THE ANAEMIAS OF INFANCY AND CHILDHOOD.

N. M. Moore, M.D., Augusta, Ga.

The normal blood of infancy differs from that of the adult in many particulars, and even throughout childhood there is a tendency for the blood under pathological conditions to revert to this infantile type.

We find during the nursing period that the red cells average about 5,580,000, being highest at birth and gradually reaching a minimum about the tenth year. During infancy a very marked physiological variation in the number of red cells is often found in successive counts. Their size varies much more during this period of life than in adult life, and occasionally nucleated reds are found in the healthy infant's blood up to the eighth month, but these usually disappear by the end of the second week. The haemoglobin, high for the first few weeks after birth, is throughout the remainder of the nursing period relatively low, but then gradually increases until the tenth or fifteenth year when it about corresponds with the adult findings.

The white cells, after the eleventh day, average 12,000 during the nursing period, and about 9,000 from the first to the sixth year. There is normally a relative increase in the lymphocytes during infancy, about 51% to 59% of the whites being made up of these cells.

This infantile type of blood is variously considered as persisting until the third or even sixth year of life. The blood during this time is peculiarly sensitive to pathological influences, and especially is this true of gastrointestinal disorders. In the resulting secondary anaemias we have a considerable increase in the number of leucocytes and in these cases the relative number of lymphocytes is often above 80%. Nucleated reds are often found

and a simple anaemia during this period of life will frequently give a blood picture which in the adult would be considered of the most grave significance.

As illustrating the peculiar blood findings in the anaemias of childhood, I desire to report the following case of secondary anaemia occurring in a child three. years old:

Family History-Excellent.

Past Medical History-Breast fed for one year. Dentition normal. Said to have had two or three attacks each year characterized by fever, vomiting and diarrhoea. at which times bowel movements contained much mucus. During intervals between attacks said to have suffered from marked constipation. Measles one and one-half years ago-uneventful recovery.

Present Illness-Taken sick February 8th, 1908, with high fever, vomiting and prostration. After four or five days apparently recovered from illness, but seemed quite weak, pale and, occasionally, was thought to have a little fever. When seen by me at my office on March 25th, six weeks after this attack, her complexion was pale and sallow with greenish tinge. Odor of breath bad. Four jaw teeth badly decayed. Examination of throat revealed nothing abnormal. Two cervical glands about size of a pigeon's egg, and practically all other lymphatic glands palpable. Examination of heart, lungs, and abdominal organs, negative. Examination of feces and urine, negative. Examination of blood smear showed no malarial organisms, but a decided lymphocytosis. On April 14th had several attacks of vomiting and slight fever. Although constipated, movements resulting from oil were very foul and contained some mucus. There was also considerable gas. Temperature at this time, 100°, and throughout present attack ran an irregular course, never exceeding 102°. Vomiting was frequent during first days of illness, and occurred at intervals until April 26th, when temperature became normal. By May 16th, child was able to be out and seemed quite

well except that she was slow to regain her strength. Examination of urine, April 20th, during continuance of fever and gastro-intestinal trouble, showed: total quantity, 1,200 cc. Reaction: acid, sp. gr. 1010; no albumen; indoxyl increased; no sugar; some large epithelial cells, crystals of calcium oxylate; no casts; no blood. Other examinations during this attack showed no albumen. The blood examinations, for which I am indebted to Dr. M. S. Levy, showed the following condition during this part of the illness:

The patient was apparently well, except that she had not completely regained her strength, from May 16th to June 28th, when she was taken with persistent attacks of vomiting from six to twelve daily, marked prostration, but no fever at this time, although during the succeeding days there was a slight fever and one day before death temperature reached 104°.

At the beginning of this second illness, June 28th, examination of the urine showed trace of albumen, few pus cells, no casts, no red blood cells. Bowel movements resulting from doses of oil given at this time, consisted largely of a gelatinous looking mucus. By July 9th both kidneys were palpable, the right one extending below level of unbilicus. Vomiting persisted to the end, death occurring July 15th, being preceded by several convulsions. Examination of urine one day before death showed that it contained only a small quantity of albumen, and examination of four slides revealed only two hyaline casts, ten red blood corpuscles, no renal cells and no pus.

My interpretation of this case is that it was a severe secondary anaemia due to an alimentary intoxication, and complicated during second attack by parenchymatous nephritis.

The points of interest in the above case are:

(1) The very great increase in the numbers of small lymphocytes; the differential count showing 91% of these cells at one time.

(2) The appearance of numerous normoblasts and one megaloblast.

(3) The very marked improvement in the blood picture between April 22d and May 16th.

(4) The small amount of albumen, and few cells and casts found in sedimented urine just one day before death, in spite of the very marked parenchymatous nephritis clinically evident and demonstrated at autopsy.

A PLEA FOR AN EARLY

DIAGNOSIS IN THE

TREATMENT OF CANCER OF THE UTERUS.

W. S. Elkin, M.D., Atlanta, Ga.

In presenting this paper I will not discuss to any great extent the pathology of cancer of the uterus, but endeavor to impress upon the members of this Association the importance of an early diagnosis in this disease, and to adopt methods for its prevention and institute treatment that will relieve and cure our patients.

Cancer of the uterus is a very common disease. It affects this organ about three times oftener than any other part of the body. It most frequently occurs between the ages of thirty and fifty, yet no age, except infancy, is a bar to its occurrence. It involves the cervix in a majority of the cases, only about from two to five per cent. of the cancers being in the corpus. It is, strictly speaking, a disease of child-bearing life, usually affecting women who are stout and healthy and have borne five or more children. It rarely occurs in unmarried or sterile women, and when it is found in this class of patients it can usually be traced to traumatism as a result of a previous dilatation of the cervix or curettement of the womb.

The cause of cancer is still an unknown quantity. There are a number of investigators who are adherent to the theory of parasitic origin and quite a number who attribute it to hemie cause, the latter being probably the most generally accepted theory since we know that suppurative processes and certain diseases produce strong antagonistic factors to cancer.

We know that cancer of the uterus in its beginning is a local disease, having its origin in the squamous epithelium of the vaginal portion of the cervix, the cylindrical