76 THOMPSON YATES LABORATORIES REPORT 
cells were present in both my cases (specimen exhibited). I return to the question of the identity 
of lympho-sarcoma and lymphadenoma. 
From the clinical standpoint two features stand out which deserve careful investigation. 
In the first place the rapid enlargement of the glands in lympho-sarcoma leads to considerable 
periglandular inflammation, or, as others say, the growth infiltrates the surrounding tissue, and as a 
result the glands become fixed to one another, the deep tissues, and the skin. 
In lymphadenoma, where the growth is slow, this does not occur, and the glands remain 
isolated and movable for months and years. 
Again, in lymphadenoma there is no leucocytosis, except, of course, during the occasional 
pyrexial attacks, when it is polynuclear in type. In lympho-sarcoma a slight excess of leucocytes 
is constant, the greater number of them being mononucleated and small. It must be remembered 
that in lympho-sarcoma occasional pyrexial attacks are not uncommon, and in such attacks the 
mononuclear leucocytosis is replaced by a polynuclear variety. This is of interest in connection 
with the often noted diminution in the tumours during the rise of temperature. Both features 
were well seen in my first case. 
A further point, also illustrated by my first case, is the occurrence of skin lesions, 
which, so far as I know, have not been noted in cases which we are accustomed to term 
lymphadenoma. 
It will be seen that I agree rather with Hamilton than with Dreschfeld in distinguishing 
between lymphadenoma and lympho-sarcoma. The differential points I have enumerated may 
appear individually very trivial, but when combined they seem to me important. I agree, 
however, with Dreschfeld in recognizing the resemblance shown by these formations to 
inflammatory formations rather than true new growth, and the suggestion arising therefrom of 
specific infective agents. 
Although the specific agents have not been determined, yet the search for them has borne 
fruit, in that some cases resembling lymphadenoma in their clinical course and anatomical 
structure have been proved to be due to the Bacillus tuberculosis ; and in others the pyrexial attacks, 
in some cases, at any rate, have been assigned to their true cause — a secondary infection. In my 
first case the pyrexial attack was due to a staphylococcic infection, secondary in character ; and I 
think that in all probability the cases reported by Traversa,* Lannois, and EROUX,t were 
similarly secondary infections. 
Kelsch and VaillardJ found a short motile bacillus, both in life and post-mortem ; 
experimental inoculations gave a negative result. 
Dreschfeld§ has recorded a case in which a short bacillus was found post-mortem in 
the kidney ; no cultivations, however, were made. 
As I have said, therefore, the organisms of these affections yet await their discoverer. 
Acute tuberculosis of the lymphatic glands is very rare, and usually presents rapid caseation 
and necrosis, with abundant periadenitis and skin implication. No direct observations, so far as I 
* 'Riforma Med. Napoli,' 1893, t. ix, p. 96. t 'Annales He I'lnstit. Pasteur,' 1890, t. iv, p. 276. 
t 'Lyon Medic,,' 1890, No. 34. § Loc, cit. 
