DIAGNOSTIC APPLICATIONS OF THE BLOOD-COUNT 221 



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. 



Anemia 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 Httle 

 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, 

 a disease which does not occur in infancy. On the other hand, a' 

 high colour-index is not infrequent, and does not necessarily 

 point to pernicious anaemia, which is excessively rare. Lastly, 

 degenerative changes, such as poikilocytosis, granular degeneration, 

 and polychromatophilia, are very common, occur in comparatively 

 mild grades of anaemia, and have not the serious import they have 

 in the adult. 



Leucocytosis in Anamia, in Infants. — This is very common, 20,000 

 to 60,000 being frequently met with ; in most cases there is a 

 predominance of lymphocytes, and the. presence of myelocytes is 

 quite common, rendering the diagnosis from leucocythaemia a 

 matter of some difficulty. As a general rule, the presence of a 

 high leucocytosis in infantile anaemia is a bad sign, and indicates 

 a worse prognosis than if it is absent. 



Secondary Anmmia in Infancy (Syphilis, Rickets, Scurvy, Tubercle, 

 g(c,'). — There are no characteristic changes by which the different 

 causes of secondary anaemia can be recognised. The colour-index 

 is usually low (especially, perhaps, in syphilis), normoblasts are 

 not uncommon, an occasional megaloblast may be seen, and there 

 is often leucocytosis, with increase of lymphocytes. 



Von Jaksch's Anainia (Anamia Infantum, Pseudo-leuh^emia). — It is 

 uncertain whether this is to be considered as a definite disease, as 

 an intermediate form between pernicious anaemia and leucocy- 

 thsemia or as a form of secondary anaemia with somewhat 

 characteristic blood changes. I am rather inclined to the belief 

 that it does represent a definite blood disease, but that it is 

 frequently associated with, and perhaps due to, other diseases 

 such as syphilis, rickets, tubercle, or gastro-intestinal diseases. 

 The blood changes are — (i) An excessive grade of anasmia, usually 



