212 THE PROTEOMORPHIC THEORY AND THE NEW MEDICINE 



cocytic relations. I have known an observer, for example, to 

 make the count by running up and down the field, thus taking 

 in cross sections, instead of working backward and forward 

 laterally along the entire length of the smear. A moment's con- 

 sideration makes it clear that if the leucocytes are not evenly 

 spread on the smear, such a method may give a record that 

 quite negatives the facts. 



It is true that strictly normal blood may show a fairly even 

 distribution of the different types of leucocytes at different stages 

 of the smear. But the distribution is probably never absolutely 

 uniform, and with the blood of a patient suffering from a pro- 

 tein toxaemia of any type there is likely to be the most striking 

 unevenness. Not infrequently the small lymphocytes are nearly 

 all left near the beginning of the smear, whereas the polynu- 

 clears and large lymphocytes, and in particular the large mono- 

 cytes, are dragged along toward the end of the smear. In such 

 a case the result of a cross-section examination (up and down 

 the field as the examiner views it, instead of from side to side), 

 will depend very largely upon the particular point that chances 

 to be brought under observation. If the survey is made near the 

 beginning of the smear, the report will show a tremendous pre- 

 ponderance of small lymphocytes, if, on the other hand, it is 

 made near the end of the smear, there will be a corresponding 

 preponderance of polynuclears or large monocytes. In either 

 case, the accounting is worse than worthless ; it conveys an en- 

 tirely wrong impression of the facts. 



But the difficulties of such a case are not entirely solved merely 

 by making the lateral survey. It is true that such a survey will 

 put one on the trail of the different types of leucocytes and will 

 ultimately bring all types into the field, whether they have stopped 

 at the beginning of the smear or have been carried to its extrem- 

 ity provided, of course, that the entire length of the smear is 

 examined. But a point I have never seen emphasized is that, 

 quite obviously when your attention is called to it you do not 

 get an accurate record if you discontinue counting while in the 

 midst of the smear. It is perfectly clear that such is the case, 

 if you are going once across the smear only, since in that case 

 you may not have come to the portion of the smear that contains 

 the chief bulk, of, let us say, the large monocytes. But a mo- 

 ment's reflection will make it clear that if, after going across 

 the smear, you turn about, in the regular way, and proceed in 

 the reverse direction, you must now go clear back to the begin- 

 ning of the smear, else you will not give proper enrollment to 

 the small lymphocytes that were largely left near the bginning. 



However often you repeat the process, you must never stop 

 short of a complete traversing of the smear, if you are to give 



