LEUKEIVIIA.
Definition.—Leulmmia is a disease characterized by a marked excess of lymphatic tissue in the body, by a pecul iar excess of circulating white corpuscles, and wide-spread and varied symptoms of tox:rmin. with the frequent presence of mechanical symptoms of pressure.
Varieties.—There arc three types of the dkease. considered from both thc pathological and clinical points of view: nivelo_zettous. or leucoeytic; lymphatic, or lymphocytic; and mixed leukannia. Thc myelog,enons and lymphatic types are chronic in their course. The mixed, or myelolymphatic, type is but rarely chronic. is usually acute, and comprises the special group of acute leukemia.
Symptorns.—SYMPTO1IS OF CHRONIC LECK:EMIA.—The onset of chronic leu kemia is usually gradual. The symp toms are best summarized by systems.
The skin may rarely appear normal in color; in some cases it is very white; in most cases it is of a dull-yellow hue. Petechiee, accidental eruptions, and areas of pigmentation or of loss of pig ment are common. There is a sudoraI type. Pruritus and parsthesim are often noted. (Edema may. occur, of four types: cardiac, anomie, due to venous compression, and the peculiar form due to obstruction of the lymphatic chan nels.
Stomatitis and tonsillitis are very common, and may pass to ulceration, from whence hemorrhage is apt to oc cur. Anorexia or perversion of appe tite is seen in most cases. Vomiting is frequent; distress after meals, regurgi tations, and eructations are almost con stant. Diarrhcea is seen oftener than constipation, and in the cases with ulceration is persistent. Hmmorrhoids are not uncommon. Abdominal tender ness is often noted. The enlargement of the liver can be usually demonstrated; it is hard and smooth and may be ten der. Ascites is uncommon. Jaundice is sometimes seen.
Rapid cardiac action is the rule. The pulse is full and of low tension; the capillary pulse is often present. The heart is rarely enlarged, but may be dis placed by the spleen, liver, or tinal gland. The first sound often lacks the full muscular note. Systolic Immic
murmurs are common at the base and at the apex, while the venous hum in the neck is still more frequent.
Case of leuktemia acutissima compli cated with ulcerative endocarditis of the aortic valves, permitting regurgitation. The most striking phenomenon in the case WaS a centripetal venous pulse, plainly visible in the veins of the back of the hand, and disappearing on pressure upon the distal portion of the vein. Sen ator (Berliner klin. Woch., Jan. 27, '90).
Ifremorrhage into the skin and from the mueosw are frequent, and may be spontaneous or induced by slight injury.
Case of leukeemia in which there was htemorrhage from the bowels, as well as gingival hemorrhage from the neighbor hood of a carious tooth. Potain (Gaz. des HOp., May 17, '88).
Case of leukmmia. which limmatoina suddenly developed in the right axilla. and extended downward to tbe sixth rib and from the nipple to the vertebral groove. Hale White (Lancet, June 9, '88).
Case of leukeemia in which fatal hemorrhage from the bladder followed the passage of a catheter. Sheawin (Australasian Med. Gaz., Oct., '88).
Case of acute leukmmia in which there was an attack of hremoglobinmmia, heemoglobinuria. and icterus, with fever and gastric disorders. The patient slowly recovered, but, after several months, suc cumbed in a second attack. Englehardt (St. Petersburger med. Woch., May 2, '92).
A slight polyuria is often seen. The urine often contains an excess of ilin. Albumin does not usually cate nephritis. Albumoses may be found. A few leucocytes and hyaline casts are often to be found in the sedi ment. Some cases have frequent hwma turia.
A fatal case of medullary leukmmia in a girl, 14 years old, the most striking post-mortem change being a diffuse leukmmic infiltration of the kidneys. Frankel (Dcut. med.-Zeit., Nov. 13, '90). Priapism is an occasional symptom, due to infiltration of the corpora caver nosa. Leukxmia does not produce potency. The menstrual function is usually deranged, and there is a tendency to much bleeding.