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S m a~ Reschad and Schilling-Torgau in 1913 f i s t described monocytic leukemia as a pathological entity, a series of case reports has appeared, sparsely at first, recently with increasing frequency.It would appear t o be a commoner condition than was at first thought and no doubt many cases still pass unrecognised under the embracing diagnosis of acute leukaemia. Apart from its intrinsic interest, monocytic leukaemia is of special importance because of its influence upon our theories of the genealogy of the blood cells and their relation to the reticulo-endothelial system. Upon the vexed questions of the origin of the monocyte and its relation to the other blood cells there is by no means unanimous agreement. We report the following cases because they seem t o us to throw some light on these questions and because of an unusual distribution of the lesions. Case 1. J. D. male, aged 39, coal miner, married. Admitted 8.2.34, died 26.9.34. History of illness.Three weeks before admission patient had a septic throat which subsided For two weoks there was persistent, sovere headache, chieflySince hc took ill the He had complained of tender gums for in a few days. frontal, and this ww the predominant complaint. temperature had been about 100" 5'. about ten days. Previous health good. State on admission.Tho mucous membranes were palo, the gums swollen, soft and tender, with bleeding a t the margins but no ulceration. Tonsils large and inflamed. Submaxillary and upper jugular glands considerably cnlarged on both sides, falrly firm, mobile and slightly tender. Spleen and liver not demonstrably enlarged. Thore wore no subcutaneous nor submucous haemorrhagos. Tongue moist and coated with a thick brown fur. A few caxious teeth. A trace of A tall well-built man with a sallow unhealthy complexion. 61 7 618 A . C. P. CAMPBELL, J . L. HENDERSON A N D J. H . GROOM albumin in the urine. and ncrvous systems normal. the striking feature wm the leucocytosis with monocytic predominance.A mitral systolic murmur was present. RespiratoryThe blood findings are recorded in table I ; Progreaa notes. The scvcre headache subsided in a fortnight, but the anEmia steadily progressed, becoming definitely mcgalocytic in type. The white blood count fell gradually towards normal but tho qualitative alteration persisted. The swelling of the gums increased until the teeth were almost buried. The tcmperaturu fluctuated between normal and 1003 F.After ten weeks, a spontaneous remission set in ; the temperature became normal and the swelling of the gums deoreased. The anaemia improved and the white blood picture became almost normal apart from a leucopenia with a relative lymphocytosis. The patient gained rapidly in strength and weight and was discharged to a convalescent home. Improvement seemed t o continue for several weeks thereafter, until nausea and abdominal pain drew attention to a large, firm, slightly tendcr maw in the right iliac fossn. Two weeks later he was readmitted to hospital, the mass being still present. Tho swelling steadily diminished...

Malignant endocarditis, under which term I include all cases of severe acute endocarditis, whether attended by actual ulceration and loss of substance of the endocardium or not, is unfortunately only too well known in connection with the puerperal state. Puerperal infection is mentioned as a possible cause by all writers since the disease was identified, and a glance at the literature of the subject suffices to show how well founded this statement is. The disease itself is actually about three times as common in the male sex as in the female. But of forty-nine fatal cases occurring in the female, in the statistics of Kanthack and Kelynack, we find eight put down to puerperal infection? an average of rather more than 16 per cent. On the other hand, the occurrence of malignant endocarditis in pregnancy is a rarity. In his Goulstonian lectures on malignant endocarditis, Osier mentions four cases as having occurred in pregnancy. In addition to these, I have been able to find only two more cases, after an extensive, if not exhaustive, search through the literature. The mode of onset, the symptoms, and the course of malignant endocarditis are all so diverse that it is not possible to draw a clinical picture that will fit every case. Two types are in general recognised?the typhoid type, and the intermittent, septic or pysemic type. These again are subdivided into cardiac

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