DIAGNOSIS 365 



ve speak of "lymphocytosis" or "leukocytosis" in a restricted sense, and 

 in this way, according to the prominence of one or the other leukocyte forms 

 in the blood picture, we may differentiate between a polynuclear neutrophilic, 

 and an eosinophilic, leukocytosis. 



It has been declared at various times that the lymphocytes have no inde- 

 pendent, active motility; if, therefore, in the course of pathological condi- 

 tions a one-sided (symptomatic) increase of lymphocytes is noted in the 

 blood, we must consider that large numbers of them have reached the circu- 

 lating blood by reason of an increased cell production in the cytogenic tissue 

 of the lymph-glands (and of the bone-marrow to a much less extent) and 

 by a more active lymph circulation ("passive leukocytosis," Ehrlich). This 

 form of leukocytosis, "lymphocytosis," is quite rare, occurring especially in 

 catarrhal affections of the stomach and intestines of nurslings, in pertussis, 

 in severe rickets, syphilis, etc., after injections of pilocarpin and tuberculin, 

 and after extirpation of the spleen. 



More frequent is the second form of leukocytosis, polynuclear leukocytosis. 

 Various irritations (infectious agents, chemical poisons, etc.) cause these 

 leukocytes, which are always present in great amounts in the bone-marrow 

 [as well as in the capillaries of the liver and especially of the lungs. — Ed.] 

 and which, on account of their ameboid movement, are always ready to pass 

 into the blood, to emigrate, and to enter the blood by " chemotaxis " (" active " 

 leukocytosis). As a rule, it is the neutrophilic polynuclear leukocytes which 

 circulate in the blood in large numbers in leukocytosis; i. e., almost all intoxi- 

 cations and infections lead to this, the " usual " form of leukocytosis. Such 

 causes are : Poisoning by potassium chlorate, phenacetin, oil of turpentine, 

 albumoses, arseniuretted hydrogen, etc.; also cachectic conditions as a result 

 of malignant tumors, phthisis, severe blood loss; and, above all, the various 

 infectious diseases — pneumonia, sepsis, diphtheria, erysipelas, etc. On the 

 other hand, in certain pathological conditions we note a one-sided increase 

 of the eosinophilic cells {eosinophilic leuhocytosis) . This is the case in bron- 

 chial asthma, in various diseases of the skin, in malignant tumors, and espe- 

 cially also in helminthiasis (due to the presence of teniae, ascarides, ankylos- 

 toma, etc., in the intestine. [As well as in echinococcus disease, trichiniasis, 

 Bilharziosis, trypanosomiasis and practically all the diseases due to animal 

 parasites. — Ed.] 



Leukemia represents a morius sui generis, the nature of which, as we have 

 seen, depends upon a pathological blood formation, i. e., not only upon an 

 excessive increase of the white blood cells but also upon their qualitative 

 change (the passage of immature forms into the blood). In leukocytosis, on 

 the other hand, the condition is only a functional alteration of the blood- 

 forming organs, and in the majority of cases (leukocytosis in the restricted 

 sense) exclusively of the bone-marrow, which reacts to pathological irritation 

 by the formation and expulsion of large numbers of normal and mature 

 colorless blood-corpuscles. This explanation of leukocytosis, the strict con- 

 ception of which as an increased function of the bone-marrow was formulated 

 by Ehrlich, has lately been fully confirmed experimentally by Rubinstein 

 [and still more fully worked out by Longcope in his studies of the marrow 



