[Reprinted from The American Journal op Obstetrics and Diseases op Women and 
Children, Vol. XIX., July, 1886.] 
A CASE OF HODGKINS DISEASE IN A CHILD. 
BY 
LACHLAN TYLER, M.D., 
Washington,' V. C. 
In presenting for consideration a case of so-called Hodgkin’s 
disease, 1 am well aware that the subject has been made one 
for assiduous study by men profoundly learned in the medical 
science. 
But since, in spite of their most earnest investigations, they 
have left so much in connection with this disease, and with 
those allied to it, undecided, I cannot think it presumptuous 
to enter the wide held still unexplored. 
In ' reference to disease conditions affecting the lymphatic 
system, it is to be said that limitations of them can be more 
or less defined in the vessels or glands, as the case may be. But 
it cannot be easily supposed that when the one is at all seriously 
diseased, the other will absolutely escape involvement in the 
morbid process. Any conclusion to this effect would be mani- 
festly incorrect. Especially so if the vessel be primarily 
affected. For just as its lymph-stream normally hows unerringly 
onward to the nearest gland, so also proceeds any inflammatory 
or other active pathological condition existing in it, to the 
same destination. It is quite certain, however, that a rela- 
tively greater degree of morbid action may occur within the 
gland structure without extending beyond it and into the sub- 
stance of the vessels. This is somewhat satisfactorily demon- 
strable in lymphadenosis, in which the glands reach great 
proportions under the conditions governing the disease, while 
the vessels connected with them have been only in a few in- 
stances found affected. In other examples, in which they have 
not been found or injected at all, instead of the assumption that 
they were destroyed by the action of the disease, it might as 
well have been inferred that they had remained during life in a 
perfectly healthy state, but that unskilfulness, or post-mortem 
hanges, had made it impracticable to expose them to view Tyler : A Case of 
2 
The anatomical structure of the glands no doubt goes far 
towards accounting for the power they possess of confining 
within their own recesses the morbid process which is going on; 
though the physiological purpose they are said to naturally 
subserve of acting as so many reservoir-like laboratories in con- 
nection with the hsematogenetic function possibly affords even 
a readier explanation of it. 
The relationship existing between the lymphatic glands and 
the spleen, as evinced by a striking similarity in structure, and 
probably by a corresponding physiological action in respect to 
the blood, has been considered sufficiently close to warrant, in 
the opinion of some, the belief that they belong to one and the 
same system, the spleen simply exhibiting, in a natural condition 
of things, the example of a remarkably developed lymphatic or 
mesenteric gland. 
It is only necessery in this connection to make passing allusion 
to the frequency with which these organs are together found 
implicated in various diseases. My own conviction is, that, so 
far as the matter of function is concerned, they are practically 
identical with each other, only differing therein, it may be, in 
degree of activity. 
However responsive one division of the lymphatic system 
may be to another in disease, the task has not been left neglected 
of assigning to each particular types of morbid phenomena. 
For though, as I have said, any serious affection of one portion 
must assuredly, in greater or less degree, according to circum- 
stances, become extended to another, a principal site of disease 
often enough exists to claim especial attention, and for the dis- 
ease itself to merit a distinctive appellation in nosological tables. 
In discussing lymphadenosis, any reference but the most 
casual and hypothetical need not be made to the lymphatic 
vessels, as they probably at most act simply as so many conduits 
through which the exciting cause of the disease is in some 
measure conveyed. Seldom or never are they found, for ex- 
ample, approximating any of the states such as our distinguished 
ex-president, Hr. Samuel C. Busey, has so fully described in his 
invaluable work on “ Congenital Occlusion and Dilatation of 
the Lymph Channels,” or as other authors have treated of. 
The almost exact resemblance, in many essential particulars, 
which obtains between typical leucocythemia and lymphadenosis 
makes it appear an arbitrary ruling by which they are generally Hodgkin’s Disease in a Child. 
3 
accepted as independent diseases. In etiology and pathology, 
in their symptoms, progress, and termination, there can only be 
the smallest, if any, distinction drawn between them. And it 
is my tirm belief that did they occur more often than ordinarily, 
thereby increasing anxiety and attracting a greater amount of 
attention, the same reasonable difference of opinion regarding 
their duality -would prevail that now relates to the question at 
to whether membranous croup and diphtheria are different 
affections. 
When the spleen is primarily enlarged, the glands, in case they 
are secondarily involved are, with few exceptions, inconsiderably 
increased in size, and thus, in one of its aspects, leucocythemia 
is said to exist. On the other hand, when the glands are first 
affected, the spleen, if at all, is, as a rule, less evidently so, and 
lymphadenosis, in like manner, becomes established. To suit 
the occasion, as it were, in those cases in which the one condi- 
tion advances perceptibly into the other, until finally they be- 
come merged, or in which both affections are simultaneously 
developed or associated in a variety of other ways, the device 
of forming out of them so many subdivisions of leucocythemia 
is resorted to by the defenders of the faith in the existence of 
more than one disease. 
