The symptoms in the leukaemias are in the main of a general kind, the direct result of the associated anaemia; and in the later stages of the disease, may, as in any severe cachexia, be related to the alimentary tract. Such symptoms, however, occasionally arise at an early period, and are then usually connected with abdominal lesions.

Enlargement of the spleen, which is so often extreme in the myelogenic cases, or of the abdominal lymph glands in the lymphatic cases, may thus produce, by their mechanical interference, pressure symptoms of varying degree; and in both forms specific lesions may occur in the tract.

Any section of the bowel may be involved, and the lymphoid tissue is particularly affected. The tonsils and pharyngeal lymphoid tissue may thus be notably enlarged; the solitary glands of the stomach are occasionally implicated; but the most common site is the Peyer's patches and solitary follicles of the bowel, particularly in the vicinity of the ileocaecal valve.

A diffuse leucocytic infiltration is sometimes met with, most commonly in the acute lymphatic cases and affecting the gums. The tissues become swollen and may even hide the teeth, around which ulcerative processes arise; and the ulceration may become extreme, with great fcetor of the breath, a foul smelling ichorous discharge, and sometimes severe haemorrhage. The lymphoid enlargements in the bowel may also ulcerate, and diarrhoea may be severe and persistent, and occasionally associated with haemorrhage.

Alimentary symptoms are often absent in the early stages of the chronic leukaemias, the appetite being satisfactory and the digestive functions easily and well performed. But even at this stage, splenic enlargement may occasion discomfort or a feeling of fullness after meals. Anorexia and flatulence may be troublesome, and the bowels may be difficult to regulate, periods of constipation alternating with spurts of diarrhoea.

As the disease progresses, the symptoms may become severe. Appetite may be wholly lost and the ingestion of food accompanied by nausea and occasional vomiting. Diarrhoea may be persistent and severe. Haemorrhage may occur even without the formation of ulcers, though it is most profuse when this obtains. Haematemesis is comparatively rare and is seldom extreme; bleeding from the bowel is more common, and is not infrequently the immediate cause of death.

In acute lymphatic leukaemia the haemorrhagic tendency is often well marked at an early stage. Haemorrhage may occur from the nose or the mouth, more particularly in those cases where local necroses or ulcerations are present, and may be profuse and continued. Gastric haemorrhage is more common than in the chronic cases, and intestinal haemorrhage is frequent. Vomiting may be troublesome; diarrhoea occurs in the majority of cases.

As we are still wholly ignorant of the causes of the leukaemias, the dietetic indications must be based upon our knowledge of the general tendencies of the disease, and on the actual condition of the patient.

A generous diet is thus indicated in cases where the alimentary symptoms are slight or in abeyance, the meals being composed of the more easily digested foods, and irritating items prohibited. The meals should be moderate in amount, so as to avoid undue distension of the stomach, and must thus be fairly frequent, and a diet with a large food residue should be avoided. Laxative medicines must always be of the milder varieties.

Special attention should be paid to the toilet of the mouth in those cases where oral symptoms are present, and the food must be fluid or semi-solid. Milk will form the main staple, and should be given in as large quantities as can be tolerated, predigested in whole or in part if gastric digestion is difficult or delayed, and reinforced, if possible, by the addition of the finer farinacea or some of the protein preparations. Meat extracts, raw meat juice, etc., are sometimes well borne.

When gastric symptoms are severe, the food must necessarily be fluid and administered in small quantities at a time, but every effort should be made to ensure the retention of as large a quantity as is possible, for starvation is badly borne, and rectal feeding can rarely be carried out satisfactorily for any length of time. Peptonized milk, "soured" milk, buttermilk, citrated milk, or whey, are often of value.

Diarrhoea, when severe, is sometimes very intractable and persistent; but if gastric digestion is fair, a considerable amount of nourishment may be afforded. The farinacea are probably of less use than protein foods in such cases, and the finer fibred fishes (whiting, soles, etc.), chicken, sweetbreads, oysters, may be utilized as well as milk and eggs. The pancreatized carbo-hydrate preparations, such as Benger's food, are to be preferred to the malted articles.

The usual drugs may afford help; and while the astringent preparations are sometimes of value, opium is probably the most generally useful, and is usually well tolerated, even in considerable doses.

Hodgkin's Disease

The lesions in Hodgkin's disease are in many ways comparable to those which may occur in the leukaemias. The spleen and the abdominal lymph glands may be enlarged and the lymphatic tissue of the bowel may be involved, and symptoms of a similar nature may thus be invoked.

Gastro-intestinal symptoms are, however, less frequently met with and need scarcely be discussed in detail. Treatment must be conducted on ordinary lines.