Schilling-Torgau divides his polymorphonuclears into: (1) The myelocyte which is always of course a pathological cell. (2) The immature form polymorphonuclear. In this there is a close resemblance to the neutrophile myelocyte but there is a nuclear indentation instead of the round nucleus of the myelocyte. It is this cell which often puzzles us as to whether to regard it as a true myelocyte. It is the meta-myelocyte of many authorities. (3) Between the mature or segmented polymorphonuclear and the immature one or metamyelocyte we have what may be designated the band-form nucleated one. These show the type of nucleus which one is familiar with in the nucleus of the transitional. (4) The mature, multilobed or segmented nucleus of the typical polymorphonuclear.
It would seem that if all tropical workers would agree upon some single method of recording differential counts it would be advantageous.
Under the blood findings in liver abscess, in a paragraph to follow in this chapter, I give suggestive counts indicating the value of Schilling-Torgau’s method.
In the differential count he not only divided up the polymorphonuclears but makes no separation of small from large lymphocytes. Although I have always divided lymphocytes into large and small ones I believe it unnecessary and unpractical and shall henceforth group all such cells in one grouping. The statement that large mononuclears and transitionals are cells of a similar origin, type and significance has always been my view.
Scheme of Schilling-Torgau
| Type of Cell | Normal Percentage | Percentage Moderate Sepsis (W. C. 14,000) | |
| 1. Mast cells | 1 | 1.0 | |
| 2. Eosinophiles | 3 | 1.5 | |
| { a. myelocytes | 0 | 0.5 | |
| 3. Neutrophiles | { b. immature forms (metamyelocytes) | 0 | 5.0 |
| { c. band-form (Stabkernige) | 4 | 13.5 | |
| { d. multilobed (Segmentkernige) | 63 | 64.0 | |
| 4. Lymphocytes | 23 | 10.5 | |
| 5. Large mononuclears and transitionals | 6 | 4.0 | |
Blood Culturing
Among tropical diseases, only malta fever, kala-azar and plague demand this method of diagnosis, although there are met commonly in the tropics many cosmopolitan diseases in which blood culturing is a principal diagnostic procedure. There are many ways of carrying out the cultivation of organisms from the blood but the one which may be strongly recommended is the following. The blood is obtained from a vein, the overlying skin of which has been painted with tincture of iodine to insure a sterile skin surface.
A stout hypodermic needle is attached to about 6 inches of rubber tubing which in turn is pushed over a downward bent glass tube which passes through a doubly perforated rubber stopper. A second glass tube, which also passes through the stopper, is bent upward to be attached to a second piece of rubber tubing for use in suction by the mouth. The glass tubes project about ½ inch below the under surface of the rubber stopper and above are about 2½ inches including the bent arm. This system of tubing and stopper is readily sterilized by boiling in a pan or instrument sterilizer. As a receptacle for the blood we employ Erlenmeyer flasks of 100 cc. capacity, containing 25 cc. of salt solution with 1% of sodium citrate, for prevention of coagulation. Blood that contains 0.2% of sodium citrate will not coagulate so that a 0.5% solution could be used instead of the usual 1% one. These citrated salt solution flasks are plugged with cotton, sterilized and kept on hand ready for immediate use, so that we only have to sterilize the stopper and tubing by boiling and flame the neck of the flask when removing the cotton plug to insert the stopper of the system. By suction we can take any amount of blood desired. I usually count the drops of blood as they fall into the citrated salt solution allowing 16 drops to the cc. In this way we may take from 10 to 25 cc. of blood at the bedside and then later on in the laboratory, when it is convenient, inoculate various media from the flask. For plates add 2 or 3 cc. of this citrated blood to 6 or 8 cc. of melted agar at 45°C. The blood mixture can also be added to various sugar bouillons for fermentation reactions. Finally we place the receiving flask in the incubator and culture it as well as the other media.