TREATMENT 



369 



It IS much more sensible to retard the increased albumin waste in the 

 organism by rational diet, or, in its later stages, to compensate it, at least 

 partially, by increased nutrition. A nourishing diet, rich in nitrogen is 

 therefore to be advised because a well-nourished organism will always of?er 

 more resistance to the disease than one debilitated by cachexia. To strengthen 

 the body, besides judicious diet, moderate systematic exercise in the open air 

 and the avoidance of too great physical exertion must be insisted upon. 



Of course, the indicatio symptomatica may require different expedients. 

 Marked diarrhea must be combated by tannigen and opium, dyspeptic symp- 

 toms by regulation of the diet, lavage, etc., exhausting sweats by camphoric 

 acid and atropin, a marked hemorrhagic diathesis by ergotin or other prepara- 

 tions of ergot in large doses (ergotin 0.2, five times daily, secale 10.0 to 150, 

 to be used in two days), cardiac asthenia by camphor, etc. It is unnecessary 

 to enumerate these indications in greater detail, for the treatment of individ- 

 ual symptoms and complications is in accordance with the same rules as in 

 other diseases. Only I must caution against the too liberal use of drugs in 

 leukemia; we must not forget that we are dealing with the debilitated, the 

 desperately ill, in whom it might be dangerous to act according to the prin- 

 ciple " anceps remedium melius quam nullum." 



[The treatment of leukemia by X-rays certainly deserves mention. Since 

 Senn's original observation in 1902, 30 or 40 cases have been published in this 

 country in which the disease has been treated by exposure of the spleen or 

 (in lymphatic cases) of the spleen and glands to the Eoentgen rays. 



Cases are treated daily, biweekly, or weekly according to the condition of 

 the skin and its ability to resist " burns." In a few cases, the rays have been 

 made to fall upon the long bones. 



In the majority of these cases improvement, sometimes remarkable and 

 (so far) lasting, has followed the treatment. A few eases have been altogether 

 unaffected, a number have relapsed after temporary improvement, and a small 

 number have been worse after the treatment. In acute febrile cases there has 

 been no success. 



The rationale of the treatment is not at all clear, for the exposures have 

 usually been made over the spleen, and not over the marrow where the disease 

 is most active. We know from the researches of Warthin and others that 

 the X-rays have a specific leukocytolytic effect on the blood forming organs 

 of animals, and if the over-production of leukocytes were occurring in the 

 leukemic spleen instead of in the marrow the effect of the X-ray would be 

 comprehensible. At present it remains a mystery, but it is none the less 

 advisable that all subacute and chronic cases of either variety of leukemia 

 should be given X-ray treatment, which at present offers the best possibility 

 of retarding (or curing?) the disease. — Ed.] 



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