A case of late Hodgkin's disease (lymphoma granulomatosum) : with remarks on various cases presenting the clinical picture of splenic anemia (Banti's disease) / by F. Parkes Weber.

  • Weber, Frederick Parkes, 1863-1962.
Date:
1911
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Licence: In copyright

Credit: A case of late Hodgkin's disease (lymphoma granulomatosum) : with remarks on various cases presenting the clinical picture of splenic anemia (Banti's disease) / by F. Parkes Weber. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    perhaps be simulated48 by malignant disease of abdominal viscera (suprarenals) with secondary infiltration of lymphatic glands in the neck, but had there been any such abdominal malignant disease in the present case, one would have expected enlargement of the inguinal as well as of the cervical glands to have ultimately occurred; moreover, the diminution and almost complete disap- pearance of the cervical swelling would hardly have been likely, had it been due to carcinomatous infiltration. II. D. ltolleston46 and others draw attention to the possibility of cases with splenic enlargement and pyrexia, suggesting a diagnosis of malaria or enteric fever, and, indeed, in the present case it was thought advisable to try Widal’s reaction, but the result was negative. In only a few cases of Hodgkin’s disease does the patient’s temperature chart help at all in the diagnosis. When there is any fever, it is mostly of an irregular kind with a moderate evening rise, but occasionally a long, regularly recurrent, periodic type of fever47 is met with, the chronic relapsing pyrexia of Hodgkin’s disease, which has been called the “ Pel-Ebstein symptom,” owing to the writings of Pel48 and Ebstein,49 in 1887. Of this, perhaps the most remarkable example in existence is an eight month’s chart, recently recorded by C. H. Melland.50 Such cases have even been labelled “Ebstein’s disease.” Less regular recurrent “pyrexia! crises” are of rather commoner occurrence. During the pyrexial periods the superficial lymphatic glands are sometimes observed to swell, but they occasionally seem to diminish rather than increase in size, as in the case of Hodgkin’s disease shown by Dr. J. Porter Parkinson before the Medical Society of London on March 27, 1911. Wherever possible, the diagnosis of Hodgkin’s disease should be confirmed at an early stage of the excision and microscppic exami- nation of one of the enlarged lymph glands. Without the help of a biopsy it is by no means always so easy, as some probably suppose, to distinguish Hodgkin’s disease from chronic tuberculous or syphi- litic enlargement of lymph glands. Many persons are doubtless alive and well today who would have been long since dead had the diagnosis of Hodgkin’s disease pronounced on them been the correct one. Mistaken diagnoses in syphilitic and, especially, tuberculous cases doubtless account for many of the supposed cures of Hodg- kin’s disease. But that arsenical therapy (Fowler’s solution, arsace- tin, etc.) and the application of Ilontgen rays can be of real use in many genuine cases of Hodgkin’s disease there can scarcely be a doubt, even if a permanent cure cannot be effected. This consider- 41 H. D. Rolleston, personal communication. 46 Practitioner, 1911, lxxxvi, 496. 47 F. do H Hall, Practitioner, 1911, lxxxvi, 473. L. Hofbauer, Wien. med. Woch., 1905, lv, S6. J. H. Musser, loc. cit. F. Taylor, Guy’s Hosp. Reports. 1906, lx, 1. 43 Berliner klin. Woch., 1887, xxiv, 044. 48 Ibid., 565. 50 Edinburgh Med. Jour., 1911, New Series, vi, 156 to 164, Chart I.