A system of practical medicine. By American authors. Vol. 3

by Unknown

¹⁰⁵ Die Leukæmie, Berlin, 1872.

¹⁰⁶ Reynolds's System, art. "Leucocythæmia."

Syphilis appears to have been in a few cases closely connected with the onset of the disease.

Injury.—Many patients give an account of a blow or strain in lifting. In 3 cases which I have seen the patients laid great stress on this. One had received a kick in the side from a horse, and the two others had strained themselves in lifting. De Chapelle¹⁰⁷ has dealt specially with this feature in the etiology of the disease.

¹⁰⁷ De la Leukémie dans ses Rapports avec la Traumatisme, Paris, 1881.

Previously-existing splenic enlargement does not seem, as we might expect, to predispose to leukæmia. It is rare for a case of simple chronic hyperplasia of the spleen—from malaria, for instance—to terminate in leukæmia.

The disease occurs in the lower animals, and cases have been described in horses, dogs, oxen, cats, swine, dogs, and mice. The majority of cases have been in dogs.¹⁰⁸ A study of the comparative pathology of the disease has not thrown any light on the etiology.

¹⁰⁸ Siedamgrotzky, Ueber die Leukæmie bei den Hausthieren, Leipzig, 1878; Bollinger, Virchow's Archiv, lix.; London Med. Record, vol. ii., 1874.

SYMPTOMS.—A division of the disease into two or three stages has been made by some writers, but as no special regularity is observed in the sequence of events, we need only recognize a period of development, in which the disease gradually becomes established, and a final period of cachexia, when there are symptoms of profound blood-change and the viscera are involved.

The mode of onset is insidious. In the majority of cases there is failure in health and strength, and the patient seeks advice for progressive enlargement of the abdomen with dragging pain in the side, or for the shortness of breath, the enlarged lymph-glands, the pallor, or the various symptoms of anæmia, as headache, palpitation, and dizziness. Bleeding at the nose is common. Vomiting and diarrhoea may be early symptoms, and in a few cases oedema of the face and feet has been noted early in the disease. Occasionally the first symptoms to attract the attention of friends or physician are of a serious nature—a sudden hemorrhage, for example. In one of Howard's cases the lad had played lacrosse two days before the onset of the fatal hæmatemesis, and in another case, a girl, there was early and fatal hemorrhage from the stomach before the condition of splenic enlargement was suspected.