DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 277 



The diagnosis between these forms of enlarged glands and 

 those due to tuberculosis cannot be made by a blood-count. 



LYMPHOSARCOMA is also associated with a practically nor- 

 mal blood condition, and cannot be diagnosed from aleukaemic 

 leucocythaemia and Hodgkin's disease. 



SPLENIC ANEMIA. It is very doubtful whether this disease 

 is really a distinct entity, and it is certain that many of the 

 reported cases have nothing in common but the accidental 

 and not unusual concomitance of anaemia and an enlarged 

 spleen. In the cases to which the name may fairly be applied 

 (and which are cured by splenectomy) there is idiopathic en- 

 largement of the spleen, with anaemia; the latter is usually of 

 medium grade, figures under 2,500,000 being uncommon, and 

 the colour-index is moderately low (07 to O'p). In severe 

 cases there may be numerous normoblasts, poikilocytes, and 

 polychromatophil degeneration of the red corpuscles. The 

 only feature that can be considered as characteristic is the 

 frequent presence of leucopenia with relative lymphocytosis; 

 there may be a few myelocytes. 



It may be confounded clinically with myelogenous leucocy- 

 thaemia or pernicious anaemia, but is readily distinguished by 

 the blood-count. In secondary anaemia with an enlarged 

 spleen (such as occurs in malignant disease, infective pro- 

 cesses, etc.) there will probably be a polynuclear leucocytosis. 

 Hodgkin's disease with an enlarged spleen and without palp- 

 able glands may be indistinguishable from splenic anaemia, 

 and probably some of the recorded cases have been of this 

 nature. 



ANAEMIA IN INFANCY. The rules for the interpretation of 

 blood-counts in adults are not applicable in infancy, where the 

 conditions of blood formation are so different. In particular 

 the presence of nucleated red corpuscles, and especially of 

 megaloblasts, is of little importance, and frequently occurs in 

 conditions insufficient to call for their appearance in older 

 patients. The colour-index is extremely variable; it usually 

 tends to be very low, although this does not indicate a disease 

 having any connection with chlorosis, a disease which does 

 not occur in infancy. On the other hand, a high colour-index 

 is not infrequent, and does not necessarily point to pernicious 

 anaemia, which is excessively rare. Lastly, degenerative 

 changes, such as poikilocytosis, granular degeneration and 



