1.  Spleen and Bone-Marrow, (Spleen-Medullary) type.—­The changes are especially localized in the spleen and in the bone-marrow while the blood shows a great increase in elements which are derived especially from the latter tissue.

2.  Lymphatic Type.—­The changes in this type are chiefly localized in the lymphatic apparatus, the blood showing an especial increase in those elements derived from the lymph glands.

Causes—­Unknown.  It is most common before middle age.

Symptoms.—­Either type may be acute or chronic.  The invasion may be gradual, sometimes with disturbance of the stomach and bowels, or nose-bleed. (a) The first type is the common one.  The spleen generally becomes enlarged; it is sometimes tender and painful, it may occupy over half of the abdominal cavity and varies in size after a hemorrhage, diarrhea or after a meal.  There may be paleness of the face, etc., early and late nausea, vomiting, diarrhea, and dysentery are common, as is also ascites (dropsy in the abdomen).  The pulse is rapid, full and soft.  Fever is usual.  Hemorrhages occur in the skin, retina, pleura, peritoneum, etc.  Headache, dizziness, short breathing, and fainting may occur from the anemia.  The liver may be enlarged.  The blood shows a great increase in the white cells.  Sometimes they are more numerous than the red blood cells. (b) Lymphatic type is rare, various groups of the lymph glands are enlarged, usually separate, but sometimes matted together; others, such as the tonsils may become large.  The blood shows an increase of the white cells, but less than in the other form.  The spleen is usually somewhat enlarged.  Recovery is rare; the lymphatic cases may last only six or eight weeks.  The course is usually progressive for two or three years.

Treatment.—­The same as for Pernicious Anaemia.

False leukaemia. (Pseudo-Leukaemia).—­Also called Hodgkin’s disease, malignant lymphoma, and general lymphadenoma.  This is a progressive anemia and enlargement of the lymph glands and the skin, with secondary lymphoid growth in the liver, spleen and other organs.

Causes.—­Males are more affected than females, and usually young persons.  Continual local irritation causes a local enlargement of the gland, but the actual cause is unknown.

[Blood and ductless glands 253]

Symptoms.—­The lymph glands of the neck, arm-pit or groin are enlarged and without any pain, followed by anemia, loss of strength and slight fever.  The glands enlarge slowly or rapidly, forming large masses, while the growth extends to other regions.  The spleen may be felt; the skin may be bronzed.  In cases with involvement of deep seated nodes the first symptoms may be those of pressure on blood vessels, nerves, trachea, bronchial tubes or other structures.

Treatment.—­Cut them out if they are small and localized.  Arsenic, quinine, cod-liver oil are good medicines.