When seen for the first time, the case often presents some resemblance to enteric fever ; and a hemorrhage from the bowels might appear to confirm this view of the illness. But the history, which usually indicates disease of considerable standing, the complete absence of rosy spots, the enlargement of the liver as well as of the spleen, the peculiar sallow tint of the skin—these symptoms are very unlike typhoid fever ; and if at a late stage cedema of the lower limbs occurs, the presence of a symptom so uncommon in enteric fever should make us at least doubt the correctness of this diagnosis. An examination of the blood showing a large excess of leucocytes is of course conclusive.
Leucocythemia may be diagnosed with certainty if, with an enlarged spleen, the proportion of colourless corpuscles is greater than one to twenty. In a doubtful case, therefore, it is well to count the corpuscles with the hcemacytometer. If the proportion of leucocytes is less than one to twenty, the case may still be one of leucocythemia in process of development ; and as Dr. Gowers has pointed out, to exclude this disease it will be necessary to make repeated examination of the blood, and satisfy ourselves that the proportion is not increasing.
In cases where the lymphatic glands undergo hyperplasia, the disease is distinguished from lymphadenoma by noticing that the lymphatic en largement is only moderate, and occurs as a late complication. Also that the excess of white corpuscles in the blood is very pronounced. In lym phadenoma this increase is either absent or is comparatively insignificant. Composite cases are, however, occasionally met with, and may be a source of perplexity.
Prognosis.—The disease invariably terminates fatally ; and the more nearly the number of the white corpuscles in the blood approaches to an equality with that of the red, the greater the prospect of an early termi nation to the illness. Haemorrhage, unless it be from the nose, is a very grave symptom.
Treatment.—No treatment has yet been discovered which is capable of arresting the progress of the disease. Arsenic, which is of great value in cases of lymphadenoma, has no influence in leucocythemia, and quinine, iron, and tonics generally have proved to be quite useless. Cod-liver oil may, however, be given, and is said to be sometimes of temporary benefit. In an early stage of the illness faradisation of the splenic region for fifteen minutes twice a day is said to diminish the proportion of white corpus cles in the blood. In a case reported by Mosier this application, com bined with the internal administration of piperine, oil of eucalyptus, and hydroch'orate of quinine, reduced the size of the liver and spleen and greatly improved the condition of the blood. Dr. G. V. Poore finds the
size of the spleen to be diminished temporarily after faradisation, but states that the therapeutic benefit derived from the application is very transient. Many times a spleen which was felt to be smaller and softer immediately after galvanism was found after only a few hours to have recovered its former size and again become tense and hard. Dr. Poore states that the leucocytes in the blood are increased in number directly after the application. Injection of various substances into the spleen has been attempted, but the results have not been encouraging. A case is re ported in which a grain and a half of salicylic acid was injected into the organ, and the patient died six hours afterwards.
Excision of the has been tried, but has invariably led to such effusion of blood that the death of the patient has very quickly followed. All we can do is to treat distressing symptoms as they arise, and to sup ply the patient with such nutritious food as his stomach can digest. Quiet is very important when the anaemia is great. Looseness of the bowels must be treated with small doses of rhubarb and the aromatic chalk pow der, or with dilute sulphuric acid ; oedema with digitalis and diuretics ; haemorrhage with the ordinary styptics. If the pain is complained of over the spleen, it is best relieved by counter-irritation and anodyne applications, such as smearing the surface with equal parts of the extract of belladonna and glycerine, covering the side afterwards with cotton-wool.
LYM.PErADENOMA (adienia, lymphatic anaemia, Hodgkin's disease) is one of the less common diseases of early life, but it occurs sufficiently often to render the affection a not unfamiliar one in Chiklren's Hospitals. Lym phadenoma consists in a hyperplasia of lymphatic tissue in various parts of the body, even in situations where such structures do not normally exist in any great quantity. The lymphatic glands are chiefly involved, but the spleen, liver, and kidneys may be greatly enlarged and altered in structure. If the enlargement be limited to a few glands or organs, the disorder may have the characters of a local complaint. Usually, however, the affection spreads very extensively and exhibits all the phenomena of a general disease, being attended with fever, wasting, great and increasing pallor, and marked weakness. In the end it is almost invariably fatal.