SYMPTOMS OF ACUTE LEUILeEMIA.— Acute leulimmia presents the picture of an acute infection. There is an irregular fever, often high, and chills are frequent. Some of the lymphatic glands become acutely enlarged, but this often subsides; the spleen is only moderately enlarged. llmmorrhages are marked symptoms, from the gums, nostrils, from the stom ach and :rectum, and into the skin; they persist for days, and produce a distinct ive picture. Ulcerations in the mouth are almost constant, and there is often a peculiar foetor to the breath. Diar rhoea may be present, and intestinal ulceration is common. Vomiting is fre quently noted. The pulse is usually very rapid, and dyspncea is marked.
Case of acute leukmmia in a child of 10 years, in which, after a few days of malaise, hiernathria, purpura, epistaxis, enlargement of the spleen, and, filially, hemiplegia rapidly ensued, and led to a. fatal termination in four and a half days_ The ratio of white to red corpuscles »as 1 to 1 '/.. At autopsy the spleen and thymus were enlarged and various pur purie lesions were discovered. Cuttinanni (Berliner kiln. Woch., 'Nov. 29, '91).
Case of acute leukzemia in a lad of S years. The clinical picture was that of purpura lilemorrliagica, and post-mortem there was found a pure lineal form of leukaemia. The duration was fourteen days. 'Twenty-seven cases of acute leu kmmia collected. Eichhorst (Virchow's Archly, B. 130, H. 3, '93).
Case of leukternia associated with rickets in a child 1 year old, with glandu lar enlargement, swelling of the spleen and liver. and purpura. The blood-count showed 2,900.000 red corpuscles and 48,000 lencocytes. There were ninnerous nucleated red corpuscles and poikilocyt es, Karyokinesis was noted in some red cor 1,useles. Morse (1loston Med. and Surg. Jour., Aug. 9, '04).
A eliartieteristic of acute leukremia is the limmorrhagic diathesis which is asso ciated NN ith SN\ ening of the glands, spleen, and liver, and \ itil peculiar blood changes. Twelve cases personally seen
in seven years. Many cases were mis taken for purpura Inemorrhagica until the blood-examination revealed their true nature. Typical heteroplastic leukiemic groNN ths occur in the liver and spleen. The blood-changes are entirely character istic. There is a remarkable increase of the mononuclear elements, which are of the most varying sizes, but do not con tain neutrophilic granules. A. Fraenkel (Deutsche med. Woch., July 1, '97).
A low delirium develops in most cases, passes into coma, and death occurs in from a few days to six weeks. No disease could possibly look more toxic. Alinute limmorrhages into the brain substance were the canse of death in a case of leukmmia. Virchow (Dent. med. Zeit., Jan. 30, 'SS).
Case in which epistaxis was the cause of death. Knipp (Maryland _Med. Jour., Nov. 17, 'SS).
Case of acute leukmmia in which the fatal event was precipitated by a punct ure of the spleen, which was made for diagnostic purposes. A. Westphal (Altinchener med. Woch., Jan. 7, '90).
Prognosis.—As just stated, the dura tion of acute leukmmia is from a few days to six weeks. The duration of chronic leulca,mia varies from one to four years, though longer cases have been recorded. Death may be directly due to some of the symptoms, to exhaustion, or to intereurrent disease.
Case of acute leukmmia following in fluenza, which terminated in three days. Bitten (Mtinchener med. Woch., Apr. 26, '92).
In cases of leukmmia complicated by various septic processes, considerable im provement. at least in the leucocytosis, occurs as the infection develops. Marisch ler (Wien. klin. Woch., July 23, '96).
The prognosis as to life in leuk-mmia iS hopeless; certain cases manifest refills sions, but ultimately go on to a fatal issue. AI. T.. Goodkind (P. and S. Plexus, Apr., .9S).
Case of acute leukiefilia in a child 3 years old ending fatally thirteen days after the onset of illness. J. I,. Morse (Arch. of I'ediatrics, May, '98).