SYMPTOMS AND DIAGNOSIS.—The diag nosis of this condition is not always easy (Osler). Enlargement of the superficial glands, enlarged tonsils, more or less swelling of the thyroid, dullness over the sternum, and enlargement of the mesen teric glands are the most prominent feat ures. The signs of hypoplasia of the vascular system are more obscure, though Quincke believes that in these cases the left ventricle is dilated and the peripheral arteries may be much smaller. The sub jects of the condition are generally in fantile in conformation and poorly devel oped.
The attention of writers has been prin cipally directed to this condition on ac count of the frequency with which it has been found in eases of unexpected death from trifling and inadequate causes. In stances of such are cited by Osler. The death of the son of Langhans, cf Berlin, immediately after the preventive inocu lation with diphtheria antitoxin; death in another child under similar circum stances; a number of cases of sudden death under anesthetics, one under Os lees personal observation during antes thesia for removal of adenoid growths; cases of sudden death of persons who have fallen into the water, and though imme diately recovered, were dead, or who have died suddenly while bathing,. and referred by Paltauf to this condition; the large group of cases of sudden death in chil dren without recognizable cause, in whom the thymus has been found enlarged (the so-called "thymus tod"). Osier also sug gests that certain of the sudden deaths during convalescence from the infectious fevers are referable to this condition. Escherich is inclined to the opinion that certain measures usually harmless, such as hydrotherapy, may have an untoward effect on children who are subjects of lymphatism, and adds that tetany and laryngismns may be associated with it.
Children with the sit/MR lonpholicus, in spite of their splendid appearance, often sink rapidly under light attacks of the disease. The prognosis in such cases ought, therefcre, to be guarded, the more so as such children are often looked upon by their parents as being particularly healthy. Ga]atti med. Bliitter,
Dec. 10, '96).
PATHOLOGY.—Osler observes that the pharyngeal, thoracic, and abdominal lymph-glands are most frequently af fected; the cervical, axillary, and in guinal less so, although they may show slight enlargement. There is usually much enlargement of the lymphatic structures of the alimentary tract, the tonsils, the adenoids of the pharyngeal vault, and the solitary and agminated follicles of the small and large intestines. The hyperplasia of the intestinal lym phatic structures, he notes, may be the most remarkable, "the ind' 'idual glands standing out like peas!' The enlargement of the spleen is usu ally moderate. The Malpighian bodies may be very prominent, and, when anae mic, may resemble "large tubercles." The spleen is usually soft and hyper tem i e.
The thymus is enlarged, swelled, and soft, and on section may exude a milky white fluid. It may measure as much as ten centimetres (3.9 inches) in length.
The bone-marrow is in a condition of hyperplasia, and the yellow marrow of the long bones in young adults, and even in persons between the ages of twenty and thirty, has been found replaced by red marrow. Hypoplasia of the heart and aorta, hypertrophy of the thyroid gland, and, in a large number of cases in chil dren, rachitis arc associated with this con dition.
— Clinical data are not sufficient to outline any specific treat ment. Further observation and study of this peculiar condition may shed more light upon the clinical features, make clear the method of sudden death in these cases, and, perhaps, point out a satisfac tory method of treatment.
Lymphangitis.—Lymphangitis (orrho selenitis; angioleucitis) is an inflamma tion of the lymphatic vessels. Two varie ties are usually noted. When the super ficial lymphatic radicles are involved, the term "reticular lymphangitis" is applied; when the larger continuous lymphatic trunks are affected it is called "tubular lymphangitis" (Bellamy).