Reticular lymphangitis may be ob served in its typical form in erysipelas, in which the streptococcus of erysipelas produces inflammation by invading the lymphatic radicles (see ERYSIPELAS). It is also seen in many cases of circum scribed dermatitis attended with more or less oedema. It is present also in the "erysipeloid" of Rosenbach, where cer tain patches of superficial inflammation of the skin slowly spread from a point of primary infection (usually on the fin gers), the point originally infected re turning to its normal condition, while the inflammation extends peripherally, until after one to three weeks the disease has exhausted itself and entirely disappears, having traveled over the hands to the wrists. Rosenbach found in these cases a specific thread-forming, spore-bearing micro-organism derived from decompos ing animal matter. In certain poisoned wounds attended by a rapidly extending inflammation, the lymphatic trunks be come involved and both varieties of lym phangitis may be present. In injuries of the hands or feet that are neglected or are subject to motion and irritation, or where scratches and abrasions are brought into contact with decomposing matter a lymphangitis of a less virulent type may develop which may at first be confined to a small area of contiguous lymphatic radicles, but may, later, extend to the larger trunks (tubular lymphan gitis) leading away from the original focus and appear through the skin as red streaks or lines running in the direction of the lymph-current, these red lines be ing tender to the touch. These streaks result from the blocking up of the lumen of the lymphatic vessels by a coagulated exudate, infiltrating, additionally, the circumjacent connective tissue, which is also inflamed.
As the infectious matter travels along the lymph-channels, it is carried to the glands into which the lymphatics empty, and inflammation of the lym phatic glands follows, sometimes without inflammation of the afferent duct. A sec ond group of glands may also become af fected without any reaction in the ducts leading from the first to the second group. It is seen, therefore, that any serious in flammation of the ducts leading from the focus of infection to the glands is not necessary for the production of trouble in the latter.
If the infectious matter consists in part of pyogenic organisms of sufficient number and activity, suppuration will re sult along the course of the inflamed ves sels, in the glands, and later in the con nective tissue about both, forming ab scesses. If the infection is less virulent or becomes weakened through treatment, the inflammation diminishes in severity, the exudate liquefies and is absorbed, and the affected vessels become normal in condition and function.
— Certain constitutional symptoms appear which are dependent upon the severity and extent of the infec tion. The patient is not infrequently seized with rigors, followed by a febrile action and attended, not infrequently, by vomiting or diarrhoea. These symptoms
may precede the local signs of the disease by twelve or fourteen hours, but most fre quently accompany them. Examination of the parts, if superficial, will reveal a number of fine, red streaks, at first scat tered, but gradually approaching one an other so as to form a distinct band, about an inch in breadth, running from the af feeted part along the inside of the limb ' to the neighboring lymphatic glands, which have become enlarged and tender. The band itself feels somewhat doughy and thickened. More or less oedema of the limb is present, from the involvement of the deeper layers of vessels and their obstruction by the inflammation. Ery sipelatous patches not infrequently ap pear along the course of the inflamed ab sorbents, and coalesce until they are of considerable size, and constitute a dis tinct variety of erysipelas. If the deeper seated lymphatics are first implicated, the glandular signs are first observed; if the inflammation continues to be confined principally to the deep vessels, it gives rise to a great and brawny swelling of the limb, with much, if any, superficial red ness. The constitutional symptoms, at first of an active form, may gradually subside into the asthenie type.
— The diagnosis of super ficial lymphangitis is usually easy. The tender red streaks indicate the tubular variety. The diffuse redness of the retic ular form, with its superficial oedema, tenderness, and constitutional symptoms, differentiate it from erythema or derma titis. From phlebitis it is distinguished by its superficial redness, the inflamma tion of contiguous glands, and the ab sence of the knotted corded state which belongs to an inflamed vein; the pain and fever are usually less in phlebitis. Inflammation of the deep lymphatics is not easily differentiated from cellulitis; if glands are early involved, if lymphatic oedema is present, if patches of reticular lymphangitis appear at points of anasto mosis with deeper trunks, inflammation of the deep lymphatics may be assumed (Keen and White).
ErtoLoGv.—The etiology of the reticu lar variety has already been referred to. Tubular lymphangitis is always caused by the entrance into the affected duct of bacteria and bacterial products of more than usual virulence. The absorption of septic matter from infected wounds al ways follows, but does not generally cause an extensive inflammation of the lymph channels; impaired constitution or gen eral debility will predispose to it. Fre quent irritation of the infected wound or retention of septic secretions in it are frequently exciting causes. Trivial wounds may be infected with virulent septic material (snake-bites, dissection wounds); bathing the hands in putrid fluid for some time, without any breach of surface, has been followed by lym phangitis.