THE SCIENCE AND ART OF PROTEAL THERAPY 133 



leucocyte count from 5,800 to 13,000, showing that the infection 

 was really more significant than the clinical symptoms might 

 have suggested. Obviously there was a marked stimulus to the 

 blood-forming organs. An interesting feature of this case is 

 that the presence of normoblasts and of amoeboid red cells taking 

 a coppery stain was observed two days before the onset of the 

 symptoms of what appeared to be an incipient influenza, which, 

 however, proved abortive. 



While the observation of the red cells On the smear may thus 

 give items of highly interesting and important information, it 

 goes without saying that the chief interest of the smear resides 

 in the observation of the white corpuscles. No one who has read 

 the earlier chapters of this book needs to be told that I regard 

 the differential count as of supreme importance. But I would 

 emphasize the fact that a good many illuminative things are to 

 be learned from careful observation of the leucocytes, connoting 

 their size, form, staining qualities, tendency to agglutinate, and 

 the like, quite without reference to the differential count, or, better 

 stated, as supplementary to that count. 



It is a not unfamiliar experience, for example, that a series 

 of slides obtained under closely similar conditions of technique, 

 and with the same stain, show striking modifications of the 

 color reaction of the white corpuscles. One slide may show 

 corpuscles that scarcely take the stain at all ; a second shows the 

 nuclei with a deep bright blue stain; a third shows corpuscular 

 nuclei of a purplish color. 



Assuming that the stain used is one of the varieties of the 

 methylene blue and cosine combination (Hastings', for example), 

 it may be accepted, I believe, that the cells showing the purplish 

 nuclei are the ones that more closely approximate the normal. 

 On the other hand, the cells that take the bright blue stain are 

 somewhat characteristic of conditions in which there is known to 

 be very marked disturbance of protein metabolism (for example 

 late stage cancer), and I have come to regard them as in a 

 measure pathognomonic of disturbed protein metabolism, how- 

 ever superinduced. As suggesting this condition, they are, I 

 believe, of distinct diagnostic value. 



It is natural to assume that cells that take the blue stain have 

 an exceptionally acid quality, since they show an affinity for 

 the basic dye. Frequently such cells show cytoplasm in which 

 the esinophile granules of the normal cell are invisible or but 

 very faintly revealed. 



I have frequently observed that cells that show these qualities 

 have a tendency to agglutinate or clump together. Not infre- 

 quently a smear may show the entire leucocyte population scat- 

 tered into a windrow at the end, even though the red corpuscles 



