TWO CASES OF LYMPHO-SARCOMA 75 
Red corpuscles, 5,000,000 ; white, 31,000, mainly polynuclear. Eosinophil cells are not 
in excess of the normal. He has a troublesome cough, profuse frotliy muco-purulent expectoration, 
no tubercle bacilli. There is some evidence of pressure upon the left bronchus. 
Some dulness beneath manubrium sterni. 
The remaining organs were normal. 
The dyspnoea became severe, but Dr. Hunt reported the larynx and trachea to be 
normal. 
This man, too, was treated witii arsenic, but without avail, and he died suddenly on 
April 5th. 
P.-M. — The morbid appearances are practically tlie same as those of Case I. 
General enlargements of the lymphatic glands are not in my experience very common, and 
it has seemed to me that of late years they have become still less common. 
The explanation of this increasing rarity, if it be true, is difficult, and I shall not attempt 
it, but it affords me one ground for bringing the subject forward. A second and more important 
feature is the obscurity which veils the exact pathology and diagnosis of these affections. 
In Clifford Allbutt's ' System of Medicine,' under the heading of Pseudoleukaemia, or 
Hodgkin's Disease, I find the following synonyms given : anaemia lymphatica, anaemia splenica, 
lymphadenoma, lympho-sarcoma, cachexia without leuka;mia, malignant lymphoma, desmoid 
carcinoma. 
No doubt a certain number of cases have been of late severed from the category of 
pseudoleukaemia by the recognition of their specific infective cause, and tliis may, to some extent, 
account for the real or apparent diminution in the number of cases that I have already referred to. 
The general enlargements of the glands whicii may still be confounded are the following : 
lymphadenoma, lympho-sarcoma, acute tuberculosis of the lymphatic glands, and lymphatic 
leukaemia. 
I exclude from consideration true sarcoma of the lymphatic glands, and thus clearing the 
ground we are met with the question — Are lympho-sarcoma and lymphadenoma distinct diseases ? 
Hamilton* states that they are essentially different, though often confounded. 
DREscHFELDt holds that they are one, and he draws a very interesting and striking comparison 
between malignant lymphoma and the acute and chronic manifestations of tuberculosis. 
The histological examination of glands from both cases — -both from the clinical standpoint, 
I mean — affords us no help. In both cases we find an increase of the lymphoid cells, an overgrowth 
of fibrous tissue, and more or less numerous giant cells. The softer glands differ mainly from the 
harder variety in the greater number of leucocytes present. In both forms there is little or no 
tendency to caseation or necrosis, an important point in the differential diagnosis from tubercle of 
the glands. 
A further point, if it be confirmed, is the statement by Goldmann,:^ that in malignant 
lymphoma eosinophil cells are present, whereas in tubercular glands they do not occur. These 
*'Text-book of Pathology,' vol. I. J ' Centialbl. f. Ally. Path.,' 1S92. 
f Brit, Mecl. Journal,' 1892, vol, i, 893 ; 'Deutsche Metl. Wochensch.,' 1890. 
