ANEMIAS AT THE END OF THE NURSING PERIOD, INCLUDING AN2EMIA PSEUDOLEUKJEMIA INFANTUM Nature and the wretched children who suffer from intestinal disturbances. rachitis, etc., and have not the physical strength of healthy children, there are always a number who, after the period of nursing has come to an end, arc conspicuous because of their pale com plexion. The majority of these cases are cured after a shorter or longer period, but in some cases the gravest clinical manifestations develop. All these cases, however, have so many points in common by their time of origin at the end of the nursing period, by their pathogenesis and not in the least by the possibility of a favorable course even in grave blood changes, that it seems justified to consider them in one common group.
The graver cases are frequently grouped under the name of splenic anaemia which Italian authors (Somma, Jemma) have given to this symptom-complex on account of the simultaneous enlargement of the spleen; or it is called pseudoleuktemic amemia. This name was pro posed in 1SS9 by von Jaksch to designate a pathological picture char acterized by oligocythtemia, oligochromtemia, considerable permanent leucocytosis, enlarged spleen, slightly enlarged liver and sometimes also enlarged lymph-nodes. The term, however, is not very happily chosen, because pseudoleukannia is even characterized by the absence of increased lcucocytosis.
Italian authors and also a number of Germans (Fisch', Geissler, Japha) include the grave infantile antemias in the secondary antemias with a toxic basis, while others regard them as a genuine blood disease (Audeoud), practically as a middle condition between anaemia and leu kemia. Evidently, different authors have described different conditions under the same name. Cases that die under a progressive increase of leueocytes should perhaps be classed as leuktemia from the beginning. Some authors (Weil and Clere, Lehnclorff) prefer to separate cases with considerable increase of myelocytes (in Lehndorff's case 1.3-12.7 per cent.) as essentially a blood disease (perhaps infantile leukaemia). True, in Lehndorff's case the organs harbored myeloid foci, but there are cases with numerous myelocytes (6.5 per cent. in the case mentioned later on) whose blood findings may become normal again, and the possi bility of a favorable termination is rather a point which might induce us to include these cases of infantile anamaia. It is a difficult question whether anemia pseudoleukmica represents the pernicious anaemia of childhood which under the changed conditions of childhood shows a somewhat altered blood picture. In this respect the observations made by Reckzeh are of special interest, that the influence of blood poisons in young animals produces a blood picture which, by the large number of normoblasts and lencocytes, resembles that of pseudoleukannic ante mia, whereas in full-grown animals the picture of pernicious anemia is the result. It is questionable, however, whether the conditions of the
animal organism can be applied to the human one.
no age arc there so many antemias with relatively grave blood pictures as at the end of the nursing period. say from the seventh month to the end of the second year. It may therefore be as sumed that at this particular period there must be a predisposition for this sort of affection. This functional deficiency in the blood-forming apparatus is analogous to the peculiar affections of the osseous and nervous systems, rachitis and tetany, which likewise occur at this riod. Among the immediate causes there are in the first place artificial nutrition and its sequehe, nutritive disturbances and intestinal catarrhs (in breast-fed children serious cases hardly ever occur), unsanitary and unhygienic domestic conditions. Also in well-to-do families children come affected if, for fear of catching cold, they are kept in badly lated rooms. Premature children are particularly exposed as well as children who have not completely recovered from some htemorrhage (umbilical lnumorrhage, melfena). The statement that tuberculosis nitz) and syphilis exert a predisposing influence is not to be wondered at, but in all the cases served by the author these affections have not been e.st abli shed wi th certainty, nor are grave anemias a particularly frequent complication of syphilis. The spleen not be the primary ological focus and can hardly have anything to do with the regeneration of the blood, since its largement becomes quently reduced before the blood picture has come. normal, while the extent of the enlargement does not always correspond to the gravity of the antenna. Generally deficient new formation of blood seems to tute the nature of the affection. Simultaneously there may under certain circumstances be an exaggerated destruction, but there are only a few cases in which the amemic (granular) degeneration of the red blood corpuscles is found as positive evidence of the effects of a blood poison. Pathological anatomical findings exist only in limited numbers even of the severer cases of antumia. In these cases the spleen is either hard or soft according to whether the stroma or parenchyma is the more affected by the hyperplasia. There is nearly always slight swelling of the lymphatic glands, and among the complications there is chiefly bronchopneumonia. Luzet and Lehudorff, whose case may perhaps have to be classed as lettkremia, found red bone marrow, the former also cells in the hepatic parenchyma which lie regarded as precursors of red blood corpuscles. Lehndorff found myeloid foci in the liver and kidneys.