Less conspicuous but equally distinctive changes occur in the spleen in four-fifths of the cases, it becoming enormously enlarged and occupying the left half of the abdominal cavity, being universally enlarged and preserving its original outlines. This splenic enlargement sometimes is simply an hypertrophy, but in many instances the spleen itself will be occupied by tumors, i. e., lymphomas, which are scattered through it and cause part of its enormous dimensions. Late in the disease the liver also becomes enlarged and lymphomas are also scattered throughout its substance. The same lymphomatous or adenoid tissue may be met with in many other parts of the body, the bone-marrow, the alimentary canal, the ductless glands, kidney, lung, etc.
Hodgkin’s disease is doubtless closely related to other varieties of leukemia and to Banti’s disease, or splenic anemia, all of which should be regarded as expressions of an infection by organisms not yet clearly described, although their better recognition and identification are clearly foreshadowed in work now under way. Death comes as the result of the exhaustion and poisoning of a terminal infection, save when it is produced earlier by absolute starvation or suffocation. To run its entire course an average case consumes from eighteen months to two and a half years.
Diagnosis.
—So far as diagnosis is concerned the microscope will serve a certain purpose even early in the disease, enabling one to recognize an increasing anemia and leukocytosis, but not until perceptible enlargement of lymph nodes and of the spleen is found can the diagnosis be made absolutely certain. One has to distinguish mainly between those forms of leukemia in which lymphomatous changes are not conspicuous, cachexia of cancer and syphilis, and the condition of lymphosarcoma, as it has been called by some, in which there is the involvement of the lymph nodes without the characteristic blood changes met with in Hodgkin’s disease. In splenomegaly we may have enormous enlargement of the spleen without the marked involvement of the lymph nodes. From lymphatic tuberculosis it is to be distinguished by absence of fever, the tendency to universal involvement of the lymphoid tissues in all parts of the body, and the absence of suppuration and caseation which occur so distinctively in tuberculous disease.
Treatment.
—Few drugs are of much or any avail in this disease. Of them all nothing compares with arsenic, which should be given for a long period and pushed to the physiological limit. The formula which was given in the chapter on Cancer will serve in the treatment of Hodgkin’s disease ([p. 296], [note]). Next to this, and especially in patients with enlargement of the spleen, the x-rays are the most effective. In one case much of this character, in which I began active treatment by both methods, I saw in forty-eight hours a diminution of 100,000 leukocytes. This did not persist, however, for the proportion was later somewhat increased, but the immediate effect as well as the benefit were very pronounced. All the affected regions may be exposed to the x-rays, which should be used with great care.
TUMORS OF THE LYMPHATICS.
The term lymphoma has been indiscriminately ascribed to various enlargements of the lymph nodes and lymphoid tissue throughout the body, so much so as to have really lost its significance. If by the term is meant simply a tumor of a lymph node it will usually fall under the proper classification as being a granuloma, a syphiloma, a carcinoma, etc. If by the term is meant a general involvement of lymph tissue throughout the body, such as is seen in status lymphaticus, then it would be best to use some other term. Finally it may be questioned whether there is any distinctly marked lymphoma, i. e., a tumor of true lymphatic structure, which is not of infectious origin. The term lymphosarcoma is still in use and probably will not be expunged until our notions of pathology are clearer. The expression lymphadenoma should be discarded. Multiple malignant lymphoma, as stated above, is but another name for the condition ordinarily described as Hodgkin’s disease. That sarcoma and endothelioma may arise in the lymph nodes is universally conceded, although as primary neoplasms in these localities they are rare. Not much can be said, then, that is distinctive about lymphoma.
In a general way, it may be said of any tumors of the lymph nodes that if isolated or not too multiple they should be extirpated.