2/8 CLINICAL BACTERIOLOGY AND H^MATOLOGY 



polychromasia, are very common, occur in comparatively mild 

 grades of anaemia, and have not the serious import they have 

 in the adult. 



Leucocytosis in Anamia in Infants. This is very common, 

 20,000 to 60,000 being* frequently met with ; in most cases there 

 is a predominance of lymphocytes, and the presence of myelo- 

 cytes is quite common, rendering the diagnosis from leucocy- 

 thaemia a matter of some difficulty. As a general rule, the 

 presence of a high leucocytosis in infantile anaemia is a bad 

 sign, and indicates a worse prognosis than if it is absent. 



Secondary Anamia in Infancy (Syphilis, Rickets, Scurvy, 

 Tubercle, etc.). There are no characteristic changes by which 

 the different causes of secondary anaemia can be recognized. 

 The colour-index is usually low (especially, perhaps, in 

 syphilis), normoblasts are not uncommon, an occasional 

 megaloblast may be seen, and there is often leucocytosis, with 

 increase of lymphocytes. 



Fon Jaksch's An<zmia(An(zmia Infantum,Pseudo-leuk<zmia). 

 It is uncertain whether this is to be considered as a definite 

 disease, as an intermediate form between pernicious anaemia 

 and leucocythaemia, or as a form of secondary anaemia with 

 somewhat characteristic blood changes. I am rather inclined 

 to the belief that it does represent a definite blood disease, but 

 that it is frequently associated with, and perhaps due to, other 

 diseases such as syphilis, rickets, tubercle, or gastro-intestinal 

 diseases. The blood changes are (i) An excessive grade of 

 anaemia, usually associated with a low colour-index; in some 

 cases, however, it may be high, and I have seen it as high as 

 i '8. (2) High leucocytosis, often 50,000 or more, with extra- 

 ordinary changes in the leucocytes, so that they can hardly be 

 classified on the usual lines; myelocytes are not uncommon. 

 (3) Striking and profound changes in the red corpuscles, the 

 most important being the presence of numerous normoblasts, 

 many of which show dividing nuclei (Plate VIII., Fig. 8); 

 megaloblasts and atypical forms occur, but are less numerous. 

 The non-nucleated red corpuscles show all forms of degenera- 

 tion, poikilocytes, megalocytes, and microcytes being present, 

 whilst many are affected with granular basophilia (Plate VIII., 

 Fig, 2) or polychromatophilia (Plate VIII., Fig. 3). In severe 

 cases the majority of the red corpuscles may be abnormal, 

 and the appearance of the stained films is very extraordinary. 



