406 



CHAMBERLAIN AND VEDDEE. 



5 main classes.^ Class I has a single nucleus which may be round or of irregular 

 shape. If the nucleus is round, the cell is then identical with Ehrlich's neutro- 

 philic myelocyte(3) which is not found normally in the peripheral circulation. 

 Class II includes the neutrophiles with 2 nuclei or nuclear fragments. Class III 

 has 3 nuclei or fragments and is the largest class in normal blood. Classes IV 

 and V have respectively 4 and 5 nuclei or nuclear fragments. A fairly constant 

 proportion between the different classes is found in normal blood. The "neutro- 

 philic blood picture" as given by Arnetli is for each one 100 polj'morphonuclear 

 leucocytes as follows: 



. Class I. 



Class II. 



Class III. 



Class IV. 



Class V. 



Index 



(Arneth). 



Index 

 (Bushnell 



and 

 Treuholtz). 



5 



35 



41 



17 



2 



40.0 



60.5 



Simon(3) gives the following normal range for each 100 neutrophiles: 



Class I. 



Class II. 



Class III. 



Class IV. 



Class V. 



4-9 



21-47 



33-48 



9-23 



2-4 



The so-called nuclear fragments seldom if ever represent separate nuclei, but 

 only lobes of a polymorphous nucleus, the connecting nuclear substance being 

 drawn out into a fine thread. The "index" is a standard for comparison of 

 different pictures. Arneth adopted as an "index" the sum of classes I and II 

 while Bushnell and Treuholtz selected the sum of classes I and II and one-half 

 of class 111.(13) (14) 



The polymorphonuclear leucocyte is the active phagocytic cell of the blood 

 stream and the corpuscles with 3 or 4 nuclear fragments are considered the 

 adults and are thought to be most active as phagocytes and best fitted to protect 

 the body against invading organisms. The superannuated cells represented by 

 class V and the immature cells represented by classes I and II are less able to 

 take up the defence of the body. Pottenger in a series of experiments found a 

 gradual rise in phagocytic power from class I to class IV inclusive, and a 

 decrease in class V. 



When the first and second classes are increased above normal and the third 

 and fourth are correspondingly decreased the condition is spoken of as a "shift 

 or a drift to the left" while the reverse alteration is called a "shift to the 

 right." Pottenger, (4) Klebs,(15) Kagan,(2) Minor and Ringer (13) and others 

 have found a decided shift to the left in patients with marked lesions of 

 tuberculosis and Kagan also found a less marked shift to the left in cases 



^ Arneth, subdivided his 5 main classes into a number of smaller groups 

 with distinctions depending upon the indentations and the character of the 

 loops and lobes. These sub-groups seem to us to be an unnecessary and im- 

 practical refinement and moreover the number in each sub-division is too small 

 to be of value unless 500 or 1,000 neutrophiles are counted(6). Such a procedure 

 is very time-consuming and does not appear to us to promise compensating 

 advantasres. 



