LEUCAEMIA LEUCOCYTH^IMIA. 759 



was also diseased, but Virchow saw one case where the spleen was of 

 normal size. I myself have seen a case on which there was no au- 

 topsy, but in which no decided enlargement of the spleen could be 

 observed during life, while the lymphatic glands were enormously en- 

 larged. In all the cases the enlarged lymphatic glands were quite 

 soft and pale, their surface smooth and watery-looking, the cortical 

 substance was particularly swollen, in some cases to the thickness of 

 one-half to three-fourths of an inch ; it had a homogeneous, almost me- 

 dullary, appearance, and, on pressure, evacuated a turbid, watery fluid. 

 Microscopic examination showed that the enlargement was entirely due 

 to an excessive formation of cells, nuclei, and granules, similar to those 

 occurring in normal glands. In most cases of this disease, the liver 

 was found enlarged; it was occasionally soft, but usually hard and 

 dense. 



An exceedingly interesting pathological new formation of lymphatic 

 elements, outside of the lymph-glands, has been observed in some cases 

 of leuchsemia. In two cases, in the parenchyma of the liver, and in 

 one case in the kidneys also, Virchow found small white spots, from 

 which, on pressure, there was evacuated a whitish fluid, consisting only 

 of closely-packed free nuclei, and some small cells, which were almost 

 filled by their nuclei. The new formation was enclosed by a fine mem- 

 brane, could be quite readily freed from the surrounding parenchyma, 

 and appeared to come from the walls of the blood-vessels and bile- 

 ducts. Bottcher observed a similar case. And, in one case of leuchae- 

 mia, Friedreich found extensive proliferation of nuclei and small cells, 

 not only in the liver and kidneys, but also at circumscribed spots in 

 the pleura, and in the gastric and intestinal mucous membrane, which 

 caused partial thickenings of the pleura, and numerous elevations, of 

 varied extent and prominence, in the stomach, small intestines, and 

 rectum. Friedreich also succeeded in proving that the leuchaemic 

 tumors of the pleura and intestinal mucous membrane originated from 

 the connective-tissue corpuscles of those membranes. 



SYMPTOMS AND COURSE. Usually the first symptoms of leuchaemia 

 are swelling of the abdomen, a feeling of pressure and fulness in the 

 left hypochondrium, and other signs of enlargement of the spleen. 

 The enlargement has either come on without pain or fever, so that the 

 time of its occurrence could not be dated, or it has taken place at in- 

 tervals, during which there was pain in the region of the spleen, and 

 the patient was feverish. And in the lymphatic form, also, the en- 

 largement of the glands in the neck, axilla, etc., which has taken place 

 slowly, or at intervals, first calls attention to the disease. In a few 

 well-observed cases, which throw a very clear light on the dependence 

 of the dyscrasia on the disease of the spleen and lymphatic glands, it 



