Sarcomatous glands present a greater likeness to lymphadenoma ; but when extension takes place in the former disease the tissues involved are not especially the lymphatic tissues ; indeed, the disease tends to spread rather to organs than to glands.
In the cachectic stage lymphadenoma is usually easy of recognition. The irregular fever, the extreme pallor, the great drowsiness and unwill ingness to speak, the general implication of lymphatic glands in all parts of the body, the character of the blood, which shows diminution in the number of red corpuscles with no or only slight increase in the proportion of leucocytes. These symptoms are sufficiently characteristic.
Prognosis.—Although some cases of recovery from this disease have been recorded, the illness is so generally fatal that little hope of a favour able issue can be entertained. In the cachectic stage speedy death may be anticipated. In the earlier period a prolonged course may be hoped for, especially if the enlargement is slow ; but it is unwise to speak too favourably even of this prospect, for the disease may at any time suddenly assume an acuter character, and variations in the rapidity of its progress are not uncommon. Examination of the blood may be of some service in estimating the probabilities of a lengthened course. If the number of red corpuscles is greatly reduced, the child's prospects are very unfavourable.
Treatment.—In every case the child should be put into as good sanitary conditions as possible, and every effort should be made to improve the general health. Cod-liver oil, iron, quinine, and tonics generally are use ful in this respect, but none of these remedies have the power of delaying materially the progress of the disease after the affection of the lymphatic glands has become general. Arsenic, however, is highly spoken of for its value, even in this stage of the disease. The dose should be a large one ; and it must be remembered that most children have a special tolerance for this drug, being often able to take it in larger quantities than can be readily borne by the adult. For a child of eight years old ten drops of Fowler's solution may be given three times a day, freely diluted, directly after food, and every few days the dose can be increased by two drops. The effect of the medicine is to increase the softness and mobility of the glands. Soon pain begins to be complained of in the swellings, and this
is quickly followed by an arrest in their growth, or even an appreciable diminution in their size. Iron may be given with the arsenic if thought desirable, and the combination is preferred by some. Phosphorus has been also recommended as useful in promoting reduction in size of the glands ; but this drug appears to be decidedly inferior-to arsenic. Iodide of potassium has been found quite useless as an absorbent in this disease.
If the patient come under observation when the glandular swelling is limited to the neck, and the general system appears to be unaffected, we may begin the treatment with greater hopes of success. Early extirpation of the growths is often advocated, and the operation is said to have been followed in some cases by complete recovery. Even if this happy result be not attained, we may expect that in a suitable case the progress of the disease will be sensibly checked by the operation. We can, however, only anticipate good results when the glandular enlargement is limited strictly to one group of glands, the spleen is unaffected, and the proportion of red corpuscles in the blood is not greatly reduced. Dr. Gowers recommends that in every case the actual proportion of red corpuscles be estimated by the limmacytometer, and states that if the proportion of coloured cells be less than per cent. of the normal average, the idea of operating should be abandoned. On the other hand, a slight increase in the quan tity of white corpuscles is not to be considered prejudicial to the success of the operation. After removal of the swollen glands the child should be sent to a bracing seaside air, and arsenic with quinine or iron should be given in full doses.
According to some writers, friction of the growing glands with the hand alone or with some simple salve has been found useful, and com pression and blistering have been also recommended. Injections into the glands of various substances, such as iodine, carbolic acid, etc., is not a safe method of treatment. In one case in which I injected tinct. iodi into a large lymphomatous swelling the operation was followed in a few days by a rapid and permanent increase in the size of the tumour.