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This disease, also known as pseudo-leukaemia and lymphoadenoma, consists in a progressive enlargement of the lymphatic glands all over the body, and a progreseive anaemia. It occurs more frequently in males than in females, and it is, during young adult life that the majority of cases occur.
In a typical case enlargement of the lymphatic glands is usually one of the first symptoms. Those in the neck are most commonly affected first. Many months may then elapse before the glands in the armpits and groins show any definite increase in size. At this stage the general condition of the patient is quite good. Anaemia makes its appearance gradually, however, and is then slowly progressive. General languor, weakness and loss of weight now become evident. Headaches and constipation may occur.
After some months the patient may complain of a heavy sensation in the "stomach," this being due to the enlargement of the spleen, which usually occurs at this stage of the disease. The spleen itself may be felt as a hard swelling of the upper left quadrant of the abdomen. In time the glands deep in the chest increase in size and, being enclosed in that cavity in close contact with the lungs, heart and great vessels, they press on these important organs. This gradually interferes with their action to the extent of producing cough, breathlessness, pain and blueness of the face. Intense itching may be experienced all over the body, and the destruction of the blood cells may prodace bronzing of the skin.
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As the disease continues its progress emaciation becomes marked and with it generalised dropsy makes its appearance. This dropsy is a waterlogging of the tissues by the blood serum owing to the extreme anaemia.
In the earlier stages the blood itself shows very little alteration, but a progressive type of secondary anaemia is gradually established. The red cells of the blood become reduced by about half, and their colouring matter (haemoglobin) becomes reduced to about 40 per cent. Occasionally abnormal forms of red cells are seen when the blood film is examined under the microseope. Variations in the number of white cells are not characteristic. The duration of the illness from the time of the first complaint is usually about six months.
Although such is the usual type, there are many other variations which may be assumed by Hodgkin's disease. Of these, the most important is the acute form, in which the whole course is run in the space of a few weeks. In the second category there may be classed those cases in which the glandular enlargement may be localised to certain groups. Should this occur in the glands in the chest or abdomen the increased difficulty in diagnosis is obvious. Yet a third list may be made of those cases in which the fever occurs in waves lasting about ten days, and is followed by a non-febrile period of similar duration. With the increase in temperature, the affected glands swell and become hot and tender, only to quiet down with the fall in the fever. These waves may be repeated for many months.
The diagnosis is often extremely difficult, as the lymphatic glands, being some of the most important defensive organs in the body, may swell for a multitude of reasons. Micro- scopical examination of a suspected gland will, if other methods fail, revcal to the pathologist the changes characteristic of the disease.
In the upper row of figures are exhibited the lymphatic glands in the neck, the armpit and the groin respectively, and in the lower row swellings caused by the enlargement of the glands in Hodgk:n's disease. A general swelling of glands over the body may occur in a number of diseases, but in Hodgkin's disease the enlargements tend to become massive and tumour-like.