Overwhelming Infection and the Battle of New Market

The presence of an excess of immature white blood cells indicates the infectious process is overwhelming the immune system.

 In 1864, the Confederacy was losing the War Between the States (or, as the American Civil War was known in the South, the War of Northern Aggression).  Grant’s armies were moving into Virginia, so a stand was made by the Confederacy to hold the Union forces near the small northern Virginia town of New Market.  However, because the South’s forces were so severely depleted, additional troops were sought for fighting in the ensuing Battle of New Market in the form of cadets from the Virginia Military Institute out of Lexington, VA.  College boys aged 15-21 were sent to fight a man’s war.  Of the 257 cadets in the battle, 10 cadets died in the struggle, and 48 were wounded. 

This tragic circumstance is an analogy for what happens to the body’s defenses when it is overwhelmed by a severe bacterial infection.   White blood cells, primarily polymorphonuclear neutrophils (known as PMNs), rush toward the area of invasion, attempting to kill all the invading organisms.  As the PMNs  available become depleted, more and more are produced in the bone marrow.  Because of the demand, these developing cells start getting kicked out at earlier and earlier degrees of immaturity, which can be recognized under the microscope because their nuclei are distinctly different from those of mature PMNs.  The percentages of the various cell types are reported as a white blood cell differential count.  Traditionally, the appearance of more than usual numbers of immature forms is known as a “shift to the left,” based upon the system that was used to tally the various cell types in previous decades.

 Recognizing the desperation represented by a left shift, the astute clinician should ensure that his therapies are as aggressive as possible, lest his patient suffer the same consequences as those brave young boys at New Market.   Seeking to avoid this compensatory process by identifying and eliminating infections earlier and more effectively is our goal.  Understanding that a shift to the left represents a clinical failure to achieve our goal will be a paradigm shift in medicine.