240 CLINICAL BACTERIOLOGY AND' HEMATOLOGY 



In Other cases there may be anaemia from the first, a normal or 

 diminished number of leucocytes, and a relative increase of 

 lymphocytes of moderate amount ; these cases are probably more 

 closely allied to lymphatic leucocythaemia, and for them the term 

 " pseudo-leukaemia " might be used. I believe them to be of more 

 rapid course than true Hodgkin's, but the two cannot be definitely 

 separated on clinical grounds alone. 



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 normal 

 blood condition, and cannot be diagnosed from aleukaemic leuco- 

 cythaemia 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 enlargement 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 (0-7 to o-g). In severe cases there may be numerous normo- 

 blasts, poikilocytes, and polychromatophil degeneration of the red 

 corpuscles. The only feature that can be considered as character- 

 istic is the frequent presence of Uucopenia 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 processes, etc.) there will 

 probably be a polynuclear leucocytosis. Hodgkin's disease with 

 an enlarged spleen and without palpable glands may be indis- 

 tinguishable from splenic anaemia, and probably some of the 

 recorded cases have been of this nature. 



An/EMia 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. 



