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Hodgkin's Disease.

Synonyms.—Pseudo-leukemia; Lymphadenoma; Anemia Lymphatica; Lymphasarcoma; Malignant Lymphoma, etc.

Definition.—A chronic disease characterized by enlargement of the lymph glands, a progressive anemia, and often attended by secondary growths of lymphoid tissue in the liver, spleen, kidneys, bone-marrow, alimentary tract, and other organs.

Etiology.—The causes of this disease are as obscure as those of leukemia. About seventy-five per cent of all cases occur in males, and the majority of cases occur under forty years of age. Syphilis, malaria, tuberculosis, rickets, chronic diarrhea, and other affections are given by some writers as predisposing causes, but just how far these diseases have been coincident factors and how far they have really influenced the disease, it is impossible to say. Unhygienic conditions seem to favor the affection, since the majority of cases occur among the lower classes.

The course of the disease in some cases, especially the occurrence of fever of an irregular type, but a recurring type, and the rapidity with which some of the cases run a fatal course, strongly points to an infectious nature. Recent studies in bacteriology suggest micro-organisms as a probable cause, though nothing specific has yet been discovered.

Pathology.—The pathological changes found will depend upon the stage of the disease. Generally the first changes are noticed in the cervical glands, and these in turn by the axillary glands, and finally the inguinal glands become involved. The affected glands are first isolated, and freely movable, and are about the size of almonds, but as the disease progresses, they become adherent, forming a tumor mass from the size of an orange to that of a cocoanut. These cervical lymphatics may form a chain extending down the trachea and large blood-vessels to the axillary glands.

The mediastinal glands, enlarging, may encroach upon the blood-vessels, and occasionally perforate the sternum and appear as external tumors.

Any of the glands of the body may become involved. When the mesenteric and retroperitoneal glands are the seat of the trouble, the diagnosis becomes somewhat difficult, laparotomy having been performed for abdominal tumors, only to find masses of enlarged lymph-glands.

As the disease progresses, lymphoid deposits take place in other organs, especially the spleen, thymus gland, and sometimes the liver and kidneys. More rarely the skin becomes the seat of lymphomatous growths. The consistency of the glands vary, being soft and jelly-like or firm, hard, and dry. The early stage generally reveals them to be of firm consistency; but as the disease advances, there is a proliferation of the connective tissue-cells, which may change the soft gland into one of almost stony hardness.

A cut section reveals this varied condition, and if made of the spleen, shows a dark-reddish, pulpy mass, interspersed by lighter sections of connective tissue. This gland rarely caseates, and when this does occur, it is probably due to secondary conditions, notably tuberculosis.

According to Stengel, the blood of pseudo-leukemia is distinguished by the absence rather than the presence of alterations from the normal. The reduction of red corpuscles is usually slight, except in severe cases, where they may be reduced to 2,000,000 or even 1,000,000 per cubic millimeter, with alterations in their size and shape. The white corpuscles are about normal in number, though they may be slightly increased or diminished.

Symptoms.—The disease comes on so insidiously that the earlier symptoms are negative. If the superficial glands are the first to be involved, and this is the rule, the patient will notice a bilateral enlargement of a chain of cervical lymphatics; even before this, however, he has noticed a progressive loss of weight and strength. As the disease advances, his attention is called to the enlargement of the axillary glands, and finally to the inguinal glands.

There is generally loss of appetite, furred tongue, and dyspeptic symptoms; especially is this marked where there is. atrophy of the gastro-intestinal mucosa. There is more or less dyspnea, which may arise either from the anemia present, or from pressure from the enlarged mediastinal glands, or from the bronchial glands, and in some cases from pressure upon the trachea by an enlarged tumor mass of cervical glands.

Edema of the ankles is not uncommon in the late stages of the disease. The presence of albumin in the urine is not infrequent. Hemic murmurs are present, and palpitation is a common symptom. Fever is present at some stage of the disease in nearly all cases; in some it is of an irregular type, while in others it will assume a remittent form. Where the skin is affected, ulceration is apt to occur.

Diagnosis.—In the early stage, Hodgkin's disease is, not readily recognized, but when well advanced, the diagnosis is comparatively easy. A few characteristic points, if kept in mind, will enable us to distinguish tills from tuberculosis, thus: in pseudo-leukemia the cervical enlargement is usually bilateral, and involves the anterior or posterior chain of lymphatics, and there is no tendency to suppurate, while in tuberculosis the enlargement is usually confined to one side, involves the submaxillary chain. and the tendency is to suppuration. In the former, there is splenic enlargement and more pronounced anemia. To differentiate from leukemia, a blood examination is necessary.

Prognosis.—The prognosis is grave, but few cases recovering. The disease usually ends fatally in from one to three years, though an acute case may terminate fatally in three months.

Treatment.—Before there is an involvement of the general lymphatic system, the removal of local tumor masses in the neck may help stay the progress of the disease.

A good nourishing diet, plenty of air and sunshine, will be important factors in prolonging life.

Arsenic in the form of Fowler's solution has perhaps been more successfully used than any other one remedy. Phytolacca, iris versicolor, and like remedies deserve a thorough trial..

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.

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