. Diseases of metabolism and of the blood, animal parasites, toxicology. Constitutional diseases; Metabolism; Blood; Medical parasitology; Poisons. HODGKIN'S DISEASE 373 mediastinal space press particularly upon the innominate vein, and thus pro- duce swelling of the veins of the nech and the wall of the chest with cyanosis and edema of the face, to which may be added dropsical effusions into one or both pleurae. These phenomena, however, are not so frequent or so marked as with other tumors and tumor-like formations in the thoracic cavity, for the glandular swellings are usually softer and le
. Diseases of metabolism and of the blood, animal parasites, toxicology. Constitutional diseases; Metabolism; Blood; Medical parasitology; Poisons. HODGKIN'S DISEASE 373 mediastinal space press particularly upon the innominate vein, and thus pro- duce swelling of the veins of the nech and the wall of the chest with cyanosis and edema of the face, to which may be added dropsical effusions into one or both pleurae. These phenomena, however, are not so frequent or so marked as with other tumors and tumor-like formations in the thoracic cavity, for the glandular swellings are usually softer and less resistant than other tumors. It is true that harder forms occasionally occur depending upon histological vari- ations the discussion of which will follow later on, and these hard tumors may produce all the phenomena of pressure and stasis. The development of dropsical effusions may be produced in three ways: (1) by venous stasis; (3) by displacement of the trunJcs, caus- ing a hindrance to the absorp- tion of tissue fluid; and (3) by progressive anemia and ca- chexia. More common than stasis phenomena are difficulties in respiration. These are caused, (1) by direct pressure which the glandular swellings exert upon the larynx, trachea or bronchi; (2) by pressure upon the vagus, or (very frequently) upon the recurrent laryngeal nerve; (3) by the decrease of erythrocytes which are the neces- sary oxygen carriers in the func- tion of respiration. Difficulty in deglutition as the result of pressure upon the pharynx or esophagus is rare. Enlargements of the thoracic lymph-glands also produce both dropsical effusions into the pleura, and true inflammations of the pleura (unilateral or bilateral), which cannot always be differentiated from dropsy, since there are fluids intermedi- ate between dropsical effusions (transudates) and inflamma- tory effusions (exudates). Another symptom which is probably to be referred to the local pressure exerted by the glandular tumors is n
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