374 PSEUDO-LEUKEMIA 



sponding abdominal region distinct glandular enlargements which probably 

 exerted pressure upon the muscle and the nerve which supplied it, and thus 

 caused the pains and contractions. 



The urine shows nothing special; its composition is that which is usual m 

 anemia provided no complications are present. Occasionally, as in leukemia, 

 it is found conspicuously rich in alloxur bodies, particularly uric acid. These 

 bodies, together with the nucleo-histon which was once found in the urine in 

 pseudo-leukemia by A. Jolles, are explained by an increased destruction of 

 leukocytes.^ 



Finally, as a frequent but not invariable symptom, we must mention hem- 

 orrhages from various organs, particularly from the nose and in the skin in 

 the form of petechias of varying size, rarely as larger efEusions of blood. It 

 appears to me that the tendency to hemorrhage is particularly great in cases 

 with glandular enlargements in the internal parts of the body, in the thorax, 

 and, above all, in the abdominal cavity. The case previously referred to, in 

 which only these internal glands were enlarged (and very decidedly so), ran 

 its course with the clinical picture of Werlhofs disease, i. e., with hemorrhages 

 from the nose and mouth, hematemesis, and blood in the urine, but without 

 other noteworthy symptoms except slight fever. The autopsy showed hemor- 

 rhages in almost every organ, and numerous lymphomata in the thorax and 

 abdominal cavity of which we had no suspicion during the patient's life. 



Shall we look upon these glands as the cause of the hemorrhages? This 

 is hardly possible, for they are invariably absent in Werlhof's disease, while, 

 on the other hand, glandular enlargement is often present without any tend- 

 ency to extensive hemorrhages. We can only say that glandular enlarge- 

 ments sometimes lead to a radical change in the blood in consequence of which 

 hemorrhages occur, and that these changes are particularly noted when the 

 lymph-glands of the internal parts of the body are diseased. 



In this case, as I have said, only the internal lymph-glands were enlarged ; 

 in other cases the lymph-gland chains situated in the digestive canal, i. e., the 

 tonsils, the glands of the mucous membranes of the mouth and cheelc, the 

 solitary and agminate glands of the intestine may he affected, with or without 

 involvement of the external Ij'mph-glands. In consequence of these enlarge- 

 ments all sorts of otherwise inexplicable disturbances occur. 



Fever does not belong to the typical picture of Hodgkin's disease. !N"ow 

 and then slight rises in temperature occur, particularly when fresh glandular 

 enlargements develop rapidly, but fever is not characteristic, and in some 

 cases may be entirely absent until the anemia becomes very grave, or until 

 near the end of life. This last type of fever corresponds to the febrile condi- 

 tions which are observed in other severe anemias. Of course there may be at 

 any period in the disease a p3'rexia due to complications. 



I am not unmindful of the fact that some isolated cases have been described 

 in which fever was a most prominent symptom, but which, nevertheless, have 

 shown in the main the clinical course of Hodgkin's disease. In these cases 



1 From the communication of Jolles it could not be determined whether in his case 

 a lymphatic or a, lienal pseudo-leukemia was present. 



