HODGKIN'S DISEASE 



373 



mediastinal space press particularly upon the innominate vein, and thus pro- 

 duce swelling of the veins of the nech and the wall of the chest with cyanosis 

 and edema of the face, to which may be added dropsical effusions into one or 

 both pleurae. These phenomena, however, are not so frequent or so marked 

 as with other tumors and tumor-like formations in the thoracic cavity, for the 

 glandular swellings are usually softer and less resistant than other tumors. It 

 is true that harder forms occasionally occur depending upon histological vari- 

 ations the discussion of which will follow later on, and these hard tumors may 

 produce all the phenomena of pressure and stasis. 



The development of dropsical effusions may be produced in three ways : 

 (1) by venous stasis; (3) by displacement of the lym.phatic trunJcs, caus- 

 ing a hindrance to the absorp- 

 tion of tissue fluid; and (3) 

 by progressive anemia and ca- 

 chexia. 



More common than stasis 

 phenomena are difficulties in 

 respiration. These are caused, 

 (1) by direct pressure which 

 the glandular swellings exert 

 upon the larynx, trachea or 

 bronchi; (2) by pressure upon 

 the vagus, or (very frequently) 

 upon the recurrent laryngeal 

 nerve; (3) by the decrease of 

 erythrocytes which are the neces- 

 sary oxygen carriers in the func- 

 tion of respiration. Difficulty 

 in deglutition as the result of 

 pressure upon the pharynx or 

 esophagus is rare. 



Enlargements of the thoracic 

 lymph-glands also produce both 

 dropsical effusions into the 

 pleura, and true inflammations 

 of the pleura (unilateral or 

 bilateral), which cannot always 

 be differentiated from dropsy, 

 since there are fluids intermedi- 

 ate between dropsical effusions 

 (transudates) and inflamma- 

 tory effusions (exudates). 



Another symptom which is probably to be referred to the local pressure 

 exerted by the glandular tumors is neuralgia. I have seen it most frequently 

 in the lower extremities, especially in the course of the sciatic nerve or the 

 crural nerve. In a case of this kind in which the patient was troubled with 

 painful contractions in the left ilio-psoas muscle, I could feel in the corre- 



FiG. 21. — Case of Hodgkin's Dise.a.se in Dr. Sal- 

 ingeb's Ward in the Jefferson Medical 

 College Hospital. Operated upon by Prof. W. 

 W. Keen for the removal of large masses of lymph- 

 glands pressing upon the trachea, which produced 

 attacks of suffocation. 



