The spleen commonly suffers, especially if the disease begins in the lymphatic glands of the neck. The organ becomes greatly enlarged. Its normal lymphatic tissue takes on a rapid growth, and shows the same ten dency to fibrosis that is noticed in the glands. Externally the organ is of a dull reddish colour with paler patches, and yellow spots from the size of a mustard-seed upwards are often seen scattered over the surface. To the touch it is usually dense and firm. On section whitish or yellow nod ules are discovered on a dark-red ground. The nodules are more or less closely aggregated so as to form masses of varying size and shape. The new material appears to originate in the Malpighian follicles and the peri arterial sheaths of lymphoid tissue. It is composed of lymphoid cells and large quantities of imperfect fibrous tissue. The fibrous stroma is Often thickened, and may show bands of fibrous tissue without definite arrange ment, or running loosely parallel so as to form oval loculi by their diver gencies. In a late stage the bands are sometimes pigmented at their edges. Under the microscope these bands appear to be formed by rapid induration of a lymphatic tissue growing around the vessels.
In the liver the new growth usually appears in the form of small, irreg ular, infiltrating masses which may project as irregular prominent patches on the surface. The structure of these growths is similar to that of the new material in other parts, but in this organ there appears to be a greater tendency to caseation. The lymphatic new growth occupies the interlobu lar spaces. In a case reported by Dr. Greenfield it seemed to start in the portal canals as small masses which extended around and into the lobules, the liver-cells becoming degenerated and shrivelled.
When the kidneys are affected the organs are enlarged and often irreg ular in shape. 'Their colour is light yellow or even dull white, and ecchy moses may be scattered over the surface. Sometimes signs of more profuse haemorrhage are found, and large purple blotches are seen through the capsule on the pale surface of the gland. On section the cortical substance is more or less swelled, and is of a yellowish-white colour mottled with points and patches of red. By the microscope an excess of adenoid tissue is seen between the tubules, sometimes separating them widely. The growth is collected in large quantities around the glomeruli, and in some cases the new tissue appears to pass along the vessels into the interior of the Ma1pighian capsule. In both liver and kidneys it is common to find blood-vessels blocked by masses of colourless corpuscles. a The new growths developed in places where adenoid tissue exists nor mally in minute quantity are usually rather soft and elastic. They are of a pinkish colour and very vascular. Such local developments of lymphatic tissue may be seen in the tonsils, at the back of the pharynx, and in the gul let, stomach, and intestines, originating in the follicular glands. All these often undergo ulceration. Growths have also been found in the testicles, peritoneum, omentum, pleura, and in the lungs. La the latter situation they often break down and form cavities.
When the blood is examined microscopically the red corpuscles are seen to be very pale in colour, but they usually form rouleaux in the or dinary manner. Amongst them are corpuscles of much smaller diameter.
The _red corpuscles are considerably reduced in quantity, but there is sel dom any material addition to the number of white corpuscles : indeed, in many cases, like the red cells they are diminished in number. Sometimes, however, the leucocytes may appear to be slightly more numerous than in the healthy subject ; but even if the spleen be greatly enlarged, no increase sufficient to constitute leummia is observed in cases of true lymphade noma, and the white Bells never present the altered characters which are noticed in the former disease. As a rule, a greater excess of white corpus cles is seen in cases where the lymphatic growth is of the soft variety than where it is hard and chiefly fibrous. Forms of mixed disease are also sometimes met with in which there is increase in quantity of the splenic pulp. The affection has then some of the characters of leucocythemia.
Symptoms.—The symptoms of lymphadenoma may be divided into those proper to the illness, which may be called the regular symptoms, and those which are irregular and accidental, being the consequence of the pressure set up by the growths upon the parts around.
The regular symptoms consist of the general constitutional disturbance excited by the disease, the changes in the state of the blood, and the pres ence of enlarged lymphatic glands.
The general constitutional symptoms may precede or follow signs of enlargement of glands. They consist of a febrile movement more or less high, with gradually increasing wasting, pallor, and loss of strength.
A little boy, aged three years, was under the care of my former col league, Dr. Mitchell Bruce, in the East London Children's Hospital. The child had been ill and languid for three months before admission, gradu ally wasting and suffering from occasional attacks of diarrhoea. When brought to the hospital he was weakly, with a pale complexion and hag gard, anxious look. His face often flushed up suddenly ; his skin gener ally was harsh and dry. At first no special disease of organs could be discovered. The spleen could be felt projecting about half an inch below the ribs, the liver was normal in size, and no enlargement of the lym phatic glands was noticed. The boy coughed occasionally, but the phys ical signs about his chest were normal. His temperature on the first evening was 101.4°, and continued to stand at much the same level for some time. It sometimes sank to 99° and at other times rose suddenly for a few hours to 104°, but it usually varied between 100° and 101°. The boy continued in much the same state, being usually apathetic and chill, although he brightened up a little at times and would play listlessly with his toys. The course of the illness was very variable, and the child seemed much worse at some times than at others. Once or twice he seemed decidedly better and regained a few ounces of his weight, then he relapsed and wasted, rapidly losing a pound and a half in a week. Often he was drowsy, and his appetite was always poor.