SYMPTOMS AND BLOOD-CHANGES 357 



his opinion, the important question, in all Hood diseases, is this: What Und of 

 poison IS It which ^s affecting the process of blood formation in each individual 

 case 1 On this depend the changes manifest in the blood 



1. If the damage chiefly affects the red blood cells, simple "anemia" re- 

 sults in which the erythrocytes deviate more or less from the normal in their 

 number, shape, maturity and hemoglobin percentage, while the white corpus- 

 cles are affected only incidentally, and especially as to their number 



3. If the poison affects chiefly the process of generation of the white cor- 

 puscles, so that their number is increased and their morphotic relation is 

 pathologically altered, the blood disease presents itself in the form of a leu- 

 kemia. 



3. If the damage affects all components of the blood equally, blood dis- 

 eases result that represent a complete upsetting of the process of blood forma- 

 tion with changes in the number and form of both the white and the red blood 

 cells— blood diseases usually described as transitional or mixed forms of per- 

 nicious anemia and leukemia. It is difficult to classify satisfactorily the 

 individual cases of this group as anemia or leukemia, if the usual terms, 

 anemia and leukemia, are used as mutually exclusive. I believe, therefore, 

 that it is advisable to give them a special name, for instance, " leukanemia " 

 or something similar.^ 



In this form of blood disease, as already remarked, the production of red 

 and white blood-corpuscles is wholly upset, and accordingly, in the blood pic- 

 ture, decided changes appear in the leukocytes as' well as in the erythrocytes, 

 such changes as we are accustomed to note, on the one hand in leukemia, and on 

 the other hand in pernicious anemia. Blood formation may cease entirely, 

 and this deficiency can no longer be compensated in any manner, so that the 

 organism soon succumbs to the pernicious blood disease. Clearly to illustrate 

 the affection which I designate as leukanemia I shall quote the complete history 

 of a case observed in my clinic: 



A boy, K. L., aged ten, entered the hospital May 6th, and died May 9, 1900. 

 Patient is said to have been always weak, but never seriously ill, and attended 

 school regularly up to April 22d. Mild symptoms; twice vomiting occurred, 

 so that the patient was compelled to remain at home from April 22d to 

 April 29th. On April 29th he sang as a choir boy in church, and on May 1st 

 again attended school, but on May 5th, on account of his pallor, which the 



1 In my opinion, it is well to carry out, in the main, this classification of blood 

 diseases, in spite of the fact that in typical leukemias not only normoblasts are found 

 but also now and then megaloblasts, and although, vice versa, apart from the alterations 

 in the differential count ( the predominance of lymphocytes ) , a few myelocytes are 

 occasionally found in severe anemias. But these findings are of subordinate and second- 

 ary importance compared with the primary condition, according to which the disease, 

 in consonance with the fundamental principle of nosology " a potiori fiat denominatio," 

 is to be spoken of in one case as leukemia, in another as anfemia gravis, and by all 

 diagnosticians is thus commonly designated. A disease can only receive the name of 

 "leukanemia" when both leukocytes and erythrocytes are uniformly and decidedly 

 damaged in their development, when the ease can neither be put in the category of 

 leukemia nor in that of pernicious anemia, and when the division of blood diseases into 

 two groups is no longer possible. 



