PSEUDOLEUKZEMIA (HODGKIN'S DISEASE).
Definition.—This obscure disease may be defined as an hypertrophy of the lymphatic tissues, accompanied by an anemia, but without leucocytosis. It resembles in many respects the granulo mata, neoplasmic proliferation, and true leukeemia. In the glands of many un doubted cases of Hodgkin's disease tubercle bacilli have been found; such is, however, not a constant condition. From the sarcomata it usually differs by virtue of its wide-spread implication of the lymphatic system; yet undoubted sarcoma may be almost universal. The local lesions are almost identical with those seen in leukemia, and cases of ap parent Hodgkin's disease have become converted into true leukemia; yet the absence of leukemic leucocytosis is usually one of the most striking features of the disease. While we are at present only upon provisional ground, patho logical analogy aids us in interpreting as a peculiar infection, in which a noxa acts upon the lymphatic tissues and stimulates them to excessive proliferation. Of the nature of the in fection we are entirely ignorant. We do not know the portal of infection, but from the fact that the disease so often begins in the cervical glands, it has been supposed to be through the mouth and throat. It may occur at any age, usually during young adult life.
Symptoms.—Instances of acute pseu doleukaemia have been described, with fever, htemorrhages, glandular enlarge ments, marked toxaemia, and an early death. While some such have been au thentic and well verified, in a majority of instances acute leukemia, sepsis, and the purpur2e have not been excluded.
The disease is usually chronic, and the symptoms may be grouped as toxic or mechanical. In some cases the toxic symptoms precede all others, but usually the glandular enlargements are the first signs. The cervical glands are com monly the ones first involved, but some one or several of the other groups soon become implicated. There is more or less pain connected with the swelling, and the glands may be tender to the touch. The cervical enlargement alters the appearance of the patient, and pro duces quite a characteristic facies. The axillary enlargements cause the patient to hold the arms away from the chest; they may press upon the nerve-trunks and cause intense pain, or may produce a destructive neuritis, with all of its symptoms; they may obstruct the flow of blood in the axillary veins and thus produce extreme cyanosis and ozdema of the arm. The enlargement of the in
guinal glands induces a peculiar attitude on standing, and the subjects walk with circumspection; pressure symptoms are not uncommon.
The general symptoms are those of weakness, malaise, and asthenia; the pa tient loses flesh, fever is often present, and regular or irregular sweats may cur. The skin is usually a pale, sallow color; it may exhibit petechim and oedema. Bronzing has been observed.
Accidental eruptions are common.
In ease of leukannia under observation for 3 V, months, there was a daily rise of temperature followed by a gradual fall during the whole period. Von Hajek (Wiener lain. Woch.. May CO, '97).
Stress laid upon the resemblance which Hodgkin's disease and lymphatic leukemia bear to one another. So far as symptoms are concerned the differ ential diagnosis cannot be made, for glandular swellings characterize both and the antenna may be equally marked. The only important difference lies in the blood-constituents. and upon this the diagnosis rests. In lymphatic leukcemia there is a marked increase in the lym phocytes, while in Hodgkin's disease their relative and absolute untidier re mains about normal. M. Einhorn (Med ical Record. July 12. 1902).
Symptoms involving the respiratory tract are frequent and important. The nares may be closed by the lymphatic overgrowth. The laryngeal growths may modify or abolish the voice or pro duce obstruction. The trachea may be pushed far to one side and deeply buried beneath the mass of enlarged cervical glands; it may be seriously and fatally stenosed. Pressure upon a bronchus or a portion of the lung may produce lapse of the lung-tissue, with subsequent pneumonia, abscess, or gangrene. non of several types occurs; it may be hmmic, cardiac, due to pressure upon some part of the respiratory tract, or rarely to pleural effusion due to pressure upon the azygos vein. The laryngeal nerves may be pressed upon, as may the vagus, with their corresponding symp toms. limmoptysis is uncommon; epis taxis not infrequent.