362 LEUKEMIA 



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not fit the facts any better ; for, in this case, there was no absolute increase of 

 the white blood-corpuscles and no absolute increase of the eosinophile cells; 

 in fact, the number of them in this case was decidedly diminished (0.6 per 

 cent.) ; moreover, Charcot's crystals were not present in the bone-marrow. 

 These facts scarcely coincide with the assumption of a leukemia which, in 

 this case, must certainly have originated in the bone-marrow (it must be 

 remembered that the myelocytes alone constitute one-seventh of all the leuko- 

 cytes). 



We may, therefore, say that in this case we were dealing with a severe, 

 perhaps infectious, disturbance of the process of formation of the blood cells 

 in the hone-marrow, and that this affected the red as well as the white blood- 

 corpuscles, with the result that both remained in an immature condition, the 

 white cells not even being perfectly granular. This reduction of the function 

 of the bone-marrow in a few days led to the complete cessation of blood for- 

 mation, and this to the destruction of the vitality of the organism. Besides 

 the cessation of the function of the bone-marrow, the function of the spleen 

 was severely damaged as regards the production of lymphocytes, which 

 were produced in a hurry and hence entered the blood chiefly as large 

 lymphocytes. 



The essential feature of this case of leuhanemia is the fact that the devel- 

 opment of both red and white corpuscles was affected. In leukemia, on the 

 other hand, it must be supposed that the specific poison is concentrated essen- 

 tially upon the white corpuscles, sometimes the lymphocytes, sometimes the 

 leukocytes, according to the nature of the irritant. The process in leukemia 

 is probably as follows : 



By the continuous, not transitory, action of the poison, a more rapid 

 production and washing out of white cells is brought about, and during this 

 process, not only mature forms but also immature elements, sometimes more, 

 sometimes less, pass into the blood — in the leukocytic leukemia the myelo- 

 cytes, in the lymphocytic leukemia large lymphoid cells (which may be re- 

 garded at least with probability as immature elements, normally not yet fit 

 to pass into the blood). The emigration of the complete polynuclear cells 

 (and partly perhaps of the myelocytes) may be easily explaiaed as a conse- 

 quence of their ameboid contractility, whereas the enormous emigration of the 

 lymphocytes which in lymphocyte leukemia are incapable of ameboid move- 

 ment is apparently difficult to understand. However, I believe there is nothing 

 against the assumption that the lymphocytes, because of their production in 

 excessive numbers, may also enter the circulating blood in large numbers, as 

 they do under normal conditions, i. e., by " passive exudation," owing to an 

 unusually strong lymph circulation, etc., provided the processes which nor- 

 mally cause the entrance of the lymphocytes are more active, which is true 

 to a varying extent in different cases. 



This of itself leads us to discuss the question of the part in the leukemic 

 process which is taken by the various organs in which blood cell formation 

 normally takes place. It may to-day be regarded as certain that the bone- 

 marrow is particularly implicated in leukemia, not only in leukocyte leukemia 

 but also in lymphocyte leukemia. 



