Case of leukreinie bulbar paralysis. Kast (Zeits. f. klin. Med., B. 8, H. 12, '95).
TWO cases of disease of the spinal cord due to leuktemia. In the first microscop ical examination of the cord revealed small myelitic foci, or, more strictly spe kin.. foci of acute or subacute nerve degeneration. scattered through the white substance from the upper lumbar region to the medulla oblongata. Some of these degenerated points were large enough to be seen by the naked eye, and all stages of degeneration were to be observed, from a simple puffed-up appearance of the myelin sheath and swelling of the axis cylinder to segmentation, breaking up, and disappearance of the nerve-fibres, with compensatory hypertrophy of the neuroglia. Changes in the vessels, htemorthages, cellular infiltration, and extravasation of leueocytes were entirely wanting, and the gray matter through out, together with the nerve-roots, were absolutely normal.
in the second case microscopical ex. arnination of the spinal cord revealed lesions identical in character, size, and distribution with those of the first case, the gray matter, nerve-roots and vessels being intact. Nonne (Deutsche Zeit. f. Nerv., Apr. 30, '97).
The spleen in myclogenous leukaemia may reach to the pelvis below and touch the liver to the right. It is hard and smooth; it may pulsate, give a friction rub, or, on auscultation, a bruit. Splenic pain and distress are quite constant. In lymphatic leukaemia tile spleen is less prominent. In all cases the enlargement is subject to fluctuations.
The lymphatic glands are inconstantly enlarged in inyelogenous, but constantly in lymphatic, leukwmia. They are not hard, often tender, and usually painful. In the axillary, femoral, inguinal, and sacral regions they may press on veins, causing cedema and cyanosis, and by pressure on nerve-trunks produce great pain and even paralysis. The cervical glands especially tend to enlarge, they limit the cephalic movements, and may press upon the veins. Enlargement of the glands at the base of the tongue and of the tonsils may produce dysphagia.
Enlargement of the thoracic glands may produce aphonia, bronchial or tracheal stenosis, pressure on the superior vena cava or its bronchus, tachycardia, dys phagia, and cardiac dislocation. On per cussion the area of dullness is usually easily demonstrable, and an actual pro trusion of the mass is occasionally served. Enlargement of the retroperi toneal glands may produce a large retro peritoneal tumor, with dislocation of the viscera, and perhaps cedema of the legs.
Method suggested to determine en largement of the thoracic glands: The patient is placed before the observer, the fingers thrust behind the sternum, and then the patient's head rotated. In this
way the thoracic glands may occasion ally be felt. Enlarged bronchial glands sometimes push the arch of the aorta up and make it palpable behind the sternum. There may be, in addition, a systolic murmur from pressure on the aorta.
Enlarged tonsils and lymphoid masses on the back of the tongue niay be observed and intestinal involvement is proclaimed by intractalule diarrInna. Jaccoud (La Sem. Mar. 11, '91).
Twenty-eight cases of leukmmia ana lyzed: In l2 eases the blood was of Vir chow 's licnal type, in 4 of lymphatic, and in 12 of mixed type. The spleen was en larged in all, the liver considerably so in 10, and in 10 there was polyadenitis. In 4 the mesenteric glands only were larged, in 4 the cervical and thymus, in 2 the mammary, and in 2 the axillary glands. Four cases occurred in the first year of life and 3 in the seventh decade. Weber (St. Petersburger med. IVoch., Feb. 12, '92).
It is somewhat curious that the first symptom of which patients complain seems to depend upon enlargement of the spleen, for one would naturally ex pect »-eakness, shortness of breath, or other consequences of anminia to attract attention at an earlier date. In 6 cases 3 complained of swelling of the abdomen and 3 of pain in the left side, while shortness of breath, weakness, sickness, loss of flesh, pallor, thirst, dyspepsia, or, more accurately, flatulence and a feeling of oppression after food have been only secondary symptoms. Epistaxis, hmma temesis, and hmmaturia occur pretty frequently, and there may be a pecul iar diarrhoea with thin, watery stools. These patients are generally anmmic looking, but there are exceptions. Oc casionally they are sallow or jaundiced. For ordinary diagnosis it is vite suf ficient to obtain a drop of blood by pricking the finger and examining it under a magnifying power of 300 to 400 diameters, when the enormous increase of leueocytes can be readily recognized; but it is now usual to make a much more elaborate examination of the blood.
The red and white corpuscles are separately counted, and by the examina tion of stained films the various kinds of leucoeytes are determined and their relative numbers estimated. Finally, the percentage of limmoglobin is calcu lated by the approximation of a diluted specimen of blood to a color-scale.
Robert Saundby (Brit. Med. Jour., Jan. 5, 1901).
Pain in and tenderness over the bones exists in some cases of myelogenous leu kmia. Its absence signifies nothing.