LYMPHATIC SYSTEM, DISEASES OF. Lymphadeni tis or inflammatory infection of the lymphatic glands is a condi tion characterized by hyperaemia of and exudation into the gland, which becomes redder, firmer and larger than usual. Three varie ties may be distinguished : simple, suppurative and tuberculous. The cause is always the absorption of some toxic or infective ma terial from the periphery. This may take place in several of the acute infectious diseases, notably in scarlet fever, mumps, diph theria and Gerhian measles, or may be the result of poisoned wounds. The lymphatic glands are also affected in constitutional diseases such as syphilis. Simple lymphadenitis usually subsides of its own accord, but if toxins are produced in the inflamed area the enlargement is obvious and painful, while if pyogenic organ isms are absorbed the inflammation progresses to suppuration.
Tuberculous lymphadenitis (scrofula) is due to the infection of the lymph glands by Koch's tubercle bacillus. This was f or merly known as "King's Evil," as it was believed that the touch of the royal hand had power to cure it. It occurs most commonly in children and young adults. Some local focus of irritation is usually present. The ways in which the tubercle bacillus enters the body are much disputed, but catarrh of the mucous mem branes is regarded as a predisposing factor, and the tonsils as a probable channel of infection. Any lymphoid tissue in the body may be the seat of tuberculous disease, but the glands of the neck are the most commonly involved. The course of the disease is slow and may extend over a period of years. The earliest mani festation is an enlargement of the gland and local formation of minute tubercles. It is possible in this stage for spontaneous healing to take place, but usually the disease progresses to casea tion. Occasionally this stage may end in calcification, the gland shrinking and becoming hard ; but frequently suppuration follcws from liquefaction of the caseating material. Foci of pus occur throughout the gland, causing destruction of the tissue, so that the gland may become a single abscess cavity. If left to itself the abscess sooner or later bursts at one or several points, leaving ulcerated openings through which a variable amount of pus escapes. Temporary healing may take place, to be again followed by further breaking down of the gland. This condition, if un treated, may persist for years and may finally give rise to a gen eral tuberculosis. The treatment consists mainly in improving the general health with good diet, sunlight or ultra-violet radia tion, fresh air (particularly sea air), cod-liver oil and iron, and the removal of all sources of local irritation such as enlarged tonsils, adenoids, etc. Suppuration and extension of the disease may require operative measures, and removal of the glands en masse can now be done so as to leave only a slight scar.
In Tabes mesenterica (tuberculosis of the mesenteric glands), usually occurring in children, the glands of the mesentery and retroperitoneum become enlarged, and either caseate or occa sionally suppurate. The disease may be primary or may be sec ondary to tuberculous disease of the intestines or to pulmonary phthisis. The patients are pale, wasted and anaemic, and the ab domen may be enormously enlarged. There is usually moderate fever, and thin watery diarrhoea. The caseating glands may liquefy and give rise to an inflammatory attack which may stimu late appendicitis. Limited masses are amenable to surgical treat ment and may be removed, while in the earlier stages constitu tional treatment gives good results. Tuberculous peritonitis fre quently supervenes on this condition.
Lymphadenoma (Hodgkin's disease), 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 pro gressive growth of the glands in the submaxillary region and axilla. The inguinal glands are early involved, and of ter a time the internal lymph glands follow. The enlargements are at first painless, but in the later stages symptoms are caused by pres sure 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. 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 lym phoid tumours may be found on its surface. Anaemia is com mon and is secondary in character; slight irregular fever is present, and soon a great and progressive emaciation takes place. The cases are of two types, the acute cases in which the enlarge ments take place rapidly and death may occur in two to three months, and the chronic cases in which the disease may remain apparently stationary. In acute lymphadenoma the prognosis is very unfavourable. Recovery sometimes takes place in the chronic type of the disease. Early surgical intervention has in some cases been followed by success. The application of X-rays is a valuable, though usually but temporary, method of treatment, superficial glands undergoing a rapid diminution in size. Of drugs arsenic is of the most service, and mercurial inunction has been recommended. It is probable that certain cases have been included under lymphadenoma which are in reality tuberculous.
Status lymphaticus (lymphatism) is a condition found in chil dren and some adults, characterized by an enlargement of the lymphoid tissues throughout the body and more particularly by enlargement of the thymus gland. There is a special lowering of the patient's powers of resistance, and it has been said to account for a number of cases of sudden death. In all cases of status lymphaticus the thymus has been found enlarged. At birth the gland (according to Bovaird and Nicoll) weighs about 6 grammes, and does not increase after birth. In lymphatism it may weigh from io to 5o grammes. 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 be coming suddenly faint, gasping and cyanosed, and the heart stopping altogether before the respirations have ceased. The most trifling causes have brought on fatal issues, such as a wet pack (Escherich) or a hypodermic injection, or even a sudden plunge into water though the head is not immersed. The greater number of deaths occur during the administration of anaesthetics, which seem peculiarly dangerous to these subjects. When an attack of syncope takes place no treatment is of any avail.
Lymphangeitis. In cases where the infective agent is very vir ulent there may be seen thin red lines in the skin tracking from the focus of infection towards the nearest group of lymphatic glands. These lines indicate the superficial lymphatics and the advancing edge travels of ten with great rapidity, reaching, for example, from the hand to the bend of the elbow in a few hours. The existence of lymphangeitis is a sign of grave importance. (For the secondary invasion of lymphatic glands in cancer, see CANCER.)