LEUKEMIA 87 



blasts but when present normoblasts and microblasts. The hemo- 

 globin index is low, that of secondary anemia. In fact all the 

 changes described are those belonging to secondary anemia as 

 shown by the following descriptions of Meier's cases. 



No. 13, great variation in size and shape of erythrocytes; few 

 megalocytes, many microcytes, many poikilocytes, no erythro- 

 blasts. 



No. 14, poikilocytosis; many megalocytes and microcytes, no 

 erythroblasts. 



No. 15, normo- and micro-blasts; many microcytes and small 

 poikilocytes. 



No. 16, many micro- and poikilocytes, small erythroblasts. 



No. 17, poikilocytosis and endoglobular degeneration of ery- 

 throcytes; many microcytes, small erythroblasts. 



No. 18, moderately many poikilocytes, many microcytes and 

 megalocytes, no erythroblasts. 



No. 19, marked deformation of erythrocytes; poikilocytosis, 

 megalocytes, microcytes and normoblasts, uneven staining of 

 erythrocytes. 



LEUKEMIA (LEUCOCYTHEMIA) 



Leukemia is a primary disease of the blood and blood-forming 

 organs. It is in the majority of instances a chronic disease char- 

 acterized by the presence of an enormous number of leucocytes 

 in the circulating blood, associated with anemia, though the essen- 

 tial characteristic is not so much the large number of leucocytes 

 as the varieties and proportions of these which are found. 



Two varieties of leukemia are described, (1) the mixed-celled 

 (myeloid, myelogenous, myelogenic, spleno-medullary, myelemia) 

 and (2) lymphatic (lymphoid, lymphemia), which are differen- 

 tiated by the condition of the blood and the blood-forming organs. 



(1). In mixed-celled (myelogenic) leukemia the circulating 

 blood usually contains an excessive number of leucocytes, many of 

 which are of varieties not found in the normal circulating blood. 

 In typical cases the red corpuscles are diminished. In 47 cases in 

 man, Cabot found an average of 3,120,000 per cmm. Toward 

 the end of the disease or with intercurrent disease the number 

 may be much reduced, 2,000,000 or less. The hemoglobin is re- 

 duced in the early stages more than the number of red corpuscles; 



