The second form of lymphatic leukaemia is marked off from the preceding
by its chronic, and often very protracted course. The spleen shews its
participation in the disease, as a rule by very considerable
enlargement. We have at present no investigations adequate to decide
whether chronic lymphatic leukaemia represents a single disease, or
should be etiologically subdivided. Haematologically, all lymphatic
leukaemias are characterised by a great preponderance of lymph cells, in
particular of the larger varieties. It should here be expressly
mentioned, that richness of the blood in large lymph cells, is by no
means characteristic of the acute form of leukaemia, for chronic, very
slowly progressing cases shew the same condition. Thus in a case of this
kind under observation in Gerhardt's wards, all observers (Grawitz, v.
Noorden, Ehrlich) found the large cells during its whole course. In
agreement with our remarks elsewhere (see p. 104), we assume with
regard to the origin of lymphatic leukaemia, =that the increase of the
lymph cells is brought about by a passive inflow into the blood; and not
by an active emigration from chemical stimuli=.
~Myelogenic leukaemia~ presents a picture that is different in every
particular. In former years the distinction between myelogenic leukaemia
and simple leucocytosis offered great difficulties. These conditions
were regarded as different stages of one and the same pathological
process, and when the proportion of white to red corpuscles exceeded a
certain limit (1:50) it was said that leucocytosis ceased, and leukaemia
began. By the aid of the analytic colour methods the fundamental
difference between the two conditions was first disclosed. Leucocytosis
is now recognised to be chiefly an increase of the normal polynuclear
neutrophil leucocytes; whereas myelogenic leukaemia brings elements into
the blood that are abnormal. The cells here introduced are so
characteristic as to render the diagnosis of leukaemia possible, even in
the very rare cases where the total number of the white blood corpuscles
is not to any extent increased. The best example of which we are aware
is a case observed by v. Noorden, in which the proportion of white to
red was only 1:200.
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