LEUKJEMIA. 203 



In all the other cases the result was death. I do not 

 wish by any means to infer from this that the disease in 

 question is absolutely incurable ; I hope on the contrary 

 that for it too remedies will at length be discovered ; but 

 it is certainly a very important fact that we have in it, 

 much, as in the progressive atrophy of muscles, to deal 

 with conditions, which, when abandoned to themselves, 

 or subjected to any one of the hitherto known methods 

 of treatment, continually grow worse and ultimately lead 

 to death. These cases possess, in addition, the remark- 

 able peculiarity that, usually towards the close of life, a 

 genuine hcemorrhagic diathesis is developed and haemor- 

 rhages ensue, which occur with especial frequency in the 

 nasal cavity (under the form of exhausting epistaxis) but 

 may also, under certain circumstances, take place in 

 other parts of the body, as for example on a very large 

 scale in the form of apoplectic clots in the brain, or of 

 melsena in the intestinal canal. 



Now, upon investigating whence this curious change in 

 the blood takes its origin, we find in the great majority 

 of cases that it is a certain, definite organ which presents 

 itself over and over again with convincing constancy as 

 the one essentially diseased, an organ which frequently, 

 even at the outset of the malady, forms the chief object 

 of the complaints and distress of the patients, namely, 

 the spleen. In addition, a number of lymphatic glands 

 are very frequently diseased, but the affection of the 

 spleen stands in the foreground. Only in a few cases 

 have I found the change in the spleen the less and that 

 in the lymphatic glands the more prominent, and in 

 these, matters had proceeded to such a pitch, 'that 

 lymphatic glands, at other times scarcely observable, had 

 developed themselves into lumps the size of walnuts, and 

 that indeed in some few places there appeared to be 

 scarcely anything else than glandular substance. Of the 



