378 PSEUDO-LEUKEMIA 



why these inflammatory afJections which are so exceedingly common rarely 

 cause much glandular enlargement, and it is also inexplicable how the enlarge- 

 ment of the glands originally irritated can distribute itself to distant parts, 

 and, finally, to all or nearly all the glands of the body. The irritation theory 

 must be supplemented by assuming a special predisposition to disease of the 

 lymph-glands, and this view must serve to elucidate those cases in which no 

 causal factor that could produce irritation has preceded the glandular enlarge- 

 ment. More plausible is the view that a poison is at work in the blood, and 

 that the glandular lesions are only symptomatic. In the cases which appear 

 to develop spontaneously and without any evidence of such a poison, it is 

 probable that there has been noticed irritation from the tonsils, or from the 

 whole pharyngeal mucous membrane. Many years ago I pointed out the fact- 

 that the so-called " vestibulum pharyngis " was a " vestibulum malorum," an 

 ante-chamber by which innumerable pathogenic agents found their entrance 

 into the body. According to this hypothesis, in Hodgkin's disease a damag- 

 ing agent finds its way from the pharynx through the lymph-glands into the 

 blood and thus causes enlargement, first in the glands of the neck, and later 

 in the others. 



That in the later stages of the disease a deleterious agent must actually 

 be present in the blood, is proven by the almost invariable implication of the 

 spleen, which of late has very aptly been designated as a lymph-gland of the 

 blood. 



COURSE, DURATION AND RESULT 



I have very little to add to what has been said regarding the course, dura- 

 tion and outcome of Hodgkin's disease. The disease runs its course with 

 paroxysms of varying duration ; as a rule it lasts from one to five years, very 

 rarely longer. Two years is an average duration. The usual outcome of the 

 disease is death, which is the result either of the previously mentioned pres- 

 sure and stasis, or of an increase in the anemia, producing exhaustion which 

 is not infrequently intensified by copious hemorrhages. A termination in 

 recovery is exceedingly rare. Occasionally, prior to death, a transition into 

 true leukemia has been observed, with the addition, therefore, of characteristic 

 blood-changes to the glandular enlargements. 



THERAPY 



Treatment of the fully developed disease is not very effectual, as an actual 

 and permanent recovery can scarcely ever be brought about, but, at the most, 

 only a cessation in the glandular enlargement with more or less prolonged 

 improvement of the general condition. Whether early treatment accomplishes 

 more, i. e., complete recovery, is questionable. Nevertheless, an ejfort should 

 be made to combat the glandular enlargement as early as possible. 



For this purpose various remedies are at our disposal to which a certain 

 beneficial effect cannot be denied; besides extirpation of the gland. 



Among the remedial agents, Billroth has advised arsenic which has proved 

 most efiicacious. This is given either internally, or, more generally, in injec- 

 tions subcutaneously or in the parenchyma of the gland. For internal use 



