This disease is characterized by a great and progressive increase in the number of white corpuscles of the blood and simultaneous diminution in the number of red corpuscles. The lymph glands and spleen are usually enlarged and the bone-marrow is pathologically altered.

Three varieties of leukemia are recognized clinically: the splenic, the lymphatic, and the medullary, according as the spleen, lymph glands, or medulla is chiefly affected. The spleen is almost always enlarged, but in some cases is so large as to fill more than half of the abdomen. Such cases belong to the splenic group. The lymph glands are usually somewhat enlarged, but in certain cases are enormously increased in size and the spleen is only moderately large. Such cases belong to the lymphatic group. When tender spots, and especially soft spots, can be found on the surface of long bones, they are regarded as evidence of the involvement of the bones in the disease, and the cases are classed as medullary. Better proof of the involvement of the medulla of the bones is disclosed by microscopic examination of the blood, for in such cases nucleated red corpuscles, polynuclear eosinophiles, mast-cells, and myelocytes are sure to be numerous.

The progressive anemia produces a sallow pallor of the face and mucous membranes. It causes feebleness, shortness of breath, and rapid heart action on slight exertion.

The onset of the disease is insidious and its progress usually slow. Acute cases exceptionally run their course in a few days or weeks.

Feebleness, or anemia, or deformities due to enlarged lymph glands are usually the first symptoms to bring leukemic patients to a physician. Later, lack of appetite and increased thirst are common symptoms. Digestion grows feeble as other bodily functions do. A little and variable rise of temperature is common in chronic cases. Metabolism is disturbed, for the elimination of uric acid is increased. Hemorrhages may take place from any of the mucous membranes. Inflammation of various viscera are common complications. Occasionally stomatitis develops and makes eating difficult.

Causes

The cause of leukemia is unknown. In so considerable a number of cases it follows malaria, syphilis, or injury of bones or of the spleen that these conditions have been regarded as causative. It sometimes develops after or during pregnancy or follows scrofulosis, rachitis, or chronic diarrhea. It recurs with frequency in successive generations of certain families, and has therefore been regarded as at times inherited. It has been suspected to be due to a specific infection or to autointoxication, but there is no evidence that either suspicion is correct.

Treatment

The disease is regarded as incurable, although very rare instances have been cited of recovery from it.

Medication must be addressed to symptoms, as no specific treatment is known. Desiccated spleen and lymph glands, as well as bone-marrow extract, have been tried, but un-availingly. Arsenical preparations, especially the organic arsenicals (cacodylic acid and its salts), often do good for a time when the number of red corpuscles is small. Exposure of patients to the x-ray also does good and sometimes seems to effect a cure.

Good hygiene and careful dieting will prolong life. There are often long periods of quiescence or improvement.

An outdoor life should be insisted upon, if possible. At the same time, exercise should be taken in moderation, and in severe cases complete rest is often necessary. Patients should be guarded against the frequent inflammatory troubles that complicate the malady, and that are seemingly due to exposure, to cold, and dampness.

Thirst should be satisfied with pure water, milk, and fruits. As appetite is usually lessened, pains should be taken to place food before these patients in as tempting a manner as possible. The food should be of a character that makes it easy to take. Often it is advisable to give some liquid nourishment, chiefly milk or egg and milk, every two hours in addition to what little food is taken at mealtimes. As digestion is impaired, only easily digested food should be taken. Milk, eggs, breast of squab and chicken, lean cold boiled ham, scraped or finely chopped beef, oysters, fish, stale bread, lettuce, spinach, boiled celery, green peas, oranges, stewed fruits, jellies, and fruit-juices are the best. In mild cases, when digestion is good, the diet may be much more varied than this.

In those rare cases in which stomatitis develops, only the blandest foods, such as milk, custards, gelatin jellies, arrowroot, and similar articles can be eaten. Sometimes it is necessary for a few days to feed a patient exclusively by the rectum.

The spleen becomes so large in some instances, and the stomach so compressed by it, that only a small amount of nourishment can be taken at a time. It is best under these circumstances to give food which is not bulky, and to give it in small amounts frequently. Scraped beef, oysters, a raw or softcooked egg, somatose, and similar preparations are useful. Often feeding by the mouth must be supplemented by rectal feeding. A nutritive enema of milk (peptonized) and starch, with a pinch of salt, is the best.

Inunctions of oil are important adjuvants to food taken by the mouth, when only small amounts are eaten.

In all cases in which the administration of food is much restricted loss of strength must be prevented as far as possible by rest.

The chemical state of the stomach juice in leukemia has not been studied. Clinically it has rarely been necessary to give hydrochloric acid or pepsin. An adjustment of food to the power of the stomach to do its work is most important. It is probable that motor inactivity is greater than chemical inactivity.

Commonly, laxatives must be administered to insure complete bowel movements and good stomach peristalsis.

Pseudoleukemia

This disease does not require extended description, as its dietetic and hygienic treatment must be the same as for leukemia, which it resembles clinically, except that the increase in white corpuscles is less pronounced and the demonstrable morbid changes are more markedly glandular. When swallowing is mechanically interfered with by enlarged glands, artificial feeding may be necessary.