It would really appear as if at different times one or the 
other, the glands, spleen, or medulla of the bones, perhaps be- 
came most susceptible to the morbific influence exerted, and 
produced in its respective way different manifestations of one 
and the same disease. 
The considerable and permanent excess of leucocytes, which 
is characteristic of leucocythemia, no doubt depends upon the 
condition of the spleen. If the spleen enlarges in the course of 
Hodgkin’s disease, the same preponderance of white corpuscles 
may be observed; the amount of their excess, over and above 
the normal, principally depending upon the extent of splenic 
enlargement. 
The fatality accompanying so-styled Hodgkin’s disease has 
not by any method of treatment yet applied been averted, ex- 
cept, perhaps, in a small percentage of cases. The develop- 
mental period of life is no more exempt from it than the degen- 
erative period. And no explanation is given of the fact as to 
why males are numbered more largely among its victims than 
females. Its predisposing and exciting causes are at best im- 4 
Tyler : A Case of 
perfectly known, and its commencement is generally so insid- 
ious as to escape all recognition. 
To what extent the production of the disease may he found 
hereafter attributable to the presence of a particular form of 
low vegetable organism can but be conjectured at the present 
time, and the same is true as to whether it may not be discov- 
ered to have a parasitical source of origin, of the nature found 
in cases of elephantiasis arabum—a disease chiefly involving the 
lymph channels, and which in tropical countries reveals as one 
cause of its appearance the parasite filaria sanguinis hominis. 
The history of the case which I now have the pleasure of re- 
cording presents a little of interest, beyond* the ordinary run of 
features. 
Alice P., aet. 11 years; mother died eight or nine years ago of 
phthisis pulmonalis; father still living, but very dissipated. 
Her condition attracted no particular attention until towards 
the latter part of the month of February, 1885, when she com- 
plained of sore throat and malaise. On examination, the pharynx 
was observed to be congested, and the left tonsil somewhat en- 
larged and inflamed, the right one less so ; the submaxillary 
lymphatic glands were increased in size, more especially below 
angle of jaw on left side. 
Submitted to treatment at my hands the following March, and 
expressed herself then, as she does now upon inquiry, as feeling 
generally very well. The thermometer, however, displayed a 
slight rise of temperature, and she was pale and evidently anemic, 
but withal bright and cheerful in spirits. The glands were now 
very prominent on left side of neck, and in the right axilla they 
were also found considerably enlarged, but nowhere else were 
they apparently different from the normal. The spleen was 
somewhat enlarged. A scaly rash covered the back. 
In consultation with Dr. George Byrd Harrison, the diagnosis 
of Hodgkin's disease was at once agreed upon, and she was forth- 
with given Fowler’s solution, combined with the bitter wine of 
iron, to be taken three times a day. The propriety of extirpating 
the worst affected glands in the neck was briefly discussed and 
decided in the negative, on account of the evidence presented of 
widely-spread disease. Later on the diagnosis was concurred in 
by Dr. Charles E. Hagner, who also approved of the treatment 
adopted. 
Meanwhile, the administration of the remedies has been perse- 
vered in without interruption; her diet has been a palatable and 
nutritious one, and in all respects her hygienic management has 
been unexceptionable. 
The result is, that her general condition has greatly improved, 
but the glands, while perceptibly reduced in size, still present to Hodgkin s Disease in a Child. 
5 
view threatening proportions. The rash disappeared, after taking 
the medicine, in a short time. The urine has been tested once 
only, and was then proven to be free from albumin. The initial 
examination made of the blood revealed a marked increase of the 
white corpuscles, but each subsequent one has shown a steady 
diminution in their number, until now they apparently do not 
exceed the normal ratio. The red blood-corpuscles present a 
crenated appearance, but do not seem to have undergone any 
numerical change. 
An interesting question is, wliat effect might the superven- 
tion of a first menstruation have upon the progress of the 
malady ? It is known that a greater susceptibility to leucocy- 
themia is created by the natural cessation of the function. 
Admitting, if only for the sake of argument, that the two 
diseases are really identical, and that the vital forces, under the 
circumstances attending the initiation and termination of the 
menstrual function, exert quite opposite influences in the econ- 
omy, it would appear that the susceptibility to the disease at- 
taching to the one period of life would not be evinced so 
strongly at the other, and that, indeed, a remedial effect would 
accompany the puberal flow of the menses. 
In conclusion, I will venture to formulate the following 
propositions: 
1. That leucocythemia and lymphadenosis are different names 
for the same disease. 
2. That this (single) disease may, and does often, appear in 
modified forms. 
3. That inasmuch as it remains undecided whether this dis- 
ease is primarily local or general, it may on that account, if 
none other, be, for the present at least, relegated to the same 
category with carcinoma.