INFLAMMATION AND LEUCOCYTE RESPONSE 65 



favorable prognosis. In two of the diseases, e.g., tuberculosis and 

 typhoid fever, in which a leucopenia is commonly encountered, one 

 may observe a degenerative shift to the left. Juvenile forms and 

 myelocj'tes do not appear in the peripheral circulation, but there 

 is an increase in the stab forms. Schilling interprets the blood pic- 

 ture during the course of an acute infection according to three 

 phases : 



Phase I. The neutrophile battle phase. 

 Leucocyte count B E M J St. S L. Mono. 



Count 'increased 16 8 55.5 18 2.5 



This phase characterized by neutrophilia with a severe regenera- 

 tive nuclear shift. Lymphopenia, monopenia, and eosinopenia 

 occur at the peak of the infection. 



Phase II. The phase of monocyte defense. 

 Leucocyte count B E M J St. S L. Mono. 



High normal 2 7.5 58.5 15 17 



Here one knows from the receding neutrophilia and the shift to 

 the right, from the reappearing eosinophiles, the rising number of 

 lymphocytes and the high number of monocytes that the critical 

 terminal period of the infection has arrived when the patient puts 

 up an energetic defense. 



Phase III. The phase of lymphocyte cure. 



Leucocyte count B E M J St. S L. Mono. 



High normal 7 4 .33.5 42.5 13 



This stage is characterized by Ivmphocytosis, eosinophilia with 

 no neutrophilic shift. 



Schilling says that the persistence of a high neutrophilic shift 

 and high monocytosis with few eosinophiles indicates a condition of 

 chronic infection. 



Leucopenia.* — An excellent discussion of the factors involved in 

 leucopenia is given by La^vrence (1941). He lists the following 

 five major mechanisms which may operate in the production of 

 this condition : 



1. Diminished production of leucocytes due to (1) simple in- 

 hibition, (2) arrested maturation, (3) bone marrow aplasia and 

 (4) infiltration of foreign cells into the bone marrow. 



*A recent paper of interest is by Olitzki. L., Avinery, S. H., and Bendersky, 

 J. : The Leucopenic Action of Different Microorganisms and the Antileucopenic 

 Immunity, J. Immunol. 41: 361, 1941. 



