remaining 22 cases the distribution in the differential count had reverted to the European type. The total and differential counts were, therefore, of no help in differentiating between tuberculous and pyogenic infection of the respiratory tract.

TABLE VII.-TOTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN ADULT MALE EAST AFRICAN

NATIVES SUFFERING FROM· PULMONARY TUBERCULOSIS

Total Neutrophil Lympho- Mono- Eosino-Serial counts poly'morphs °t cytes % cytes % phils % BasoDhils %

I 3,200 1,952 61 1,216 38 32 I 2 4,000 2,200 55 1,560 39 120 3 120 3 3 4,000 2;200 55 1,680 42 80 2 40 I 4 4,500 2,970 66 1,395 31 90 2 45 I 5 4,800 2,400 50 2,016 42 240 5 96 2 48 6 5,000 2,700 54 2,000 40 250 5 50 1 7 5,000 3,000 60 1.550 31 100 2 350 7 8 5,000 2,800 56 1,950 39 . 150 3 100 2 9 5,100 3,060 60 1,530 30 510 10

10 5,200 2,392 46 2,496 48 312 6 Il 5,500 3,'190 58 1.870 34 165 3 220 4 55 12 5,800 2,900 50 2,436 42 290 5 174 -3 13 6,000 3,300 55 2.520 42 180 3 14 6,000 3,660 61 1.620 27 720 12 15 6,200 3,596 58 2.542 41 62 I 16 6,400 3,392 52 2,496 39 384 6 128 2



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262 Total and DifferentialLeucocyte Counts

Total Neutrophil Lympho- Mono- Eosino-Basophils %

Serial counts J)olymorphs % cytes % cytes % phils %

17 6,500 3,640 56 2,470 38 64 1 325 5

18 6,600 2,970 45 1,914 29 396 6 1,320 20

19 6,900 3,933 57 2,001 29 207 3 690 10 69

20 7,000 4,410 63 2,100 30 210 3 280 4

21 7,200 5,544 77 1,368 19 144 2 144 2

22 7,500 4,500 60 2,615 35 150 2 225 3

23 7,800 3,978 , 51 3,276 42 156 2 390 5

24 8,000 5,680 71 2,080 26 160 2 80 1

25 8,200 4,838 59 3,034 37 82 1 246 3

26 ,8,400 5,460 65 2,436 24 252 3 252 3

27 8,500 4,165 49 3,995 47 340 4 28 9,000 4,410 49 4,050 45 180 2 360 4 29 10,000 7,000 70 3,000 30 30 10,500 6,300 60 2,835 27 630 6 735 7

31 10,500 7,245 69 2,730 26 210 2 315 3 0

Total and differential leucocyte counts were also performed in 20 patients suffering from ,a variety of pyogenic infections. A leucocytosis associated with an increase in the number of neutrophil polymorphs i.n the circulating blood was present in 13 of ;these patients and in the remainder the distribution in the differ-ential count had reverted to the European type.

TABLE VIII.-ToTALAND DIFFERENTIAL LEUCOCYTE COUNTS IN ADULT MALE EAST AFRICAN

NATIVES SUFFERING FROM MISCELLANEOUS PYOGENIC INFECTIONS

Total Neutrophil Lympho- Mono- Eosino-Serial counts polymorphs % cytes % cytes % phils % Basophils %

1 4,400 2,860 65 1,452 33 88 2 2 4,800 2,880 60 1,776 37 96 ·2 48

3 5,200 3,692 71 1,352 26 156 3 4 5,500 3,190 58 2,035 37 220 4 55 5 5,800 3,480 60 2,320 40 6 6,000 3,360 56 2,280 38 180 3 180 3 7 7,500 4,050 54 2,025 27 675 9 750 10 8 7,900 6,083 77 1,659 21 158 2 9 8,000 5,200 65 2,400 30 80 1 320 4

10 8,000 4,160 52 3,440 45 160 2 240 3 11 8,300 3,901 47 3,154 38 83 1 1,162 14 12 8,800 5,456 62' 2,904 33 264 3 176 2 13 9,000 6,840 76 1,980 22 180 2 14 9,200 5,336 58 3,220 35 368 4 276 3 15 10,000 6,900 69 2,900 29 200 2 16 11,000 5,500 50 4,840 . 44 220 2 440 4 17 12,000 9,600 80 1,680 14 600 5 120 1 18 14,000 11,200 80 2,100 15 420 3 280 2 19 20,000 14,800 74 5,200 26 20 34,000 32,300 95 1,700 5

Total and differential leucocyte counts were performed in 16 patients with non-specific diarrhcea or bacillary dysentery, who originally presented with fever but without symptoms referable to the gastro-intestinal tract. A leucocy-



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tosis, associated with an increase in the number of neutrophil poly morphs in the circulating blood; was present in 5 cases and in the remainder the differential count revealed a European type of distribution.

