TWO CASES OF LYMPHO-SARCOMA* 
WITH REMARKS UPON THE DIFFERENTIAL DIAGNOSIS OF SOME 
GENERAL GLANDULAR ENLARGEMENTS 
By JOHN HILL ABRAM, M.D. Lond., M.R.C.P., Assistant Physician Royal 
Infirmary, Assistant Lecturer on Pathology, University College Liverpool 
The cases which I report were in the Royal Infirmary under my care in the latter part 
of 1897 and the earlier part of 1898. 
Case I 
J. M., aet. 41, sailmaker, was admitted on September 8th, 1897, for pains in the joints 
and glandular swellings. Apart from consumption in a collateral branch the family history was 
good. 
He stated that his general health had always been good, and that he had never had any 
venereal disease. There was no scar on the penis. The swellings were first noticed in March, 
1897, in the neck as usual ; then the groins, and then the armpits. In June pains in the limbs 
were present. Whilst under treatment a rash appeared on the body, and afterwards on the face 
and head, attended with marked pruritus. 
On Admission. — A well-built, powerful man. There is present thickly on the face, and 
more sparsely on the trunk and extensor aspects of the limbs, a raised, dusky-red rash, slightly 
scaly, but with no sign of vesication. It does not now itch. 
Glands. — Marked swelling on both sides of the neck and face from the clavicle to the 
zygoma, also in the submaxillary triangles, the groins, and the axilla?. The glands can be separated 
from one another, and can be readily moved beneath the skin and on the deep tissues. Numerous 
isolated subcutaneous nodules are present over the trunk. The fingers and toes are swollen, and 
the skin thereof livid ; they are very tender. 
The tonsils are not enlarged. Dr. Hunt reports ' that a distinct swelling exists below the 
vocal cords, narrowing the lumen of the air-passage to a comparatively narrow slit.' The spleen 
reaches the costal margin. The liver is not enlarged. 
R. 26. P. 84. 
He has some dyspnoea, but can lie down. Some cough, with tough, blood-stained sputum. 
There is some dulness, with increased resistance behind the sternum. The respiratory movement 
is entirely abdominal. Chest emphysematous. Bronchitic sounds all over. Heart normal. 
Nervous system normal. Urine, 1024 acid, no abnormal constituents. Blood, Hh. 45 per cent. 
R.C. 3,600,000. Wh.C. 24,800. W : R : : I : 145 roughly. 
* Reprinted from the 'Liverpool MeiHco-Chirurgical Journal,' July, 1899. 
* K 
