In recent years many reports (1 through 14) have appeared of a condition first described by Schwarz (15) and called by Schultz (16) agranulocytic angina. This is characterized by fever, by intense prostration, by a sore throat, sometimes almost gangrenous in appearance, by largepurpuric areas on thebody which frequently become necrotic, and by a marked leukopenia, especially of the polymorphonuclear cells. The courseis usually acuteand the mortality is so high that when a patient recovers it is sufficently significant to merit a report.

No definite causative agent has as yet been found. Moreover, some skepticism exists as to whetheragranulocytic angina is a clinical entity (14). Blumer (17) describes agranulocytosis, the outstanding feature of the condition, in other infectious diseases and Wilson (18), and McCord (19) point out its occurrence in arsenic and benzene poisoning. On the Second Medical Division of Bellevue Hospital a considerable depression of the granulocytes was found in some of the patients with pneumonia and tuberculosis. Roberts and Kracke (20) believe that there is a definite disease entity known as agranulocytosis and base their opinion on a case which showed a marked marrow deficiency before anyother symptom or sign occurred. Their conclusion does not necessarily follow because blood cell response usually precedes other symptoms and signs in most conditions. For instance a nmrked" shift to the left" of the polynuclears in an infectious condition is usually present from 24 to 48 hours before other symptoms and signs are seen (21). The present evidence makes it probable that agranulocytosis is due to a depression of the production of granulocytes or of their delivery into the circulation because of an 381