Evening star. [volume] (Washington, D.C.) 1854-1972, 1931-08-21
AgranuIoCytic Angina, First
Recognized in Germany,
May Be Increasing.
is FATAL
IN MAJORITY OF CASES
Complete Absence of White Blood
Cells, Gangrene and Fever
Clinical Features.
BY THOMAS r.. HENRY.

A rare new disease, fatal in the great
majority Of cases. which may be rapidly
increasing in the United States and
winch appears TO be associated in some
way with carbon monoxide gas from au-
tomobile exhaustS and from other types
OF gas-producing machinery, is described
in the current medical bulletin Of the
United States Veterans Bureau.
rms disease, agranulocytic angina,
was f1rst recognized in Germany nine
years ago. Since then scattered cases
have been diagnosed in the United
States. and the medical bulletin records
the striking case of World War vet
eran for whom all hope had been given
up. but who revived suddenly at the
point OF death. Whether an expert
mental treatment adopted at that time
was responsible for his recovery or
whether the two were merely eoinci-
dental Is not known
The disease is described as character
lied by three clinical features. First.
there Is almost a complete absence of
ACKNOWLEDGEMENTS cells in the blood
These constitute about 10 per cent of
the white blood cells. Normally they
are manufactured in the bone marrow,
which appears to suspend operations al
together for some unknown reason
Secondly, gangrene makes its appear
ance. usually in the throat. The third
feature is a prostrating fever. Most
cases thus far encountered have de-
veloped very rapidly, death following
within few days.
Resembles Septic Infection.
The remarkable Veterans Bureau
case is reported by Drs. Henry A. Dykes
and M. T, Moorefleld of the United
States Veterans Hospital at Kansas
City. In many ways. they report, the
disease resembles a septic infection, but
no constant organism has ever been
found. Poison gases have been
thought to have possible connection
The disease appears to be on an increase
paralleling the increase in automobiles
and other gas-producing machinery.
This has led some investigators to sus-
pect that carbon monoxide or other
products OF combustion might play some
part. Two naval medical officers dfd
some very good experimental work in
this connection after noting the occur
renee Of agranulocytosis in sailor who
bad been exposed to the gas from gun
fire. A group OF men were subjected
to blood examination before and after
exposure to the gas from these guns.
In many cases they noted a lowering
OF the count.
The Kansas City case which they de-
scribe was that Of a young veteran who
had been employed since the war as a
fireman on oil-burning locomotives and
he himself regarded his condition as due
TO his long exposure to the gases pro-
duced. He was admitted to the hospital
for minor ailment and it was during
the course Of this treatment that an in
cioentsl blood test showed that the pol
umorphonuclear cells suddenly had al
most entirely disappeared. The gan
grenols condition OF the throat and
mouth followed rapidly and in q few
days the man is described as Gin ex-
tremiS, irrational, with temperature of
1o5 and pulse of 40. There is no
known treatment for the disease and
the man was given up for dead.
Recovery Proves Puzzle.
At this time cultures OF the mouth re-
vealed the presence of one of the strep-
tococcus micro-crganisnns and the pfly-
Sicians began simultaneous injections
OF the well known anti-streptococcus
serum. The patient began to recover.
within two days the missing white blood
cells were reappearing and within
month he left the hospital in good con-
clifton. In reporting this cure, the two
physicians have no theory as to why
the serum worked as 1t did, If the pa
TENTS recovery was not q coincidence.
They question whether the strepto
coccus itself was at the bottom of the
trouble, although 1t may have aggra-
waited 1t, because other cases of which
the diagnosis was Just as clear failed to
show this organism. but did show un-
related heterogeneous Only repeated
use OF the serum would establish the
cure as valid
Why they say "the bone marrow
cells OF this mans body went on strike
and ceased the manufacture of poIv-
morphonuclear leucocyteS is beyond ol1r
limited knowledge, and why these same
Cells should suddenly resume their out
pouring when life seemed at its very
lowest eob Is even more perplexing. 1t
seems quite possible that poisonous
gases, acting over period Of months
or years, might injure the bone marrow
cells to an extent that would render
ICrther leucocytogenesis impossible"
Few Recoveries Reported.
Earlier reports Of this disease, they
point out, showed an approximate 90
per cent mortality. Recently there have
been a few recoveries besides that OF the
veteran and at the Johns Hopkins Uni
versity Hospital in Baltimore a case
has been found with cyclic recaveries
and relapseS extending over MANY wears
First described as disease entity by
the German physician, Warner Schulz.
in 1922. they point out, agranulocytic
angina probably hes been in existence
for a much longer period and a very
similar condition was pictured In Ger
many as far back as 1907, at the very
dawn of the carbon monoxide era. 1t
may be, they say, that minor upsets in
the bone marrow mechanism which pre-
vents the manufacture OF the blood
cells are fairly common, but cause little
discomfort and go unncticed except
when they become suddenly aggravated.
ON the other hand" the report con-
cludes, cit may develop that this Is a
new and rapidly increasing disease