MELAJLEMIA. 



ally enlarged. The patients become much emaciated, and have a very 

 pale, cachectic look; the dyspnoea increases, and becomes extreme. 

 Sediments of the urates, or of pure uric acid, are very frequently found 

 in the urine. It is possible that their formation is partly due to the 

 dyspnoea and fever ; but there is also a probability that the uric acid 

 is formed by the higher oxidation of the hypoxanthin that is so abun- 

 dant in the blood. In many cases there is bronchial catarrh, so that 

 the patients have severe cough, with mucous expectoration. Still more 

 frequently there is intestinal catarrh, which leads to obstinate diarrhoea. 

 Dropsy often occurs toward the end. That this does not occur sooner, 

 as we should expect from the analogy with other conditions where the 

 patient is pale and cachectic, is doubtless due to the fact that, in leu- 

 chaemia, the decrease of the red blood-corpuscles is not accompanied 

 by a corresponding decrease of the serum of the blood, as it is in other 

 exhausting diseases. In the later stages of leuchaemia, the fever, which 

 was at first temporary, usually becomes permanent. Uhle, who care- 

 fully measured the temperature, in one case, found a constant increase 

 of one to one and one-half degrees during the latter weeks of life. If 

 no complication occurs, death results from gradual exhaustion; it is 

 often preceded by symptoms of disturbed brain-function, delirium, or 

 stupor. 1 



TBEATMEOT. Up to the present time no case of recovery from 

 leuchaemia is known, hence we cannot recommend any treatment that 

 has actually proved successful. Quinine, iron, and iodine preparations 

 have been used on account of their efficacy in some diseases of the 

 spleen, and in anaemia. In the case of lymphatic leuchaemia that was 

 under my observation, the enlargement of the glands temporarily sub- 

 sided under the opposite mode of treatment, under the use of Zitt 

 manrfs decoction. I afterward sent the patient to a water-cure es- 

 tablishment, where he improved and became healthy-looking. After a 

 few months, however, the disease returned, advanced rapidly, and 

 ended in death. 



CHAPTER II. 



MELAN^EMIA. 



ETIOLOGY. In melanaemia there is found in the blood a gianular 

 pigment, partly free, partly enclosed in cells, partly embedded in small 

 hyaline coagula. There is no doubt that this pigment comes from the 

 coloring matter of the blood, but it is a question where and under 

 what circumstances it is formed. 



Almost all observers regard the spleen as the place where the pig- 

 ment is formed in melansemia. The frequent occurrence of pigmented 



