382 PSEUDO-LEUKEMIA 



emphasized by Osier. — Ed.] At other times, with, the same relation of the 

 erythrocytes and of the hemoglobin, leukopenia is present; that is, there is 

 a conspicTiOTis diminution of the leukocytes below the lowest normal limits. 

 In still other cases there is a relative decrease in the polynuclear neutrophilic 

 leukocytes, which normally make up about three-quarters of the leukocytes. 

 Sometimes the cells designated as lymphocytes are predominant, i. e., a lym- 

 phocythemia is present. In conclusion, a blood change is found which in some 

 respects resembles pernicious anemia; namely, nucleated erythrocytes of nor- 

 mal or larger size (normoblasts and megaloblasts) are seen, and with this an 

 increase in the leukocytes, sometimes of the polynuelears, sometimes of the 

 lymphocytes. 



This latter blood composition is observed pre-eminently in infancy, and 

 has been described by v. Jaksch as anemia infantum pseudoleukemica. This 

 is a pseudo-leukemia which has special characteristics in the infantile organ- 

 ism. JSTormally the infant's leukocytes are more numerous than those of the 

 adult, and in the child the lymphocytes also are more profuse, and from the 

 hyperemic red marrow of the growing bones nucleated young erythrocytes 

 more readily enter the circulation. These nucleated erythrocytes, according 

 to our present views, are to be regarded as immature corpuscles. 



Other blood lesions such as poikilocytosis, increase of the blood plaques, 

 etc., are not characteristic. 



We must not expect that the same blood condition will be present in every 

 case and at all times for, in the first place, these changes arise gradually in the 

 blood with an increase of the anemia, and probably also with the growth in the 

 spleen, corresponding to the growth in the glands, as in Hodgkin's disease. 

 Thus, in this malady, as in the other form, periods of transitory improvement 

 in the condition occur and the blood composition improves. Further febrile 

 conditions may arise under the influence of which the number of leukocytes 

 may change; for example, a leukopenia may give place to a leukocytosis; or, 

 again, profuse hemorrhages in the disease may entirely alter the blood picture. 



In the splenic form of pseudo-leukemia, certainly in adults, hemorrhages 

 are even more frequent than in the lymphatic form, especially hemorrhages 

 from the nose and from the gastro-intestinal canal ; but there are also hemor- 

 rhages from the gums, from the skin, and from the vitreous body of the eye, 

 etc. [Osier has explained the gastric hemorrhages as due to the inability of 

 the stomach veins (anastomosing with those of the spleen through the msa 

 Irevia) to empty themselves on account of the cirrhotic process which forms 

 part of the changes in the spleen. — Ed. J 



The urine is very similar to that of the lymphatic form. 



The implication of the liver in splenic pseudo-leukemia is very interest- 

 ing. In the lymphatic form enlargement of the liver also occurs, due to the 

 previously mentioned metastatic lymphomata or lymphomatoid formations. 

 But these lymphomata are rarely of decided extent and rarely give rise to 

 marked disturbance. In the splenic form, however, the liver is very fre- 

 quently and conspicuously involved. Banti deserves credit for having iirst 

 called attention to the comlination of pseudo-leukemic enlargement of the 

 spleen with cirrhosis of the liver, and for having remarked the causal connec- 



