HODGKIN'S DISEASE 371 



intestine. But as we are not -always able to differentiate these changes ive 

 cannot discard the name which describes the typical clinical picture. 



This, of course, must not prevent us from investigating so far as is possi- 

 ble tlie anatomical conditions in each individual case of pseudo-leukemia, and 

 finding, if we can, the exact lesion present, particularly as support may be 

 gained in this way for prognosis and therapy. [The studies of Dorothy Eeed, 

 confirmed by those of Longcope and of Simmons, have, I think, established 

 Hodgkin's disease upon a definite histological basis, and difl^erentiated it alike 

 from tuberculosis, from sarcoma, and from leukemic infiltrations. In view of 

 these findings, the diagnosis can and should be made by the excision of one (or 

 more if need be) of the superficial lymph-glands and examining it histo- 

 logically. — Ed.] 



The organs which are to be considered in pseudo-leukemia, the lymph- 

 glands and the spleen, are almost always simultaneously affected, although not 

 often to the same extent. In pseudo-leukemia we know but little regarding 

 the third organ which is important, or probably important, in blood forma- 

 tion, namely, the hone-marrow ; it has sometimes been found hyperemic and 

 of the same consistence as in leukemia, but in regard to this further investiga- 

 tion is necessary. 



In the majority of cases the enlargement of the lymph-glands is more con- 

 spicuous than that of the spleen. Hence some clinicians recognize as " pseudo- 

 leukemia" only those multiple lymph-gland enlargements first described by 

 Hodgkin, and distinguish sharply the cases in which enlargement of the spleen 

 is more prominent, or is present alone. To me it appears that this limita- 

 tion of the conception " pseudo-leukemia " is unwise, for an enlargement of 

 the lymph-glands alone or of the spleen alone rarely occurs. Even though 

 during life we find many cases with decided enlargement of the glands, and 

 no apparent enlargement of the spleen, still I believe that at the autopsy the 

 spleen is almost invariably found enlarged. On the other hand, in cases with 

 predominant enlargement of the spleen, some enlarged lymph-glands are almost 

 always found at the autopsy, if not the superficial ones then those of the abdo- 

 men or of the thoracic cavity. A sharp distinction therefore cannot he drawn 

 here, and there are many cases in which the spleen and lymph-glands are 

 equally — or, rather, proportionately enlarged. 



If j however, we wish to lay special stress either upon lymph-gland enlarge- 

 ment or upon the spleen, in the former case we may use the terms " pseudo- 

 leulcemia lymphatica" or true Hodgkin's disease, in the latter case "pseudo- 

 leukemia licnalis " or " splenica " ; finally the cases with equal implication of 

 the lymph-glands and of the spleen may be designated as " pseudo-leuhemia 

 lymphatico-lienalis " or " spleno-lymphatica." 



We shall first describe the more common form, pseudo-leulemia lymphatica 

 or Hodgkin's disease. 



HODGKIN'S DISEASE 



The most conspicuous and usually the first symptom is the enlargement of 

 a gland or of a few glands in the neck, oftenest at the angle of the jaw. This 

 enlargement occurs as a rule quite gradually, so that only in the course of 



