In acute leukmmia there is increase of leutocytes and eosinophile cells. Micro organisms in great number in blood and enlarged organs. Hintze (Deutsches Archiv f. klin. Med., 13. 53, II. 3, 4, '95).
Special transparent polynuclear leuco cytes also found, but in remarkably in creased quantities, in case of lcukcemia. Georgierski (Bolnitchniaja gaz. 13otkina, No. 10, '95).
The red cells arc in all cases reduced, little in some, extremely in others. As a general rule, poikilocytosis, microcyto sis, and macrocytosis exist in degree responding to the oligocythmmia. Ery throblasts are very common in even mild cases of leukemia with little mia; normoblasts are the most frequent form noted, but microblasts and macro blasts may appear in large numbers. All the erythrocytic alterations seen in perni cious antemia niay be seen in leukxmia. The quantity of nucleated red cells seems, in a measure, due to the mechan ical conditions in the marrow, but the mere presence of them is not a leukpemic sign, being simply the result of genetic overactivity attempting to com pensate for the limmolysis.
Chemical changes of leukremic blood are such as could be explained by the excess of leueocytes and the decrease of red corpuscles. Freund and Obermayer (Zeit. f. physiol. Chemie, Mar. 24, '9I).
Attention called especially to the pres ence of large numbers of nucleated red corpuscles, and to free nuclei of such. The latter seemed to have been extruded from the cell. Indistinct evidence of mitosis was also a common feature of these nucleated red cells. McWeeney (Dublin ,Tour. Med. Science, July 14, '94).
Attention called to the process of filamentary budding of erythroblasts through the endothelial wall as a factor in the formation of red blood-cells. Ob servations made on leukmmic spleen. John Guit6ras (Inter. Med. Mag., Dec., '95).
From the circulating blood the white corpuscles are deposited in the various tissues, and these collections. constitute the most important secondary lesions of the disease. Probably mechanical dep osition and emigration both play a role in the formation of the collections, and it is commonly believed that, once estab lished, the collections can maintain by cellular division their own existence. The spleen is the organ most often af fected. Tremendous numbers of the leukmmic cells are deposited in the spleen, causing most remarkable en largement, as a result of which the cap sule thickens and the fibrous trabeculee hypertrophy; so that in the late stages the organ is very hard. The essential lymphocytic structures of the spleen take no part in the process of prolifera tion; on the contrary, they are very scarce. The enlargement of the spleen is further augmented by the exercise of its functions in connection with the hm molysis constantly going on. It is clear
that the spleen is only secondarily af fected in myelogenous leukemia, and the term "spleno-myelogenons" leulue mia, while serving to emphasize the splenic symptom, is not correct patho logically.
The liver is usually very much en larged, due chiefly to the deposition of the circulating leukemic cells. It is hard, smooth, light in color, and presents an excess of iron-pigment. The leukm mic collections follow the vascular chan nels. The excess of free hmoglobin, effected by the hmmolysis, imposes upon the liver an augmentation of its func tions, which doubtless increases its en largement. In a few cases signs of a re turn to fcetal hmmogenesis have been seen in the liver.
The intestinal tract is often the seat of large leukfemic depositions; the essen tial lymph-nodes of the submucosa, how ever, -undergo no abnormal proliferation. The collections not infrequently necrose and ulcerate, the destruction being prob ably due to a mixed infection from the tract.
The skin may be the seat of deposi tions, which may ulcerate. Some of the cases of cutaneous multiple sarcomata are of this nature.
The kidneys usually present some in filtrations, which follow the vascular channels. Of the other organs of the body the pancreas, adrenal and thyroid bodies, the heart, the lungs, the upper respiratory tract and mouth (where ulcerations may occur), and the brain may present infiltrations which are usu ally slight in degree. Depositions within the lymph-glands are not uncommon in the rnediastinum, in the retroperitoneal g.lancls, and in the peripheral glands; pressure-effects are then frequently pro duced. Infiltrations into the spinal cord are very rare.
HTmorrhages are quite frequent in myelogenons leukeernia. They may be in the skin as petechim, under the sera, rf om the mucosa, and into organs, espe cially the brain. The blood and tissues after death often contain the well-known Charcot-Leyden crystals; in rare in stances they are present preformed in the blood.
Charcot-Leyden crystals in the blood of a lenk-mmic both before slid after death, though especially after death. Ord and Copeland (Lancet, May 30. '91).
Chareot-Leyden crystals found in fluid drawn from the spleen during life. Westphal (Deutsehes Archiv f.
Med., 13. 47, II. 5, 6, '91).
Thromboses are not rare, most often in the veins. Fatty degenerations in the parenchymatous structures of the heart, liver, kidneys, pancreas, and in the ali mentary epithelium are quite the rule. Hyaline changes are often seen in both varieties of muscle.