760 APPENDIX TO THE DISEASES OF THE SPLEEN. 



was found that the enlargement of the spleen and glands existed for 

 months and years before the disorder of the blood showed itself. 



As the blood becomes impoverished in red corpuscles, the patient 

 becomes pale and cachectic ; and as the corpuscles not unfrequently 

 become fewer in leuchaemia than in the highest grades of chlorosis, 

 the patients have a waxy appearance in typical cases. There are also 

 almost always complaints of want of breath and hastened respiration, 

 for which symptoms no sufficient explanation can be found in the respi 

 ratory organs, and which appear due to decrease of red blood-corpuscle, 

 by which the exchange of gases in the lungs is apparently effected. 

 If the diaphragm be much pressed upward by the enlarged spleen, or 

 if, as often happens, bronchial catarrh develop in the course of the dis- 

 ease, the dyspnoea may become very great. Such a combination of 

 symptoms should always excite the suspicion that the patient is suffer- 

 ing from leuchaemia, and induce an examination of the blood. For 

 this purpose we do not need a large venesection, and the debilitated 

 and bloodless state of the patient almost always forbids this. In the 

 blood that has been drawn we find at the border, between the buffy 

 coat and the clot, single clumps, or a connected, loose, grayish layer, 

 consisting of colorless blood-corpuscles. If, by beating, we free the 

 blood that has been drawn of its fibrin, after standing for some time in 

 a narrow glass, the heavy red corpuscles sink, and the lighter colorless 

 ones form a whitish, purulent-looking, or milky layer in the upper part 

 of the vessel. If we place a drop of the blood, recently drawn, under 

 the microscope, we do not see a very few white corpuscles in the field, 

 as we do in normal blood, but there are quantities of them which are 

 not scattered around among the red corpuscles, but are more apt to be 

 congregated in irregular clumps, as they are very adherent. 



The course of the disease varies. In some, but, by no means, in 

 all cases, besides the above symptoms, there is a haamorrhagic dia- 

 thesis. The patients have numerous haemorrhages, from the nose par- 

 ticularly, more rarely from the intestinal canal, or into the tissue of the 

 skin, sometimes into the brain. The fatal termination is hastened by 

 tiiis complication. The patients either die suddenly of apoplexy, or 

 are so exhausted by repeated and abundant loss of blood that they 

 soon die of exhaustion and anaemia. If a haemorrhagic diathesis does 

 not develop, the disease almost always runs a tedious course, and may 

 even continue for years. In such cases the enlargement of the spleen 

 and lymphatic glands reaches a very high grade ; the tension of the 

 capsule of the spleen, and the inflammatory irritation in it, developed, 

 perhaps, by the tension, or by haemorrhagic infarctions accompanying 

 the hypertrophy, cause occasional pain in the region of the spleen and 

 febrile symptoms. In these protracted cases the liver also is gener- 



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