TABLE IX.-ToTAL AND DIFFERENTIAL LEUCOCYTE- COUNTS IN ADULT MALE EAST AFRICAN

NATIVES SUFFERING FROM NON-SPECIFIC DIARRH<EA OR BACILLARY DYSENTERY

Total Neutrophil Lympho- Mono- Eosino-Serial counts polymorphs % cytes % eYfes % phils % Basophils %

I 3,000 1,500 50 1,350 45 90 3 30 -1 30 2 4,200 2,604 62 1,554 37 42 1 3 4,500 2,250 50 1,800 40 450 10 4 4,600 2,390 52 2,024 44 184 4 5 4,800 2,928 61 1,776 37 96 2 6 5,000 3,000 60 1,700 34 300 6 7 5,000 2,500 50 2,300 46 100 2 100 2 8 5,800 3,190 55 2,378 41 174 3 58 1 9 6,500 3,900 60 2,440 36 65 1 195 3

10 7,000, 3,360 48 3,290 47 140 2 210 3 11 7,500 4,050 54 2,925 39 300 4 150 2 75 12 8,000 4,400 55 2,240 28 560 7 800 10 13 9,500 6,650 70 2,755 29 95 1 14 9,600 5,568 58 3,360 35 384 4 288 3 15 10,000 7,300 73 2,500 25 200 2 16 11,000 7,590 69 2,750 25 440 ,4 220 2

Total and differential leucocyte counts were performed in.17 patients suffer- -ing from infective hepatitis. -

A leucocytosis was present in -5 cases, associated with· an increase in the neutrophil polymorph count 4 cases and with an eosinophilia in 1 case. In the remaining 12 cases, the European type of distribution 'was absent from the differ-ential count in only 2 cases.

TABLE X.-TOTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN ADULT MALE EAST AFRICAN

NATIVES SUFFERING FROM INFECTIVE HEPATITIS

Total Neutrophil Lympho- Mono- Eosino-Serial counts polymorphs % cytes % eytes % phils % Basophils %

1 4,000 2,000 50 1,800 45 80 2 120 3 2 4,400 2,288 52 1,980 45 132 3' 3 4,500 2,475 55 1,800 40 90 2 135 3 4 5,000 3,250 65 1,500 30 100 2 150 3 5 5,200 3,016 58 1,976 38 104 2 104 2 6 5,200 2,340 45 2,756 53 104 2 7 5,500 3,245 59 2,090 38 110 2 55 1 8 5,800 1,624 28 3,770 65 240 4 174 3 9 6,000 3,720 62 1,800 30 300 5 180 3

10 6,500 3,315 51 2,860 44 195 3 130 2 11 6,800 4,012 59 2,380 35 272 4 136 2 12' 7,000 4,200 60 2,380 34 210 3 210 3 13 8,200 5,330 65 2,378 29 246 3 246 3 14 8,200 3,690 45 3,608 44 164 2 738 9 15 10,000 7,400 74 2,400 24 100 I 100 I' 16 12,000 9,000 75 2,400 20 360 3 240 2 17 13,000 8,450 65 3,900 30 520 4 130 1



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. Finally total and differential leucocyte "counts were performed in 39 cas~s of short-term pyiexia of uncertain origin. In 31 of these cases the total and differential counts were within normal limits as defined above for adult male East African natives. The remainder showed a leucocytosis associated with an increase in the neutrophil polymorph count. It is our opinion that these cases of short-term fever are really cases of malaria, in which the parasit,a~mia is submicroscopic in density [2]. The findings in the total and differential. counts in no way conflict with this hypothesis (see Table XI).

Few papers appear to have been published, which deal in any detail with the variations in the leucocyte count in ,adult male East Afl1ilcan natives. Hennessey [3] performed total leucocyte counts on 50 apparently healthy convicts in Uganda attd found a me¥l:n of 8,100 tells per c.mm. He did not record any differential counts. Apart from excluding convicts with malarial parasites in the blood stream or with a history of a recent overt attack of malaria, he gives no details of the criteria adopted in his assessment of healthiness. Indeed, he himself points out that no assessment can be made of the

TABLE XL-TOTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN ADULT MALE EAST AFRICAN

Serial

I 2 3 4 5 6 7 8 9

10 II 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

NATIVES SUFFERING FROM PYRE.XIA OF UNCERTAIN ORIGIN

Total counts

3,500 3,600 4,000 4,000 4,000 4,200 4,500 4,600 4,800 4,800 4,900 5,000 5,200 5,300 5,400 5,500 5,600 5,800 5,900 6,000 6,000 6,100 6,200 6,300 6,400 6,500 6,600 6,800 6,900

Neutrophil polY1norphs'

1,505 '2,016 1,720 2',400 1,600 1,260 1,575 1,840 1,680 2,256 1,666 2,300 2,548 2,279 2,592 2,475 2,240 2,494 2,419 2,760 1,980 2,623 2,666 4,158 2,752 2,925 2,606 1,564 4,002

0,1,

43 56 .

