360 LEUKEMIA 



vessels as a whole were free from amyloid but contained numerous detached 

 large myelocytes besides red corpuscles. As a curious iinding may be men- 

 tioned small foci of liquefaction about one-fourth the diameter of an acinus 

 filled exclusively with polynuclear leukocytes and liver cells in the process 

 of gradual dissolution, but containing no cocci. These foci were situated 

 sometimes near the edge of the acinus, sometimes near the center, and were 

 rarely confluent. No siderosis could be determined in several examinations. 

 The heart muscle showed fatty degeneration with fragmentation of the fatty 

 muscle fibers and hemorrhages the size of a millimeter. Kidneys principally 

 anemic. The bone-marrow contained chiefiy large myelocytes with large nu- 

 clei, slightly or not at all granular. Normoblasts were found mostly around 

 the small hemorrhages; megaloblasts were more scanty. 



Epicrisis. — The blood findings, in so far as they relate to the red blood- 

 corpuscles (250,000 erythrocytes, 76 normoblasts, 152 megaloblasts in a 

 c.mm.), would class this affection as pernicious anemia, and at that the usual 

 form — the metaplastic — ^with transition of the yellow bone-marrow into red, 

 with formation of profuse, nucleated red blood-corpuscles, and especially of 

 megaloblasts in the marrow, and their entrance into the circulating blood. 

 The erythrocytes were relatively rich in hemoglobin, corresponding to the 

 usual finding in pernicious anemia. 



The condition of the white corpuscles in the case in question is more 

 important than that of the red. We note, point for point, that the findings 

 correspond to leukemic blood, yet there is no absolute increase worth men- 

 tioning in the white blood cells. 



The great number of myelocytes in the blood (and also in the bone- 

 marrow) is primarily conspicuous; they form one-seventh of all the leuko- 

 cytes. According to our present knowledge of the genesis of the leukocytes, 

 myelocytes may be looked upon as the product of blood cell formation in the 

 hone-marrow, and as the prior stage of the polynuclear leukocytes of the blood. 

 It can hardly be disputed that in our case the transportation into the blood 

 of these immature leukocytes (the mononuclear neutrophilic and eosinophilic 

 myelocytes) represents a process in the blood analogous to the emigration 

 of the immature erythrocytes, the normoblasts and the megaloblasts. This 

 analogy is so natural that the question may well arise whether this condition 

 —emigration of immature leukocytes with the simultaneous emigration of the 

 immature erythrocytes from the bone-marrow into the blood — does not occur 

 frequently in pernicious anemia, and even whether it does not invariably 

 occur. To decide this question, only the latest investigations, based upon 

 methods of staining that are in use to-day, should be considered. From re- 

 searches which are in this respect decisive it is shown that the appearance 

 of myelocytes in the blood of patients suffering from pernicious anemia is not 

 usual; generally none or apparently but few (at the utmost up to 0.5 per 

 cent.) of these immature leukocytes are found. In our case, however, the 

 blood was rich in myelocytes— they represented one-seventh (!) of the white 

 blood cells and the one-hundred-and-eighty-fourth part of all the blood cells. 

 We must, therefore, assume in this rare case, that we were dealing with an 

 insufficiency in the function of the hone-marrow, affecting simultaneously the 



