Circulatory symptoms consist of rapid cardiac action, hremic basal or apical murmurs, the murmurs and pulsation in the jugular veins, nutritional disturb ances due to pressure upon vascular trunks, and peripheral or central haemor rhages. Endocarditis and pericarditis are rare. The mediastinal growths may dis place the heart and seriously disturb its action.
The alimentary symptoms are impor tant. Stomatitis and pharyngitis are not rare, while dyspeptic symptoms are common. Crises of pain are probably the result of nerve-pressure. Dysphagia may be produced by pressure. The liver may be enlarged, and the enlarged glands at the hilum, which may be pal pable, may cause, by pressure, ascites or jaundice. Constipation is the rule; di arrhoea should excite suspicion of in testinal ulceration. Hmatemesis and mehena are uncommon. The retroperi toneal glands may be palpable, as may the nodules in the intestinal tract.
Other symptoms are irregular. Al buminuria is uncommon, but amyloid disease may induce it. Casts may be present. The urine seems to be nearly normal. In particular the uric acid and the purin bases are usually not increased. Disturbances in urination are rare. Pains in the bones are sometimes com plained of. The menstrual function is usually disturbed, but sterility does not follow in either sex. Insomnia, vertigo, and headaches are common. The local nervous symptoms are those of pressure: pains, parmsthesia, anesthesia, paralysis, and trophic changes.
The condition of the blood is that of a simple anminia. There is a moderate oligocythzemia and a slightly dispropor tionate oligochrommia. Poikilocytosis is usually moderate, and nucleated red cells are not frequent. The leucocytes are usually quite normal, both as to quality and quantity. Some cases ex hibit a simple polymorphonuclear leu cocytosis, particularly during the last stages; in a few cases the eosinophilic cells are increased, while in other cases a lymphocytosis may be present.
Remissions and exacerbations are of frequent occurrence. The glands may decrease in size and then may increase, and with these alternations the symp toms, particularly the fever, fluctuate. The duration of the disease is from six months to several years. The disease is nearly always fatal.
Diagnosis.—In adults it must be diag
nosed from the granulomata, sarcomata, and leukaemia. As against sarcoma, the extent of the implication, the rapidity of the process, the leucocytosis, and the cachexia will usually permit of a diag nosis. Ordinary lymph-tuberculosis is localized, and sooner or later the glands break down; there are, however, in stances of wide-spread lymph-tubercu losis in which no caseation occurs, and such can be with difficulty separated from pseudoleukremia. In children rickets, syphilis, amyloid disease, chronic gastro-enteritis, or any of the secondary ancemim which produce splenic enlarge ment must be excluded.
Pathology.—In pseudoleukmmia the implication of the lymphatic tissues is wide-spread. It is never confined to one set of glands, nor has it ever been shown to have been confined to the spleen or to the bone-marrow. The glands may be come enlarged singly or in chains. The capsule is usually thickened, and the growth does not tend to break through it. Early in the disease the glands are soft, later they may become hard. They may be gray in color, may have a chlo romatous hue, may be deeply pig mented, or may be hemorrhagic. Soft ening and necrosis are not common, and the surrounding tissues are rarely ad herent to the glands.
Microscopically there is a marked hyperplasia of the lymphatic cells. While these are of the common lym phatic type, there is a noteworthy poly morphism in the cells. There are also present fibroblasts, large endothelial cells, and globuliferous giant cells. The walls of the blood-vessels arc not impli cated. The typical arrangement of the germ-centres is entirely distorted, but there is no predominance of the mother cells, such as is seen in the glands in acute leukemia, the condition resem bling more those exhibited in chronic lymphemia. Cellular degenerations are frequent, while mitoses bespeak the rapid proliferation.
Case of acute lymphatic pseudoleu krentia in which repeated examinations of the sputum were made during life and of the fluids after death. No tu berculous lesions were discoverable: on the other hand, the microscopical ex amination of the lymph-nodes showed the characteristics peculiar to lympho sarcoma. J. L. lleffron (Amer. Medi cine, April 12, I902).