Some contained caseous matter. New growths very similar in appearance were found in the pleura and peritoneum. There were some ulcers in the ilium and mcura. The follicles of the tongue were swollen. Both tonsils were large and ulcerated. Small ulcers were found on the anterior wall of the trachea ; and on the posterior surface of the epiglottis were yellowish infiltrations of a roundish shape. All the mucous membrane in this neigh bourhood was highly injected. Both lungs were the seat of consolidation which had broken clown into cavities. The spleen was large, soft, and con gested. The Malpighian tufts were not visible. The kidneys and liver were normal. The marrow of the right femur was mottled, red, and gray.
The irregular or accidental symptoms arise from pressure set up by enlarged glands or organs upon adjacent parts. Thus the swollen glands in the neck may press upon the jugular veins, and by impeding the es cape of blood from the interior of the skull, cause heaviness, drowsi ness, oedema of the head and neck, and epistaxis. They may also ham per the movements of the lower jaw, press the larynx and trachea to one side, and cause dyspnwa by their interference with the air-passages. Sometimes they obstruct the channel of the gullet so that food passes with difficulty or swallowing becomes actually impossible. Enlargement of the bronchial glands may produce dyspnma, spasmodic cough, and all the symptoms which have been enumerated elsewhere as the consequence of pressure within the chest (see page 181). Growths of the mesenteric glands may set up ascites and jaundice by their pressure on the bile-ducts or portal vein, and cedema of the scrotum and lower limbs by their inter ference with the return of blood through the inferior vena cava.
Paralysis has been occasionally noticed. Thus Dr. Goodhart has reported the case of a little boy, aged six, who was admitted a patient under Dr. Pavy, in Guy's Hospital, for complete paraplegia, with incontinence of urine and deficiency of sensation below the umbilicus. After death a lympho matous growth was found in the thorax, which had entered the spinal canal in the dorsal region by passing through the intervertebral foramina. Here it had lined the laminae of the vertebrae from the axis to the eighth cervical segment. In addition it had formed a mass which at one point completely filled the canal, compressed the cord, and had formed adhesions with the cord and the dura mater. Below this point the sub arachnoid tissue was distended with fluid.
In a case which was under my own care in the East London Children's Hospital—a boy ten years old, who suffered from an enormous mass of enlarged cervical glands on the right side of the neck, besides lesser en largement of the mesenteric and inguinal glands—for some weeks be fore the child's death ptosis was noticed of the right eyelid, and on exam ination it was found that the pupil of that eye was somewhat dilated, and that there was paralysis of the internal rectus. At times, too, the boy
complained of severe neuralgic pains in the right eyeball. After death, inspection of the body showed a mass the size of a walnut, which lay in the middle cerebral fossa, and was adherent to the dura mater covering the cavernous sinus. The mass had a prolongation which passed through the foramen lacerum medium and joined the general glandular mass in the neck. Its pressure upon the right third nerve had caused some atrophy of the nerve—for it was appreciably thinner than that on the left side—and had, no doubt, given rise to the paralytic symptoms which had been noticed during life.
The duration of a case of lymphadenoma is very variable. When the illness begins as a local disease, the course is usually very slow at the first, and it may be years before the general glandular system becomes affected. When, however, the cachectic stage begins, the course is more acute. Still, the progress of the malady is always variable, and growth is more rapid at some times than at others. In the child the general disease rarely lasts longer than six or eight months. Death may result from asthe nia or from some complication, as pneumonia, pleurisy, vomiting, or 'diar rhoea. It may be preceded by convulsions. Sometimes the end is has tened by the injurious effects of mechanical pressure upon the air-passages, the gullet, or the large veins of the abdomen.
the diagnosis of a case of lymphadenoma we have to search for evidence of general fiffection of the glandular system. So long as the disease remains limited to a few glands of the neck the nature of the swelling is not always easy to ascertain ; but even at this time it may be sometimes distinguished by the elasticity of the growth, for, ac cording to Birch-Hirschfeld, even in the harder variety of lymphadenoma there is a certain elasticity as compared with the dense, boardlike hard ness of the cheesy gland. Moreover, there is no inflammation set up round the mass, and caseous degeneration and softening are very rare. In a group of scrofulous glands some usually soften early and form an ab scess. In such a case, too, the general signs of scrofula may be noticed.