TREATMENT 357 



transitory, benign character of the increased number of lymphocytes in 

 lymphocytosis, determines the correct diagnosis. On the other hand the 

 following symptoms point to leukocytosis: The absence of enlargement of 

 the spleen and of the lymph-glands which is almost always present in lympho- 

 cytic leukemia ; and, secondly, the presence of a primary disease which would 

 lead to leukocytosis (gastro-enteritis infantum, etc.). 



PROGNOSIS 



The prognosis of leukemia may be briefly summed up: ii is absolutely 

 unfavorable; death is the only outcome of the disease. This is true not only 

 of the acute form of leukemia in which death occurs usually in a few days 

 or weeks, but also of chronic leukemia, of leukocytic leukemia, as well as of 

 chronic lymphocytic leukemia. However, in both forms of chronic leukemia, 

 especially leukocytic leukemia, remissions may occur with considerable im- 

 provement of symptoms, and the disease may sometimes last for from one 

 to four years. But since we have learned positively to recognize leukemia 

 by new methods of blood examination, no actual cure has as yet been ob- 

 served. From this standpoint we must look with suspicion on " recoveries " 

 reported from time to time, and I do not hesitate to pronounce as doubtful 

 a case of cure which came under my observation twenty-five years ago, since 

 the diagnosis made at that time does not conform to the requirements of 

 to-day. 



This gloomy view concerning the prognosis of leukemia is, however, based 

 on the present state of our experience, and it is to be hoped that when we obtain 

 more exact knowledge of the nature of the specific poison causing this disease, 

 our therapy will become more effectual, and the prospects of cure more 

 favorable. 



TREATMENT 



At the present time there is nothing that can be regarded as the fulfilment 

 of an indicatio morli. All that has been thus far attempted in treatment 

 may be regarded merely as efforts to feel our way, and these have so far been 

 abandoned as soon as undertaken. A few drugs only have held their place 

 in the treatment of leukemia, and by most physicians, as well as by myself, 

 are employed faute de mieux, though it is true that the long duration of a 

 few cases treated in this manner, and the transitory but decided remissions 

 in the course of the disease may, at least in part, be referred to the action 

 of the remedy. 



Arsenic is the drug which most deserves our confidence. During its ad- 

 ministration, we see in some cases an improvement in the condition of the 

 blood (not only an increase in the number of red but also a decrease in 

 the number of the white corpuscles), an arrest of the splenic enlargement, and 

 the disappearance of the hemorrhagic diathesis. ^ 



The best way of administering arsenic is in the form of Fowler's solution 

 with two parts of aqua cinnamomi : 



