DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 239 



in absolute numbers, but the increase mainly affects the poly- 

 nuclears and the eosinophiles ; the lymphocytes are relatively so 

 scanty that they may be difficult to find. In addition, there are 

 abnormal cells : eosinophile myelocytes and large cells with 

 basophile granulations, cells occurring in practically no other 

 disease, and both Ehrlich's and Cornil's myelocytes. 



There is usually anaemia of the secondary type, and normo- 

 blasts are numerous. 



The whole picture is most characteristic, and can hardly be 

 mistaken for anything else. 



Lymphatic Leucocyth^mia. — There is no difficulty in the 

 recognition of a typical case of chronic lymphatic leucocy- 

 thaemia ; the leucocytes are enormously increased (100,000 to 

 1,000,000), and consist almost entirely of lymphocytes (often up 

 to 99 per cent.) : in many cases the large forms predominate. 

 There is also a varying degree of secondary anaemia. 



In an adult these appearances are quite characteristic, but in 

 childhood similar counts may be seen in a variety of conditions, 

 such as hooping-cough, broncho-pneumonia, etc., though it is 

 rare to find a figure as high as 100,000. 



In some acute cases of lymphatic leucocythsemia similar 

 appearances occur. In others the increased percentage of 

 lymphocytes is present, but not the total increase ; thus, in one 

 case fatal in a few weeks I never found more than 10,000 

 leucocytes, in which the lymphocytes varied between 76 per cent, 

 and 100 per cent. These cases are very difficult to diagnose 

 from acute tuberculosis of the lymphatic glands. In the latter 

 case the total count may be expected to be low, in the former 

 slightly raised ; in tubercle the percentage of lymphocytes rarely 

 exceeds 50, whilst 75 per cent, at least would be required before 

 the condition under discussion could be diagnosed. 



Other diseases (especially acute purpura haemorrhagica) give 

 very high lymphocytoses in adults, but as they are quite different 

 clinically, the blood-count would not be misleading. 



Hodgkin's Disease.— There is little doubt that several diseases 

 are included under this heading. In the true Hodgkin's disease 

 there is at first no change in the blood, not even ansmia ; in one 

 case I examined at intervals for over a year the red corpuscles 

 were always above 5,000,000, and the haemoglobin above 100 per 

 cent. Later, there is anaemia of secondary type, with a slight 

 leucocytosis, with or without a moderate increase of polynuclears. 



