Study of the pathological findings in the reported cases, shows that only the bone marrow is affected in all cases, the spleen and lymphatic glands being normal in some cases.

The following case occurred in the practice of Drs. R. Luedeking and Justin Steer, who asked the writer to make the blood examination and to whom the author is indebted for notes on the case and permission to publish the same.

E. L., age 12 years, nativity, St. Louis County - occupation, school. Both parents are alive and while the family is somewhat neurotic, there are no evidences of any hereditary taint. E. L. had always enjoyed good health previous to his last illness with the exception of an attack of measles which he had in early life. He was one of twins and was considered rather robust.

His last illness began during the night of June 8th, 1905, when he had a severe attack of Epistaxis and later vomited a large amount of blood which had probably been swallowed. The following day the father who resides in a suburb of St. Louis brought him into the city on the street cars to consult Dr. Luedeking. He was quite anaemic at this time with a somewhat muddy complexion and showed a few small purpuric spots. Examination

of the fresh blood by Dr. Luedeking at once showed the increase in the white cells. The gums were swollen and tender and the temperature ranged from 99.5° to 100.5°.

Dr. Luedeking left the city a day or two after his first visit and referred the case to Dr. Justin Steer who saw him first on June 12th, four days after the onset of the trouble.

At this time he was covered with subcutaneous hemorrhages varying in size from the smallest flea-bite to those that could hardly be covered by the palm of one's hand. His gums were swollen aud bled readily and the nurse stated that he had vomited a bloody fluid that day. The lymphatic glands were not enlarged excepting the post-cervical and these were only moderately so. The spleen was normal in size. bones were not tender on pressure.

The long

The writer saw him six hours before death on June 13th. His pulse was almost imperceptible and he was quite restless. The following blood examination was made at the time:—

Examination of the stained specimen showed no nucleated red cells and no poikilocytosis although there was some difference in size in the red cells.

Death ensued at 5 p. m. June 13th, somewhat less that five days after the initial epistaxis before which he seemed in perfect health.

There was no autopsy.

Is is very possible that the comparatively low leucocyte count was due to approaching dissolution as it has been found in other cases that the number of leucocytes diminishes one or two days before death, although counts of 20,000 (Demig)2 and 22,000 (Gilbert and Weil) have been reported.

In the terminal stages of chloroma the blood often shows the typical picture of an Acute Lymphatic Leukaemia. This condition can be differentiated from Leukaemia only by the pressure

symptoms produced by the green tumors or by post-mortem examination.

1107 N. Grand Ave.

BIBLIOGRAPHY.

1 Deutsche med. Wochenschrift, 1895. 2 Archiv de Med. Experimental, 1899. 3 Muench. med. Wochenschrift, 1900.

WORK FROM OTHER LABORATORIES.

A STUDY OF THE BONE-MARROW IN TYPHOID FEVER AND IN OTHER ACUTE INFECTIONS.

BULLETIN OF THE AYER CLINICAL LABORATORY OF THE PENNSYLVANIA HOSPITAL. NO. 2.

In the report of this investigation, Dr. Warfield T. Longscope gives a brief outline of work thus far done. We find the names of Ehrlich, Ponfick, Mallory, Fraenkel, Chiari, Councilman, Magrath, Brinkerhoff, among many others.

The close relationship between certain cells of the haemopoietic organs and the cells of the circulating blood, as pointed out especially by Ehrlich, renders a study of the bone-marrow, lymph glands and spleen in acute infectious diseases of special interest, since examinations of the elements of the circulating blood have been productive of great information in the histology of such diseases.

In this study examinations of the bone marrow were made in twenty-six cases of typhoid fever, fifteen cases of pneumonia, four of peritonitis, two of miliary tuberculosis, one of acute cerebrospinal meningitis, one of retroperitoneal abscess, one of puerperal septicaemia, four of chronic nephritis, one of carcinoma of the gall bladder, and of two normal individuals. The marrow chosen was from the upper third of the femur, and was examined in sections and in smear preparations. The marrow in the two normal cases was obtained from the lower end of the tibia.

The tissues were hardened in Zenker's fluid and for staining, haematoxylin and eosin, eosin and polychrome methylene blue, eosin-aurantia-toluidin blue, and Weigert's fibrin stain, were used. The smears were treated in most cases with Jenner's mixture or Ehrlich's triacid stain; other methods were occasionally employed.

SUMMARY.

Verbatim. The bone marrow from twenty-six cases of typhoid fever showed certain definite and constant histological lesions. These lesions resembled very closely the changes in the mesenteric lymph nodes and the lymphoid follicles of the intestine and spleen. The alterations were characterized by the presence of many lymphoid cells, large phagocytes, and foci of necrosis. There was more or less hyperplasia of the blood-forming cells. In many of the marrows from cases dying of perforation and general peritonitis there were, besides the disseminated foci of necrosis, diffuse degenerative changes in the blood-forming cells, accompanied by marked oedema and congestion of the tissues. Differential counts of the bone-marrow cells from ten cases showed a marked relative increase of the lymphoid cells over the granular myelocytes.

The bone-marrow from fifteen cases of acute lobar pneumonia, four cases peritonitis, one of acute cerebro-spinal meningitis, one of retroperitoneal abscess, and one of puerperal septicaemia, all showed the same variety of alterations, differing however in many important points from the cases of typhoid fever. There was more or less extensive hyperplasia of the blood-forming cells with a marked relative increase of the granular myelocytes over the lymphoid cells. In the cases of peritonitis due to causes other than typhoid perforation, diffuse degenerative changes were absent. In no cases of this group were foci of necrosis found. Large phagocytic cells were exceedingly rare or entirely

absent.