Untitled - Clpdigital.org

12 Rapitjm
ooo per cubic millimetre. Cases have been recorded in which the number
of the leucocytes has exceeded that of the red blood corpuscles. A differential
count of the white blood corpuscles reveals some striking features.
'The lymphocytes may be reduced to 5 per cent or even less. The
polymorphonuclears are relatively diminished; the eosinphilcs are increased.
Myelocytes, both neutrophilic and eosinophilic, are present in
large numbers, and may form 25 per cent to 50 per cent of all the white
corpuscles. Nucleated red blood corpuscles and poikilocytes are also
present in varying numbers. There is generally a moderate reduction
in the number of the red blood corpuscles, the total rarely falling below
2,000.000 per cubic millimetre. The hemoglobin is usually diminished
in a slightly greater proportion, giving a color index of from 0.7 to 0.9.
Hemorrhages are common. Epistaxis is of frequent occurrence. Bleeding
from the jaws, hematemesis, cerebral and retinal liemorrhages. extensive
purpura, and multiple ecchymoses are met with. The disease usually
proves fatal in two or three years, though some cases of recovery
have been recorded.
Radium is unquestionably of great value in the treatment of spienomedullary
leukemia. The immediate result in the improvement of the
blood condition is very remarkable. It is often possible to record a definite
decrease in the white cell count three days after the termination of
the exposure, and this decrease may be steadily maintained for four or
five weeks, at the end of which time the number of leucocytes may be
reduced to between 20,000-50,000 per cubic millimetre. There is usually.
in addition, a concomitant rise in the hemoglobin content, the anemia
is lessened, and the tendency to hemorrhages diminished. The patient's
general condition is also improved, appetite and strength returning. If
the disease is of comparatively recent origin, there is a great decrease
in the size of the spleen, the organ rapidly shrinking to almost normal
dimensions, and permitting the performance of splenectomy, if this be
considered desirable. If the condition is of long standing, and the spleen
has previously been subjected to much treatment with X-rays, but little
actual decrease in its size is likely to be effected by radium, as extensive
fibrosis of the splenic interstitial tissue will have taken place. The radiation
employed in the treatment of spleno-mcdullary leukemia should be
wholly of the gamma type. "Half strength" flat surface applicators,
screened with 2 mm. of lead, are used, and containing from 100 to 400-
mgrs. of radium clement according to the size of the spleen. The total
radiation should be of from twenty to thirty hours, and, when possible,
this should be spaced over two or three days, as by so doing the possibility
of inducing some slight systemic disturbance is much lessened.
Patients vary greatly in regard to the amount of disturbance experienced.
possibly the most constant feature is a feeling of nausea (which in very
susceptible patients may induce actual attacks of vomiting), with headache
and a slight rise of temperature. These symptoms arc, however,
quite transient, and disappear within twenty-four or forty-eight hours.
The patients need to be kept under careful observation and periodic
examinations of the blood should be made. A steady progressive increase
in the leucocyte count should be regarded as an indication for further
radium treatment. This is. however, rarely necessary at lesser intervals
than four months, and in favorable cases a period of six or nine months
may elapse between exposures. In very advanced cases accompanied by
severe anemia, transfusion of blood may advantageously be employed
between the radium treatments.