As time went on the liver and spleen became moderately swollen, signs of enlargement of the bronchial glands were noticed, and deep pres sure in the abdomen discovered some enlargement of the mesenteric glands.
The bowels remained more or less loose. The boy grew slowly weaker, and died after a residence of four months and a half in the hospital. There was never any cedema of the limbs, and the glands in the neck were not affected.
On examination of the body after death, large yellow, cheesy-looking masses were found adherent to the under surface of the breast-bone, and the anterior mediastinum was filled with a large mass of agglutinated glands. A similar mass was found in the abdomen • in front of the spine just below the diaphragm and surrounding the head of the pancreas. The liver was large, soft, and flabby to the touch. Its section showed a half translucent appearance, and on close inspection this was found to be due to a multitude of closely set little masses, the size of a pin's head or less, some clear and transparent, others more yellow. The spleen also was large, and its section showed the appearance usually noticed in this disease and which has been already described. Both lungs were found on section to be pervaded with small masses of new adenoid growth.
In this case the general symptoms preceded the signs of local mischief. Often, however, especially if the illness begins, as it commonly does, with enlargement of the cervical glands, the affection has at first the characters of a local disease. But sooner or later, as the lymphatic tissue becomes more and more involved, the patient begins to suffer from irregular fever and grows very decidedly aiimmic.
The glandular swellings in the neck usually form an irregular nodular mass which may extend from one side to the other, passing underneath the chin, or may be limited principally to one side. At first the individual glands can be made out, and the masses are movable. Afterwards the glands become more welded together and the masses are fixed. The swellings are painless, and unless of very rapid growth are dense and firm to the touch.
In some cases a mass of enlarged glands will become very soft and suppu rate, forming an abscess which discharges and heals up in the ordinary manner. Besides the neck, enlarged glands may be felt in the and groins. In the armpits the size of the growths may interfere with the movements of the arms. Examination of the chest and belly often dis covers a similar change in the glands lying in the anterior mediastinum and abdomen. The enlargement of the liver and spleen is usually mod erate, although sometimes—especially in the case of the latter organ—it may be very considerable.
While the disease is limited to swelling of a few glands in the neck, the child, although pale, may be active and cheerful, apparently. suffering in no way except from the local inconvenience. When, however, the glands grow rapidly, or the disease spreads from the neck to other parts of the body, constitutional symptoms begin to be noticed. Fever is almost invariably present, although in the earlier stage it is slight and intermittent. In the cachectic stage the temperature often rises to a high level, and for a few days together may range between 103° and 105°, sometimes even passing the higher limit. Sweating is not common ; indeed, in most cases the skin is excessively harsh and dry. The digestive organs almost inva riably suffer. The tongue is covered with a white fur, and the papilla; are prominent and red. Ulcerative stomatitis may be present on the inner side of the cheek, The appetite is poor and indigestion and vomiting may be complained of. The bowels are sometimes costive, but often they are loose, and the clejections may be preceded by griping pains in the belly. The looseness is due in many cases to small ulcerations of the ileum. There is then usually abdominal swelling, increased tension of the parie tics, and tenderness on pressure. More or less cough is a common symp tom, and an examination of the chest often discovers signs of consolida tion and softening. These lesions commonly result from growths in the lung which soften and break down into cavities.