The blood presents striking changes. The leucocytosis is not marked, rarely over 250,000 and often not over 50,000 per cubic millimetre. The larger ma jority of the cells are lymphocytes of large size, corresponding to the prolifer ating cells of the germ-nests. The lym phocytes are very polymorphous in ap pearance, and degenerations are com monly seen. The polymorphonuclear, eosinophilic, and basophilic cells are seldom increased, the polymorphonuclear cells are often decreased, and the eosino philes may be almost absent. Myelocytes are not usually found in the circulating blood, despite the hyperplasia in the marrow. The red cells are more reduced than in chronic letiluemia. Nucleated red cells are not, however, a special feat ure. The qualitative changes in the red cells are marked.
The secondary depositions in the tis sues are not 'narked. This is due to the acuteness of the process. Nevertheless, they exist in most of the organs and tis sues. The spleen is proportionately not more enlarged than the lymph-glands; it is usually very soft. The depositions in the tissues correspond to the cells in the blood. ll'emorrhages are very common into the glands and organs, from the mucosa, into the skin and sera; they are present in three-fourths of the cases. Fatty degenerations are not so marked as in more chronic cases, but hyaline changes and areas of focal necrosis are common.
The digestion of most cases of leukw mia is chemically and physiologically de fective. The salivary juice seems little affected. The gastric juice, however, is commonly deficient in HC1, pepsin, and the curdling ferment. Motility is often reduced. The assimilation of food by such patients is usually notably below the normal.
The urine presents very important alterations. In most cases a marked in crease in uric acid is found, often up to 2 to 3 grammes per diem. The alloxuric bodies are likewise somewhat increased. These conditions may produce stone. The performed and ethereal sulphates, the neutral sulphur, the phosphates, and calcium are eliminated in excess of the normal. Albumin is often present, usu ally not with casts. Acetone and dia cetic acid may be present in periods of tissue-waste, while pathological urobilin and htematoporphyrinuria are usually demonstrable.
The tissue-changes in leulaemia aro unusually active, the 0 input and CO, output are above the normal; there is, therefore, rather hyperoxidation than ' suboxidation. The parenchymatous de generations are due to toxmmia.
Excretion of uric acid decidedly in creased in three cases of leukemia. The proportion between the quantity of nitro gen contained in the excreted nrie acid and the total amount of nitrogen in the urine was also decidedly altered. Boh land and Schurz (Deutsche med.-Zeit., Nov. 10, '90).
In leukemia in the cases where uric acid excretion is normal or diminished, the allozur bodies are increased, and their amount varies directly with the amount of leueoeytes. Clumprecht (Cent. f. allg. Path. if. path. Anat., vol. vii, p. S20, '90).
:Metabolism in acute and chronic leu klemia studied. Acute cases were char acterized by excessive elimination of uric acid, great loss of nitrogen, and large amounts of urine, all increasing up to death; in the chronic cases there was an approximate nitrogen equilibrium, moderate quantity of urie acid, no ante mortal increase. There is no parallelism between the number of leucoeytes and quantity of alloxur bodies. :Magnus Levy (Virchow's Archiv, 1;. 152, H. 1, '9S).
Influence of infectious diseases on leukemia. On the occurrence of in fectious disease in leukeemia it is often found that the specific tumors become smaller, and that the white corpuscles diminish in number: changes to be explained by the destructive action of the bacterial poison on the tissues. A qualitative change, due to the chemo tactic action of the bacterial poison in the blood, may also take place; in this the lymphocytes take no part, but the polynuclear granulated cells in crease, while the other granulated cells diminish. The chemotactic action of the bacterial poison is often, as in the case reported, more notable than the destruc tive. 1n this way it may happen in mye logenous leukmmia that, while the polY nuclear cells increase and the other g-ranulated cells diminish in number, the gross total of white corpuscles remains the same. The influence of the bacterial poison upon the red corpuscles is not so important, and no notable alteration takes place save in certain severe cases in consequence of hmmorrhage, and it may be of hwmatocytolysis. Kfirmfiezi (Dent. Med Woch., No. 47, '99).
Treatment.—Rest, the best of care and hygienic surroundings, and a nutritious diet are the general indications. Arsenic is the best remedy, and should be given in ascending doses and for a long- period of time. If it disturbs the stomach or provokes diarrhcea, it should be given hypodermically.