43 60 40 30 35 40 35 47 34 46 49 43 48 45 40 43 41 46 33 43 43 66 43 45 41 23 58

Lymphocytes

1,750 1,368 2,000 1,600 2,200 2,520 2,475 2,530 2,736 2,400 2,940 2,500 2,600 2,650 2,160 2,750 2,800

.2,900 3,422 2,880 3,540 3,355 3,100 1,890 3,392 3,120 3,630 4,828 2,760

%

50 38 50 40 55 60 55 55 57 50 60 50 50 50 40 50 50 50 58 48 59 55 50 30 53 48 55 71 40

Monocytes

210

200 210 270 184 384 144 245 100

265 432 165 224 290

180 420

372 126

130 264 264 138

%

6

3

5 5 6 4 8 3 5 2

5 8 3 4 5

3' 7

6 2

2 4 3 2

Eosinophils

35 216 160

210 180 44

49 100 52

106 216 110 336 116 59

180 60

122 62

126 256 325

264

% Basophils %

I 6 4

5 4 I

1 2' 1 2 4 2 6 2 1 3 1 2 1 2 4 5

3



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Total Neutrophil Lympho- Mono- Easino-Serial counts polymorphs % cytes % cytes % phils % Basophils %

30 7,000 3,990 57 2,800 40 140 2 70 1 31 7,000 4,130 59 2,450 35 280 4 140 2 32 7,600 . 4,408 58 2,736 36 152 2 304 4 33 8,000 4,240 53 3,200 40 240 3 320 4 34 8,000 5,600 70 2,080 26 160 2 160 2 35 8,800 4,664 53 3,168 36 176 2 792 9 36 9,000 6,030 67 2,790 31 180 2 37 9,200 5,060 55 3,220 35 184 2 736 8 38 9,600 6,432 67 2,880 30 192 2 96 1 39 11,000 5,060 46 4,950 45 660 6 330 3

effects of parasitic infestation on his results-a statement which suggests that his material was not as carefully screened as ours. It may well be that this explains the discrepancies in our results. ,

In seeking for explanations of the diminished neutrophil polymorph count which we had found in 3 out of every 4 apparently healthy adult male East African natives we initially postulated racial andj or dietetic factors as likely causes. But total and differential leucocyte counts performed on 3,3 adult male Europeans, who had been screened in exactly the same manner as the East African natives before being deemed healthy, revealed that 8 out of these 33 Europeans had differential counts in which the normal neutrophil polymorphjlymphocyte ratio was reversed. It seems unlikely, therefore, that the alterations in the normal East African native counts can be due to either racial or dietetic factors (see Table XII).

Roberts [4] examined 200 healthy adult male Europeans in Nairobi._ He found a mean total leucocyte count of 7,600 cells per c.mm. with a range from 4,000 to 9,900 per c.mm. He also obtained' weekly serial counts on 12 newly arrived R.A.F. personnel. During a five-week period, the neutrophil polymorphs fell from 58 per cent to 50 per cent of the total counts, while the average total count rose from 7,400 to 9,400 cells per c.mm. He concluded that changes in the leucocyte series appear to be influenced both by altitude and sun, and that polymorphonuclear reduction takes place in the heat of the Red Sea with a further reduction caused by altitude on arrival at Nairobi ..

The 8 Europeans, in whom we found reversal of the' polymotphjlymphocyte ratio, were all encountered at Mackinnon Road at an altitude of about 1,100 ft. No such reversal was found in the 18 Europeans examined a t Nairobi at an altitude of 5,500' ft.; they all had normal total differential leucocyte counts. A further 12 Europeans with reversal of the polymorphjlymphocyte ration were encountered at Mackinnon Road, suffering from either malignant tertian malaria or shorHerm fevers-diseases which in East Mrican natives have little effect on the leucocyte count. No such cases have been encountered in Nairobi. While, therefore, we agree with Roberts that sunlight is the most likely cause of the diminution in the neutrophil polymorph count, our results give no support to his contention that altitude also has an effect upon the neutrophil polymorph count. .



