NATHAN S. DAVIS, Chicago.
ADENITIS.—Gr., a gland; itis, inflammation.
Definition.—Inflammation of a gland.
Varieties.—Adenitis may be acute, due almost invariably to infection from an attack of angioleucitis and occasionally to injury or strains; or chronic, resulting from either of the preceding, especially in strumous or cachectic persons, and from slight sources of irritation, and not uncommonly resulting in permanent en largement and induration or in tuber culous degeneration. Adenitis of spe cific origin will be described under SYPHILIS and URINARY SYSTEM.
Acute Adenitis.
Symptoms. — The general symptoms depend upon the extent and severity of the infection. Rigors may occur when pus forms. The temperature is fre quently elevated. If the infection is severe, symptoms of profound septice mia appear.
The local symptoms are, by far, the most prominent in the majority of cases, and consist of pain, heat, and swelling. The suffering varies from a slight sore ness only to intense pain, according to the position of the gland, its relations with the surrounding tissues, and the density of the tissue in which it is im bedded. The heat may vary according to the degree of the congestion present. The swelling may either be great or slight. If the lesion be confined to the gland, it will be well defined; if peri adenitis is present, the swelling will be more or less diffuse. Glands in any re gion of the body may be affected, but those of the neck, axilla, and groin more than the others; this is due to the fact that infection generally enters the sys tem through the mouth, throat, genital organs, and the extremities.
In the congestive, or exudative, stage, pain and swelling are present in the region of the glands; if the glands are superficial the swelling is ovoid with the long axis coinciding with the direction of the afferent lymphatics. and palpation reveals several movable, hard, elastic, and tender rounded masses.
When the glands are deep. as in the axilla, abdomen, or even the neck, the results of palpation are less definite and satisfactory.
In the suppurative stage the pain in creases and becomes sharp and catching, the skin reddens, and the periglandular tissue swells.
If the gland alone suppurates the skin remains normal, while under it may be felt the softened and enlarged gland. This latter opens outwardly or into the neighboring cellular tissue on from the sixth to the fifteenth day of the affection. When the gland opens outwardly, the cicatrix is much smaller than when it ruptures into the cellular tissue, as in the latter case it gives rise to an abscess.
If the cellular tissue around the gland suppurates the skin becomes hot, swollen, and painful, and fluctuation may be felt. Two foci of suppuration are thus estab lished. The skin is occasionally under mined by the pus. Recovery is possible, however, without suppuration of the gland.
Both the gland and the cellular tissue around it may suppurate, either simul taneously, or suppuration of the cellular tissue may precede that of the glands, or the latter may suppurate and rupture into the surrounding cellular tissue and form an abscess. Pus is usually pro duced in considerable quantity, and the affection is of long duration.
Suppurative adenitis may result in cicatrization after several weeks. This cicatrix may reopen to allow the exit of pus from a suppurated gland. On the other hand, a fistula may result, which may give exit to sero-pus or to lymph (Despres). A lymphatic gland or vessel will then be found at the bottom of the abscess-cavity, below the crater-like opening.
As the suppuration usually starts in more than one focus in the gland, the first sensation to the touch will be one of bogginess, which periglandular con gestion may render obscure. Well defined fluctuation is found only when considerable tissue is destroyed.
Diagnosis,—The diagnosis of ordinary superficial acute adenitis is usually easy; it is more difficult when the neighboring cellular tissue is also inflamed; it may be impossible in cases of deep-seated or visceral adenitis.