The exact relations of this disease, or group of diseases, are somewhat obscure. In many respects it presents the characters of the infective tumours, and on the other hand it is related to leukaemia, this latter disease • sometimes presenting most of the organic lesions of Hodgkin's disease. By some leukaemia is also included amongst the specific new-formations. The uncertainty as to the nature of the disease may be inferred from an enumeration of the names applied to it. Besides the above we have Adenia, Pseudo-leukaemia, Lymphosarcoma, Malignant lymphadenoma, Malignant aleukaemic lymphadenoma, and Anaemia lymphatica. The disease is accompanied by marked anaemia and dropsy, but there is no increase of leucocytes in the blood. Fever is present in some cases.

We include here cases in which there is first an enlargement of a group of glands, and a subsequent extension to other groups, followed in many cases by a further extension to the spleen and liver, and even to other structures. This is the disease described by Hodgkin and properly designated by his name. It is an infective disease, having some analogies with tuberculosis, but limiting itself much more to the lymphatic system.

The disease begins with a local enlargement of a certain group of lymphatic glands, frequently those of the neck, but it may be those of other situations, such as those of the axilla and those accompanying the thoracic and abdominal aorta. Beginning in one set it is liable to extend to others till there may be a widely-extended enlargement of the glands in many regions. The affection of the glands consists in a proliferation of the lymphatic gland tissue. The enlarged glands may be of the same consistence and appearance as the normal glands, but they may be softer or harder. There is not infrequently a trace of caseation in the glands, especially when they are hard. In the soft form the new-formation may extend beyond the boundaries of the glands and invade surrounding parts.

The spleen is affected in most cases of Hodgkin's disease, although not in all. It is enlarged, and its outline shows localized elevations as if there were distinct tumours present. On section, however, these have not the appearance of definite separate growths, but rather of localized infiltrations of the spleruc tissue. There are areas of yellowish white appearance, which have been compared to lumps of suet in a pudding. Under the microscope it is seen that in these areas the tissue is lymphatic, consisting of round cells with a reticulum like that in lymphatic glands. Moreover, the tissue arises by proliferation of the lymphatic follicles of the spleen (the Malpighian corpuscles) which normally accompany the splenic arteries. The liver is also commonly affected, there being here an infiltration of the capsule of Glisson, such as occurs in some cases of leukaemia. The kidneys also in some cases show in their external configuration rounded swellings, which are due to localized infiltrations of round-cells. There may also be enlargements of lymphatic structures other than those of the lymphatic glands and spleen, such as the closed follicles of the intestine, the tonsils, etc.

Hodgkin's disease may give rise to amyloid degeneration, as in a case observed by the author. In this case a sago spleen was the seat of secondary lymphatic new-formations. The new-formation occupied the same structures as the amyloid disease, and it was interesting to observe how the round-cell infiltration caused absorption of the amyloid material, and how the arteries, whose walls were amyloid, recovered their structure under the influence of the new-formation. .

It is proper, as Steven has pointed out, to distinguish Hodgkin's disease from lymphosarcoma. The former has more the characters of a general disease of the lymphatic system, originating locally but spreading in the lymphatic system. The latter is a local disease of a certain group of glands, usually the mediastinal ones, and showing chiefly a local malignancy.

Literature

Hodgkin, Med. Chir. trans., 1832; Wilks (who.suggested the name Hodgkin's Disease, and has chiefly brought it into prominence), Guy's Hosp. Reports, 3rd series, vols. ii. and xi., also cases in Path, trans.; Murchison, Path, trans., xxi., 372; also papers by Wilks, Greenfield, and others in Path, trans., xxix., 1878; Hilton Fagge, Medicine, 1886, vol. ii., 334; Steven, Glas. Med. Jour., vols. xxxv. and xxxvi., 1891; Flexner, Johns Hopkins' Hosp. Rep., 1893.