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TABLE XII.-ToTAL AND DIFFERENTIAL LEUCOCYTE COUNTS IN APPARENTLY HEALTHY

EUROPEAN MALE ADULTS SERVING IN EAST AFRICA

Serial

2 3 4 5 6 7 8 9

10 I I 12 13 14 IS 16 17 18 19 20. 21 22 23 24 25 26 27 28 29 30 31 32 33

Total counts

4,000 4,600 5,000 5,200 5,40.0. 5,600. 5,600 5,800 6,000 6,200 6,200. 6,40.0. 6,40.0. 6,600 6,600 6,800 6,800 7,000 7,0.0.0. 7,0.0.0. 7,20.0 7,200 7,400 7,800 8,0.0.0. 8,0.0.0. 8,0.0.0. 8,200 8,400 8,500 8,900 9,10.0. 9,80.0

Neutrophil polymorphs

2,280 2,852· 3,150 2,80.8 2,80.8 4,144 2,856 3,480 4,080 3,968 3,472 2,752 2,368 1,716 2,640 4,488 3,740 1,680 3,50.0.

, 3,850. 4,032 4,104 2,442 3,822 4,40.0.' 5,360. 6,240. 4,756 3,612 ~,695 4.549 5,915 7,0.56

% 57 62 63 54 52 74 51 60 68 64 56 43

'37 26 40 66 55 24 50. 55 56 57 33 49 55 67 78 58 43 57 51 65 72

Lymphocytes

1,560 1,518 1,800 2,340. 2,538 1,344 2,632 2,262 1,800 2,0.46 2,356 3,20.0. 3,584 4,752 3,498 2,108 2,448 4,620. 2,730. 2;870. 2,664 3,096 4,366 3,744 3,280. 2,160. 1,20.0. 3,116

, 4,620

2635 4,094 2,912 2,450.

%

39 33 36 45 47 24 47 39 30 33 38 50. 56 72 53 31 36 66 39 41 37 43 59 48 41 27 15 38 55 31 46 32 25

Mono-cytes %

120 3 184 4

54 I 112 2 112' 2 58 I

120 ,2

372 6' 320. 5

64 I 66 1

26-1- 4 204 3 340 5 420. 6 210. 3' 140. 2 288 4

296 4 78 I 80. I

320. 4, 320. 4 246 3'

170 2 178 2 273 3 98 I

Eosino-phils

40 46 50. 52

186

128 384

198

272 280. 350.

70. 216

296 78 80.

160. 240. 82

168

89

196

% Basophils %

1 1 1 1

3

2 6

3

4 4

66

5 210. 3 1 70. I 3

4 1 78 1 160. 2 2 3 1 2

2

From the practical point of view, total and, differential leucocyte counts have proved most useful'in two ways. Firstly, in the adult male East African native admitted with fever but no symptoms or signs pointing to any particular part of the body, the counts help in differentiating between an undeclared infection, most commonly in the respiratory tract, and an attack of malaria with a parasit~mia of submicroscopic density. Secondly in patients with a frank malarial parasitcemia who respond slowly to antimalarial therapy, the counts are helpful III excluding concurrent infections, particularly of the respiratory tract.

SUMMARY

Total and differential leucocyte counts have been performed on 480 adult male East African natives.

In apparently healthy natives, the total leucocyte ~ounts are lower than



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those accepted as normal for Europeans in temperate climates; and in 3 out of every 4 healthy natives the distrib,ution of the differential count differs from that in Europeans. Both differences ,are due to the small number of neutrophil polymorphs in' the circulating blood.

In patients suffering from malignant tertian . malaria and from short-term fevers, the total and differential leucocyte counts are usually unchanged but in both groups a leucocytosis occurs in about 1 patient in every 5.

In schistosomiasis, the total and differential counts are usually unchanged unless eosinophilia is present or secondary pyogenic infection gives rise to a leucocytosis.

In patients suffering from pyogenic and dysenteric infections and from infective hepatitis a leucocytosis is common and the differential counts show a European distribution whether or not a leucocytosis occurs.

Similar findings in pulmonary tuberculosis render the total and differential leucocyte counts useless as an aid to differentiating tuberculous from pyogenic infections of the respiratory tract.

The possible causes of the small number of neutrophil polymorphs in the circulating blood of most adult male East African natives and of a small prcr portion of Europeans serving in East Africa are discussed.

The chief uses of leucocyte counts in military medical practice among East African natives are indicated.

REFERENCES [1] WHITBY and BRITTON (1946) Disorders of the Blood. 5th Edition. [2] FAIRLEY, N. H. (1947) Transactions of the R?yal Society of Tropical Medicine and

Hygie-ne, 40, No.' 5. [3] HENNESSEY, R. S. F. (1936) East African Medical Journal, 13, No. 7. [4] ROBERTS, J. I. (1948) Journal of Tropical Medicine and~Hygie-ne, 51, No. 12.



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some observations on the total and differential leucocyte counts in' adult...

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