220 CLINICAL BACTERIOLOGY AND HjEMATOLOGY 



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 anaemia ; in one 

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

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

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

 leucocytosis, with or without a moderate increase of polynuclears. 

 In other cases there may be aneemia 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. The 

 opsonic index to tubercle may be of assistance. 



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 in 

 which the name may fairly be applied there is idiopathic enlarge- 

 ment 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 (07 to o'g). In severe cases there may 

 be numerous normoblasts, poikilocytes, and polychromatophil 

 degeneration of the red corpuscles. The only feature that can be 

 considered as characteristic is the frequent presence of leucopenia 

 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 



