Frederick G. Parsons and Harriette L. Hennessy

“ Lymphadenoma (Hodgkin’s Disease) , a disease which was first fully described by Hodgkin in 1832, is characterized by a progressive enlargement of the lymphatic glands all over the body, and generally starts in the glands of the neck. The majority of cases occur in young adults, and preponderate in the male sex. The first symptom is usually enlargement of a gland in the neck, with generally progressive growth of the glands in the submaxillary region and axilla. ”

“ The inguinal glands are early involved, and after a time the internal lymph glands follow. The enlargements are at first painless, but in the later stages symptoms are caused by pressure on the surrounding organs, and when the disease starts in the deeper structures the first symptoms may be pain in the chest and cough, pain in the abdomen, pain and oedema in the legs. The glands may increase until they are as large as eggs, and later may become firmly adherent one to another, forming large lobulated tumours. ”

“ In birds the thoracic duct is first recognized, and opens into both right and left precaval veins, as it always does in some mammals. In birds, however, some of the lymphatics open into the sacral veins, and it is doubtful whether true lymphatic glands ever occur. In birds and mammals lymphatic vessels become more definite and numerous and are provided with valves. ”

“ In fishes, for instance, there is a large subvertebral lymph sinus surrounding the aorta and another within the spinal canal. In Amphibia the subvertebral sinus is also found, and in the Anura (frogs and toads) there is a great subcutaneous lymph sinus. Lymph hearts are muscular dilatations of vessels and are found in fishes, amphibians, reptiles and bird embryos, and drive the lymph into the veins; they are not known in adult mammals. ”

“ If the blood vessels enlarge more than the lymphatic, haemolymph glands result, but if the lymphatic vessels become predominant ordinary lymphatic glands are formed. At an early stage in the embryo pig two thoracic ducts are formed, one on either side of the aorta, and the incomplete fusion of these may account for the division often found in man’s duct. ”

“ The clinical features are indefinite, and the condition frequently passes unrecognized during life. In most cases there is no hint of danger until the fatal syncope sets in, which may be after any slight exertion or shock, the patient becoming suddenly faint, gasping and cyanosed, and the heart stopping altogether before the respirations have ceased. ”

“ Common iliac glands (fig. 2, C.I.) lie around that artery and receive afferents from the external and internal iliac glands as well as a few from the pelvic viscera. [2] The aortic glands are grouped all round the length of the aorta, and are divided into pre-, retro- and lateral aortic groups (fig. 2 P.A. and L) , all of which communicate freely. The upper preaortic glands are massed round the coeliac axis, and receive afferents from the gastric, hepatic, splenic and pancreatic glands; they are known as coeliac glands. ”

“ Increase of growth in this manner in the neck may cause obstructive dyspnoea and even death. In the majority of cases the spleen enlarges, and in rare instances lymphoid tumours may be found on its surface. Anaemia is common and is secondary in character ”