352 LEUKEMIA 



from adenoid tissue areas of the wall (i. e., the solitary follicles). Dyspeptic 

 phenomena and diarrhea point to this complication but do not permit cer- 

 tainty in diagnosis. In some patients a leukemic stomatitis and pharyngitis 

 develop. 



It is noteworthy that, in spite of the diminution of the erythrocytes, nei- 

 ther dyspnea nor orthopnea occurs in leukemia, at least not according to my 

 experience (provided there are no complications on the part of the respiratory 

 organs). [I have repeatedly seen dyspnea and even orthopnea in leukemia as 

 soon as anemia became severe or circulatory stasis marked. — Ed.] Petten- 

 kofer and Voit first demonstrated in one of their patients, who was suffering 

 from leukemia, the ability of the organism, during rest, regardless of the 

 diminution of the erythrocytes, to assimilate as much oxygen as a healthy 

 person with the same nourishment. Neither do marked disturbances of 

 metabolism occur in the course of leukemia, or, if they are now and then 

 noted, they are at least not dependent upon the leukemic processes as such. 

 The tendency of the leukemic to catarrhal affections of the respiratory passages 

 may favor the production of pulmonary inflammation in some cases; in other 

 cases lymphatic infiltrations form in the lungs. The development of lym- 

 phatic nodules has been noted in the epiglottis, in the larynx and in the 

 trachea, also upon the pleura ; not rarely do transudates appear in the pleural 

 cavity. 



Painful non-ulcerating nodes occasionally develop in the shin, and must 

 be looked upon as leukemic lymphoid formations. [Deafness was produced in 

 one of my cases by nodules in the ear. — Ed.] A tendency to profuse sweat- 

 ing is not rare, and adds to the exhaustion of the patients. 



The murmurs noted upon auscultation of the heart are of an accidental 

 nature, the result of the marked anemia which occurs in leukemia. [Late 

 in the course of the disease. — Ed.] In consequence of poor nutrition and 

 exhaustion of the heart muscle such a dilatation of the heart may occur that 

 the valves though still normal in their length can no longer close. Thus rela- 

 tive mitral and tricuspid insufficiency may develop. 



Not only such relative cardiac insufficiencies and accidental murmurs may 

 occur as a consequence of the anemia which develops in leukemia, but also 

 quite a number of other symptoms such as appear more or less regularly in 

 any anemia ; e. g., palpitation, weakness and lassitude, vertigo, headache, 

 attacks of syncope, and edema ; perhaps also fever which is irregular but may 

 be at times quite high (102° P. to 104° P.). 



In the course of leukemia, in rare cases, long-continued priapism occurs, 

 due perhaps to a thrombosis in the corpora cavernosa. This symptom has 

 been observed a number of times, and occurs so rarely in other conditions 

 that its presence should be considered suggestive of leukemia. 



Of special interest in the diagnosis of leukemia are the changes in the eye- 

 ground which occur in the course of the affection. In keeping with the in- 

 creased number of white • corpuscles and the anemia the fundus of the eye 

 has an unusual, pale, orange-yellow appearance. But this discoloration is not 

 conspicuous in all cases ; it is always absent if the amount of hemoglobin has 

 not been materially decreased. The so-called retinitis leuhemica is character- 



