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Lymphatic Leukemia.


Definition.—A leukemia characterized by an increase in the lymphocytes and enlargements of the lymphatic structures.

Etiology.—As in myelogenous leukemia, various theories have been suggested, but none satisfactorily proven.

Pathology.—Hemorrhages occur in the skin, the retina, the mucous membrane of the intestinal tract, the pleura, pericardium and peritoneum, the pelvis of the kidney, and sometimes into the brain, and, if in the motor region, give rise to paralysis.

The lymph glands are universally enlarged, hard and firm in consistency, marrow-like and white, unless hemorrhage occurs, when they are pink.

The spleen may be normal in size, though usually slightly enlarged, and in children it occasionally is of enormous size. It is soft, confluent, and of a brownish red or chocolate color.

The Bone-Marrow—The changes in the marrow are constant and characteristic, usually affecting the tubular bones throughout their entire extent; the marrow is red in color, and the consistency of jelly.

The "characteristic change produced in the blood by lymphatic leukemia is the tremendous increase in the absolute number of circulating lymphocytes. While in healthy blood these constitute less than thirty per cent of the whole number of white cells, in this condition they form over ninety per cent of a total leukocyte count, which is many times the normal."

Symptoms.—Acute Lymphatic Leukemia.—The onset is sudden and the course rapid, the disease terminating in a few days or weeks. The symptoms are those of an infectious disease, there being fever, nausea, vomiting, and diarrhea. Hemorrhages into the skin and mucous surfaces are characteristic, attended by anemia. The enlargement of the lymphatic glands is never so marked as in chronic lymphatic leukemia, in fact, may not be noticeable till near the close of the disease. As the disease progresses, it assumes a typhoid type, with delirium, coma, and finally death. A painful and somewhat characteristic symptom is severe ulceration of the mouth and gastro-intestinal tract. Acute nephritis is sometimes present.

Chronic Lymphatic Leukemia.—This form comes on slowly and insidiously, the enlargement of the lymphatic glands being the first symptom, many times, to call attention to the disease. The first to be noticed are the cervical, to be followed in turn by the axillary, inguinal, etc., till all the glands of the body become affected. Thev gradually increase in size, are usually soft, though they rarely suppurate. Occasionally they are quite firm. The spleen is enlarged, but not to the extent as seen in the myeloid form.

As the glands enlarge, the patient becomes anemic; there is failing strength, and emaciation more or less marked, are the danger-signals of an incurable malady. Hemorrhages may occur late in the disease.

The disease runs its course to a fatal issue in from one to three years, though occasionally it terminates in a few months, through some intercurrent disease, like pneumonia, tuberculosis, and kindred diseases.

The treatment of all forms of leukemia is unsatisfactory; the most we can do is to retard, to some extent, the progressive changes by symptomatic treatment. Outdoor life in a suitable climate, a nutritious diet, and arsenic, the bitter tonics, and iron, may accomplish some good.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.

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