354 LEUKEMIA 



leukemic, one of the most important symptoms of leukemia as regards diag- 

 nosis, and especially as regards prognosis. Hemorrhages may occur in the 

 urinary passages and in various parts of the body, i. e., in the respiratory pas- 

 sages, in the digestive tract, in the skin (purpura), in the subcutaneous con- 

 nective tissue (sometimes in the form of colossal hemorrhagic tumors), in the 

 muscles, in the internal parts of the ear, etc. ; hemorrhages are also noted 

 in the central nervous system in the course of leukemia, and may give rise to 

 apoplectic attacks with paralysis, or they may result in sudden death; these 

 intercurrent hemorrhages are usually the cause of the fatal outcome of leu- 

 kemia, or, at least, they predispose to it. Multiple effusions of blood occa- 

 sionally occur in the peripheral nervous system, in the sheaths of the nerves 

 or in the nerves themselves, and these result in fatty degeneration of the nerves 

 and the muscles supplied by them. In some cases of leukemia the hemorrhagic 

 diathesis may so dominate the clinical picture that the cases appear to be 

 purpura hemorrhagica until the examination of the blood discloses the error. 

 [This is especially true of the eases of acute lymphatic leukemia. — Ed. J 



The symptoms of leukemia — the increase in the number of leukocytes in 

 the blood as well as the enlargement of the spleen and lymph-glands — may for 

 a time ameliorate greatly in the course of intercurrent infectious diseases. 

 [Or even without any known cause. Some of these spontaneous remissions 

 happen to coincide with the inception of a special method of treatment and 

 lead to the reports of curative drugs, etc. 



Of the remissions under X-ray treatment, mention will be made later. 

 —Ed.] 



The classification generally in vogue until lately by which individual cases 

 of leukemia were grouped as " myelogenous " or as " lymphatic " leukemias, 

 according as the spleen or the lymph-glands were enlarged, can no longer be 

 maintained from a hematological standpoint, chiefly because of the impor- 

 tant researches of Neumann and Ehrlich. For some time we differentiated 

 not only between splenic and lymphatic leukemias, but also between cases of 

 the splenic-medullary variety, or those of the pure medullary form (" myeloge- 

 nous leukemia"). But these designations for the individual varieties of leu- 

 kemia, based as they are on the changes prominent in the clinical picture in 

 organs more or less implicated in the formation of the blood, are not Justified 

 either from a hematological or from a clinical standpoint. For, in both 

 forms, the lienal and the lymphatic, the bone-marrow is primarily implicated 

 in the changes of the hematopoietic process, and, on the other hand, the char- 

 acteristic blood picture, which in one case may show a marked preponderance 

 of lymphocytes, in another a great majority of leukocytes and their primary 

 stages, is usually not at all altered, whether the lymph-glands or the spleen 

 are enlarged or not. We therefore recur to my chosen differentiation of only 

 two varieties, according to the point of origin of the cell forms which are 

 markedly increased in the hlood— lymphocyte leukemia and leukocyte leu- 

 kemia. The differentio-diagnostic points of these two varieties of leukemia 

 are the following: 



1. Lymphocyte Leukemia. The blood picture is characterized by a con- 

 spicuous preponderance of large and small lymphocytes in comparison to the 



