Seven cases of articular rheumatism in which the lymphatic glands situated above the affected joints were swollen and painful, the pain or tenderness in creasing with that of the joint-affection. During the attacks some were of the size of a nut and rolled under the finger. No periadenitis or diffuse swelling was present.
In almost every case some previous in fectious disease was to be found with which the chronic rheumatism could be connected. Bacteriological examinations, however, carried out either with the intra-articular liquid withdrawn by aspiration or by fragments of glands removed aseptically, gave almost no re sults. A. Chauffard and F. Ramond (Rev. de Med., May 10, '96).
Prognosis. — The prognosis is usually favorable; it may be unfavorable, how ever, when extensive abscesses form in the neighborhood of important organs.
Deep-seated suppurative adenitis may give rise to dangerous complications, especially in certain regions, like the neck and mediastinum, on account of the purulent extensions (through burrowing) and the difficulty of evacuating the pus.
Ulceration of the great vessels of the neck giving rise to grave hmnorrhages may also occur.
Case, in the practice of Johnston, in i eh the internal jugular vein was ligated for profuse limorrhage, caused by a sloughing adenitis following malig nant scarlet fever. L. H. Adler, Jr. (Univ. Med. Mag., Dec., '91).
Treatment. — The first indication in acute adenitis is to remove any source of irritation or infection. Any wound, abrasion, opening, or any natural cavity with which either of these may connect should be so treated as to bring about absolute local asepsis.
If the case is seen early enough, cold applications should he made to the af fected region. Cold inhibits the multi plication of bacteria, but when applied late it favors the death of cells, and should consequently be avoided.
The region in which the affected gland is situated should be kept at rest and, if possible, elevated. In this manner the afferent arterial current is diminished, while the efferent venous and lymphatic currents are increased.
To prevent suppuration gray mercurial ointment, very gently rubbed in, is use ful. The injections of from 5 to 10
minims of a 3-per-cent. carbolic-acid solution into an inflamed gland have also proven satisfactory.
Case in which injections of carbolic acid destroyed the tendency of the glands to develop. Schwartz (Revue CCM. de Clin. et de Then, Mar. 4, '91).
In cervical adenitis it is necessary be fore the skin is altered to treat abscess by punctures with a fine needle and modifying injections. If this method adopted, cure without cicatrix in 99 per cent. of eases. When with general treat ment and stay of six months or more at sea-side, gland remains swelled and in durated, neither showing signs of reso lution nor advancing toward softening, injections of 1-in-50 ebloride-of-zinc solution gives best results. Injection re peated three or four times, at two days' intervals, with 30 to 60 drops of this solution. This nearly always leads to commencement of softening, which is finished by injections of camphorated naphthol. Calot (Presse Med., Oct. 22, 'OS).
If it is desired to hasten suppuration, warm antiseptic fomentations are to be used in preference to poultices. The Compound resin cerate of the pharma copoeia is effective for this purpose, and is antiseptic as well.
When pus has formed the gland should be opened by a generous incision, sinuses. if present, being opened throughout their entire length to facilitate treatment. The contents are then carefully removed, and the infiltrated wall scraped with a sharp curette. The cavity should then be packed with iodoform gauze, or gauze impregnated with camphorated naphthol or salol. The dressing may be removed on the third day.
In the treatment of cases of simple chronic adenitis, applications of iodine, compression, and local blistering have given the best results.
Blisters, nitrate of silver, or iodine tincture should be applied around, but not over, the inflamed gland.
In adenitis complicating articular rheumatism the best results are obtained from the tincture of iodine given in ternally; 100 drops in divided doses are given daily; long continued use is ad vised. A. Chauffard and F. Ramond (Rev. de Mdd., May 10, '96).