Finding
Both axillee were prominently occupied by their glands, abnormally large, and those situated in each groin and in the upper part of each thigh were much enlarged.
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in some places, to disappear after treatment was commenced. It is to be regretted that no drawings were taken of the man's appearance, especially of his neck, both before and after treatment, as these would have given a better idea of the degree of the enlargement which Vxisted than any description can do; but it was not expected that medicine would do him any good; hence the omission. In the light of the result it may be asked, was this a case of Hodgkin's disease ?-for the latter is said to be a form of malignant disease, and to be always ultimately fatal, " though its courhe is by no means uniformly from bad to worsie." (Bristowe.) But here we have speedy, if only temporary, cure. That it was not a case of leucocythsemia ig pretty certain, because the spleen was only slightly enlarged, and microscopically the white corpuscles of the blood were not at all in excess, and most of the symptoms of this affection were absent. Moreover, in only about one-third of these cases are the lymphatic glands generally or partially enlarged (Gowers), and this glandular affection is said to be almost always a late event in the progress of the disease, whereas here it is the earliest. Then in the cases described as lymphatic leucocythemia, in which the lymphatic glands and tissues have been found alone or chiefly affected, the general symptoms have in the main resembled those assigned to splenic leucocythb3mia (Bristowe>; but in this case they were absent. A. L., aged 36, was admitted into the infirmary on August Ist of this year. Hiis present occupation is that of a nigger minstrel. He was formerly in the army for twelve years, three of which were spent in India, where he had fever and ague. He left the army six years ago, and has had good health since until about last May, when his cervical and other glands began to enlarge. For this he sought advice, and aleo because his voice became altered and he could not sing as formerly, so that he temporarily left the minstrel troupe. On admission he was well nourished, but markedly* pale, and looked older than his years, his hair getting grey. his neck on each side was considerably disfigured by a mass of enlarged glands, which were the first object one noticed on looking at him. They were rather soft and tender. Both axillee were prominently occupied by their glands, abnormally large, and those situated in each groin and in the upper part of each thigh were much enlarged. The gland above each inner condyle of the humerus, not usually felt, was as large as a filbert. The spleen and liver were somewhat enlarged, and could just be felt below the ribs; there was no albumen in the urine. No history or evidence of syphilis. That the mediastinal and bronchial glands were also affected in the same way, producing pressure, was rendered evident by the severe spasmodic attacks of dyspnoea the man had every night for the first week or so, and these were so alarming that he thought he would die in one of them. He had rather severe follicular tonsillitis soon after he came in, and this sent his temperature up to 1020, the cervical glands becoming tender at the same time. With the exception of this rise of temperature it maintained the normal throughout, as did also the pulse rate. On August 2nd he was given 1 minims of tinct. ferri perchlor., and 7a minims of liq. arsenicalis t. d., and the improvement which soon showed itself was very striking, for in all visible and tangible parts the glandular swellings began rapidly to diminish; and that pri pas8U those which were invisible were doing the same was rendered certain, inasmuch as the attacks of, dyspneea gradually became less severe, and very soon ceased altogether. The spleen, which was never much enlarged, also shrank beneath the ribs. He went out after one month's treatment practically well, and to-day (September 30th) on seeing him again and examining him I find no trace of cervical glandular enlargement, none above the inner condyles of the humerus, and only a trace of it in the armpits, groins, and thighs. His spleen cannot be felt, though the liver is somewhat enlarged. He looks bronzed and well, can sing again, and, in short, has nothing to complain of in the shape of ill-health. His neck, which was so swollen on admission that he could not button his collar (a 16a-inch one) is now quite slim, and there is room to pass the hand down on each side of it. It will be interesting to watch the future medical life of this man. It is a pity-the arsenic and iron were combined, as thereby one cannot tell which bad the greater share in the result.
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Journal
British Medical Journal