SYMPTOMS AND BLOOD-CHANGES 359 



76 eosinophiles) ; mast-cells were absent; however, there were large mono- 

 nuclear leukocytes (238) and remarkably numerous lymphocytes (4,260), 

 large and small — almost as many as polynuclear cells. Expressed in per- 

 centage the blood contained: Lymphocytes 40.2 per cent, (large 35.3 per cent., 

 small 4.9 per cent.); polynuclears (neutrophilic leukocytes) 44.1 per cent.; 

 myelocytes 13.6 per cent, (neutrophiles 13 per cent., eosinophiles 0.6 per 

 cent.) ; large mononuclears 3.1 per cent.; and but very few mast-cells (only 

 one found in all the blood preparations examined). 



The course of the affection during the four days in which the patient was 

 in the hospital was extraordinarily rapid. The temperature, which varied 

 between 102.3° and 104° F. from the first to the second day, dropped on the 

 third day to 100.4° P., falling upon the fourth day, when death occurred, to 

 91.1° F. ; consciousness, which had been lost prior to his admission to the 

 hospital, returned on the second day, and continued until death. The energy 

 of the heart, however, weakened from hour to hour. The cardiac dulness, 

 which was normal at the onset, became more and more extended without 

 the appearance of murmurs. Weakness increased until death occurred on 

 May 9th. 



The clinical diagnosis entered at the Pathological Institute was : " Pro- 

 gressive pernicious anemia, enlargement of the liver and spleen, infectious 

 degenerative processes in the bone-marrow with disturbances in the formation 

 of red and white blood-corpuscles; dilatation of the heart, myocarditis (?)." 



The main points in the autopsy report (v. Eindfleisch) may be mentioned 

 as follows: Excessive anemia of the entire body. The marrow of the femur 

 in its lower half everywhere red, that of the sternum reddish. Spleen some- 

 what enlarged, 13.5 cm. in length, 8 cm. in breadth, 3| cm. in thickness; upon 

 section lighter than normal, consistence somewhat soft; Malpighian bodies 

 enlarged, indistinct. Liver of firm consistence, gives a distinct amyloid reac- 

 tion, which, however, soon disappears when the organ is placed in water. 

 The heart is distinctly dilated, particularly in the right ventricle; the left ven- 

 tricle somewhat less so. The muscles of the heart are very anemic, parts 

 showing grayish discoloration and punctiform hemorrhages; fatty degenera- 

 tion of the muscular trabecule in the left heart. No enlargement or change 

 in the lymph-glands. Kidneys pale, in part showing a dappled anemia; 

 capsule peels easily; consistence somewhat firmer than normal. 



The anatomical diagnosis (v. Eindfleisch) was as follows: Ancemia maxima 

 corporis totius; Hypercemia ossium cum infiUratione cellulari partim leuko- 

 cytica partim erythrocytica. Lien hyperplasticus ex intumesceniia leukocytica 

 corpusculorum Malpighii. Hepar modice aucium degeneratio hepatis amy- 

 loidea. Degeneratio cordis adiposa prcesertim ventriculi sinistri^ dilatatio 

 ventriculi smistri. Myocarditis. (Edema pulmonis, atelectasis. 



Microscopical examinations (v. Eindfleisch) showed: In the spleen areas 

 of softening, in the internal parts of which were abscess-like accumulations 

 of polynuclear cells but without pyogenic cocci; a softening of all the Mal- 

 pighian bodies with transformation of their lymphocytes into pus cells. Amy- 

 loid degeneration of the liver not affecting the interstitial tissue but merely 

 the liver cells proper, which alone gave the amyloid reaction. The blood- 



