204 LECTURE VIII. 



glands which lie between the inguinal and lumbar glands 

 we are wont to hear but little, nor have they indeed even 

 a suitable name. Some of them lie in the course of the 

 iliac vessels, and some in the real pelvis. But in two of 

 these cases of leukaemia I found them so enlarged that 

 the whole cavity of the pelvis proper was, as at were, 

 stuffed full of glandular substance, between which the 

 rectum and the bladder only just dipped in. 



I have therefore distingushed two forms of leukaemia, 

 namely, the ordinary splenic, and the lymphatic, form, 

 which are certainly not unfrequently combined. The 

 distinction rests not only upon the circumstance, that in 

 the one case the spleen, in the other the lymphatic glands, 

 constitute the starting point of the disease, but also upon 

 the fact that the characteristic morphological elements 

 which are found in the blood are not precisely similar. 

 Whilst namely in the splenic forms these elements are 

 generally comparatively large and perfectly developed 

 cells with one or more nuclei, and in many cases bear a 

 particularly great resemblance to the cells of the spleen, 

 we notice in the well-marked lymphatic forms that the 

 cells are small, the nuclei large in proportion and single, 

 usually sharply defined, with dark outlines and somewhat 

 granular, whilst the cell- wall is frequently in such close 

 apposition to them that an interval can scarcely be de- 

 monstrated. In many instances it looks as if perfectly 

 free nuclei were contained in the blood. In these (the 

 lymphatic) cases, therefore, it seems that the enlarge- 

 ment of the glands alone, which is accompanied in its 

 progress by a real increase in the number of their ele- 

 ments (hyperplasia), also conveys a larger number of cel- 

 lular elements into the lymph and through this into the 

 blood, and that, just in proportion to the predominance 

 of these elements, the formation of the red cells suffers 

 obstruction. This is in a few words the history of these 



