HODGKIN'S DISEASE 375 



the fever is usually remittent or intermittent, with regular or irregular pauses 

 some of which last several days (recurring). Such eases have been described 

 by Pell, Ebstein and others as " chronic relapsing fever " or as " recurring 

 glandular fever." -But in many, perhaps in the majority, of these cases, tuber- 

 cle bacilli and other changes indicating tuberculosis have been found in the 

 glands, and the question has therefore arisen and been discussed whether these 

 cases should be designated as "pseudo-leukemia." 



DIAGNOSIS 



This brings us to the difficult realm of diagnosis, difficult for the reason 

 mentioned at the beginning of the article, viz., because the conception of 

 " pseudo-leukemia " is not a sharply defined one, or, more accurately expressed, 

 because there is no unanimity as to which glandular enlargements are to be 

 considered as belonging to the disease. There is general agreement only on 

 one point, that all cases of secondary or symptomatic adenitis, i. e., all those 

 which appear in the course of other infections and are in causal relation with 

 them, are not to be designated as " pseudo-leukemia," but only those appearing 

 as primary, multiple, glandular enlargements which dominate the clinical 

 picture. 



Such lymph-gland enlargements, however, are by no means always of one 

 type; indeed, from a pathological standpoint they vary greatly. I have already 

 mentioned that in the cases described as " chronic relapsing fever," or as 

 " recurring glandular fever," tuberculosis is often found in the enlarged 

 lymph-glands. But it is also true that in a large number of the cases described 

 as " pseudo-leukemia " and showing the typical clinical picture of that disease 

 without fever or with only an occasional rise in temperature, tuberculosis of 

 the glands has been found. In other cases anatomical investigation has re- 

 vealed sarcomatous changes, and the disease for this reason has been desig- 

 nated lympho-sarcomatosis (Kundrat). Finally, in still other cases the 

 glandular swellings resembled leukemic lymphomata. 



This latter form of multiple lymph-gland enlargement, and this alone, 

 Ehrlich and Pinkus desire to have designated as " pseudo-leukemia." They de- 

 fine the latter as a disease with lymphadenoid cell-accumulations which in every 

 respect resemble the lymphatic leukemic form, running its course with an in- 

 crease of the lymphocytes at the expense of the multinuclear leukocytes but 

 without any material increase in the total number of the leukocytes. Their pro- 

 portion to the erythrocytes is said not to exceed 1 to 200 or 1 to 100. In such 

 cases the lymphadenoid proliferations occur, not only in the lymph-glands, but 

 in the organs of the chest and abdominal cavity and in the shin, Just as in lym- 

 phatic leukemia. Whether the bones are afEected in pseudo-leukemia as in 

 leukemia is, as I have already remarked, still questionable. 



This discovery represents (if true) an essential advance in the conception 

 of pseudo-leukemia, even although for the time it has no great practical impor- 

 tance, particularly for clinical diagnosis. For, in the first place, if the blood 

 condition required by Ehrlich and Pinkus is actually present, the differentia- 

 tion of pseudo-leukemia from leukemia may be difficult or even impossible. 



