SOME CASES OF INVETERATE SCROFULA RESEMBLING. “HODGKIN’S DISEASE,” OR LYMPHADENOMA.
THERE is a disease of the lymphatic glands, called after the first accurate describer of it “Hodgkin’s disease,” which consists of an enlargement of the glands without much tendency to suppuration, but with much constitutional weakness, anaemia, enlargement of spleen, and an almost invariably fatal result. Though distinct in nature from scrofulous disease, the two affections are often so closely alike as to defy distinction, cases having occurred where the diagnosis was not even cleared up at the post-mortem examination.
It is possible to have the two combined. The cases I am now about to relate were really, I believe, scrofulous in their nature, but they presented many points of resemblance to Hodgkin’s disease. At the risk of being thought tedious, I shall give full length pictures of these cases, as it is only by watching them over a course of years that a complete view of the disease in all its phases can be obtained.
CASE XIII.-DISFIGURING ENLARGEMENT OF GLANDS OR NECK WITH VERY LITTLE TENDENCY TO SUPPURATION. CONSECUTIVE INFLAMMATION OF THE EYES. FREQUENT COLDS. CONSTITUTIONAL CURE.
Charles M., 16, brassworker, consulted me at the Hospital on March 26th, 1884. For six years he had had very large glands on the left side of the neck and under the chin. Last winter, blotches appeared on his legs, and since then they come and go. Last winter, for the first time, he had a cough; it was bad for three weeks, and since then has continued to be trouble some. It continues during the day, and also in the night till he goes to sleep. He has a little swelling under the instep of each foot, which pains him when he walks. He looks pale. Family history negative.
Rx Arsen. 3, Baryta c. 6, every two hours alternately.
April 16.-Feet and legs better. Swelling gone from feet. Cough gone. Has a contracting feeling in abdomen when he coughs; cannot get his breath for some time.
May 7.-Breath better. Legs all right, but blotches have appeared on his face. The glands go smaller in hot weather, but this year there are more of them. Repeat.
June 7.-A gland under the chin has softened and discharged. A lotion of Nitric ac. I x, 3i. to 3zvi. of water, was ordered, and healing took place rapidly.
July 2.-Great inflammation of conjunctiva. No photophobia; not much lachrymation. Matter; eyes red all round.
Rx Euphras. I every two hours; a lotion of 0 tincture.
July 5.-Pain in eyes less.
Rx Acon I every two hours. Boracic acid lotion.
July 19.-Eyes almost well. Lumps in neck smaller. Repeat.
Aug. 2.-Eyes well. Neck smaller. Repeat Aconite
Oct.10.-Has a cold. Glands smaller. Have been still smaller, but have become a little bigger since the weather became colder. Repeat. p73 Nov.12.-Neck smaller. Has another cold. Repeat. (Last year he had colds and cough alternately.)
Dec. 10.-Cold soon got better. Glands smaller (they are usually worse in winter).
Dec. 24.-Has had another cold the last ten days. Nose very much stopped. Glands much smaller than they usually are at this time of the year.
Rx Arsen.3 four times a day till the cold is better.
Jan 21, 1885.-Cold in nose still very bad. Glands smaller. To use Vaseline.
Feb. 4.-Eye has been inflamed. Nose less sore. Glands small. Has had sores on face.
Rx Sacch. Lact. Vaseline to nose.
Feb. 11.-Better. Nose getting better. Right eye sore still.
Rx Aconite 6 four times a day. Lotion of Acid Borac. for eye.
Feb. 21.-Eye a little better. There are two vesicles on upper margin of cornea. Nose better.
Mar. 5.-(Dr. Moir, who was then in charge of the eye department of the hospital, kindly examined the patient’s eyes for me, and prescribed Pulsatilla 3x, with the Borac. acid lotion.) Eyes better. Nose still very sore.
Mar. 18.-Eyes much better, but still mattery. No pain. Glands same. Nose better.
Rx Mercurius sol. 3, gr. ii. ter die. Lotion, Borac acid.
April I.-Nose much better.
April 15.-Better Nose nearly well but a few days ago gland on right side of neck became very large. Repeat.
May 13.-One gland on right side has been larger, others smaller. Has a cough in morning on rising; dry. Eyes and nose keep right.
Rx Bryonia 3. four times a day for a week, then Aconite 6.
June 3.-Cough gone. Face same. Two weeks ago had throbbing pains in feet and hands; now they are stiff.
Rx Caulophyllum Ix four times a day.
June 17.-Feet and hands all right now. Has had eye bad for a few days; better now. Lumps about the same. a “pimple” came on the side of the eye as at first.