Document LJYmrq8aNbLEV42EzpmRpgDNz

THE C.LYADIXN kIEDIC.U, . MYEL0GEN0US LEU LERI1A-TRE ATMEN `r BI' BENZOL. AND 5-RAI' BY H. A. LAFLEUR1, I.D. ilf ontreal ~4N O S G the various methods of treatment recomxendpcl - myelogeenous leukmniu none has attracted more aGtent;.JIl -recent yeais than that which consists in the administratiun benzol. Given alone, or in combination with x-ray treatm(-! to the spleen and long bones, the improvement has been SO rap:$! so marked, and has extended over so long 3 period, that the it!, : of spontaneous remission, in explanation of the favourab!e rc-ui: may be confidently excluded. Starting with the first therapeutic administration of the drt:: by Von Koranyi in 1912, a considerable literature has grown r:p around this topic, which has not only emphasized the efficacyI - i this method of treatment but also drawn attention to its pod!^. dangers. Both of these aspects may be appreciated by referencv to the communications of Billings, in the Journal of the Amen'Ccn Medical dssociution, 1913,and of Barker and Gibbes in the J d a - c Hopkins Hospital Bulletin,December, 1913. The following case is an instance in which benzol, combint-i with z-ray treatment, has unquestionably produced a mnrkt-i improvement not onIy in the blood picture but on the patient'- general health, without inducing any of the untoward effect: th:i! :- some c s e s have followed the administration of the drug. G. H. K., aged forty-eight, came under obsCn-:l::iu:! first on May 20th, 1919,complaining of loss of weight and t;trclwth- and "a depressed feeling in the stomach". He h`d h d disrrh(l**- one or two watery motions with some mucus daily for sis wA- The loss of weight amounted to about twenty-eight p o d : ` . had become sallow in the last year. He had 3 slight %tt:ic'k influenza in 1918, and two or three years ago had suffercrf ir',In hzemorrhoids. There was no history of serious illness :mi !:-- habits were good. \ The family history was unimportant. Phc.sic*alt'.r(l'''i ' ` *. ASSOCIATION J O U R N f i 997 ;bo-pd him to be of rather salIom and nnEmic appearance. There 3s nothing in the visceral examination except il slightly palpable xver and a considerably enlarged, hard and palpable spleen. The 1 $enic dulness measured 1Tx 11 cm. Blood eraminatim on AIay .othgave: Red blood celb. . . . . . . . . . . . . . . . . 3,700,000 White blood cells. . . . . . . . . . . . . . . . . 73,000 H3emoglobin.. . . . . . . . . . . . . . . . . . . . . . . . .69 per cent. Differentialcount, 11:Ly 30th: Polymorphs. ......................... .-I6 per cent. .Small mononuclents. . . . .: . . . . . . . . . . . . . . .4per cent. Large mononuclears.. .................. .I per cent. ;"Iast cells. . . . . . . . . . . ................ .2 per cent. Myelocytes.. ........................ .47 per cent. 2 normoblasts were observed in thiszcount. *'* BenzoE was begun on May 30th, m. v. with anequal quantity of olive oil, in capsule, three doses daily, increasing the dose by m. i every second day, and was continued until he left hospital on June 20th. X-ray treatment was started on June lst, and continued daily, mth an intermission of five days, from June 7th to June l l t h , to he date of leaving hospital, June 20th. Blood counts made on June 4th, L4th, and 19th, gave respectively 109,000-114,000 and 18,400 white cells. It is interesting to note the temporary increase of the white elements at the beginning of the treatment, which is the rule in moet of the cases hitherto reported. Coincidently with *e decrease of the white cells there mas a marked reduction in the 4% of the spleen, which became barely palpable. Rlr. IC. had planned a trip to the Pacific coast, and as he was reeling much better it seemed advisable to allor him to leave with the caution that he was to continue treatment and to have a careful blood count made on arrival at his destination. I saw him again on July 31st, and was surprised at the change the blood picture. Red cells 5,600,000-white cells, 3,000 (an Utual leucopenia). There were still a few myelocytes to be found sfter a careful search. Benzol w8s discontinued at once, and as he felt very well , ' 'here seemed to be no objection to his returning to his home in hw Brunswick on the understanding that he should km-e s a - "ently frequent blood counts macle in St. John by Dr. .\brsmson to h r n I am indebted for the followvi11g: - 998 THE CANADIAN MEDICAL September 18th,R. C., 4,100,000; W. C.,3,300; H., 75 per cent. November 13th, R. C., 5,270,000;JV.C.,14,333; E.,98per cent. December l l t h , R. C., 5,080,000;W. C., 6,600;H., 100per cent. (no myelocytes) June llth, 1920, W. C., 15,800 (no myelocytes). During the period extending from November, 1919, to , J ~ ~ ~ . ~ . 1930, benzol and 2-ray treatment r e r e taken intermittently Kriting on June l4th, 1920, Mr. K. states: " I h w r been very well indeed for the 1 s t sis montll.. 1, ,. recently my white cells begin to run up again." He is nom again haL-ing a course of the combined treatnltx!,:. It is probable t h a t the condition is only in abeyance, but ti::. much can be said that no other form of treatment can show L. beneficial effects in what is admitted to be an incurable disease, : ~ i if it be borne in mind that frequent blood esminations and vcr; guarded dosage are absolutely essential, it may be admitted that tt& is a distinct advance in the therapeutics of myelogenous leuk3emi:i.