64 



IMMUNOLOGY 



The segmented forms constitute the major portion of the neutro- 

 philes. The cytoplasm is mature and filled with neutrophilic 

 granules. The nucleus consists of two to five unequal segments 

 united by fine threads. A Schilling hemogram follows : 



HEMOGRAM* 



*After Schilling: The Blood Picture, The C. V. Mosby Co., p. 148. 

 'Per cent. 



From an inspection of the differential count recorded in the 

 above hemogram it is obvious that the young forms of neutrophiles 

 (stab forms) and their precursors are recorded to the left of the 

 line separating the stab forms from the older or segmented neutro- 

 philes. For various reasons Schilling has found it expedient to 

 place the basophiles and eosinophiles on the left and the lympho- 

 cytes and monocytes on the right. 



When a blood count is made on a patient suffering from an acute 

 pyogenic infection, the percentages of the various types of cells are 

 recorded in this form of hemogram. When the sum of the per- 

 centages to the left or right of the dividing line between the stabs 

 and segmented nuclears shows an increase above normal, it is re- 

 corded as a shift to the left or right as the case may be. In acute 

 sepsis, appendicitis, etc., there is a high total white count with a 

 regenerative shift to the left. This is due to the appearance of 

 myelocytes and juvenile forms in the peripheral circulation and 

 also to an increase in stab forms. 



Schilling thinks that repeated counts are of great value in mak- 

 ing a prognosis. A continued or increased shift to the left is re- 

 garded as unfavorable, while a shift to right is indicative of a 



