—The disease usually ter minates in resolution at the end of a week or ten days; exceptionally it may termi nate in erysipelas. In some cases limited suppuration may take place or a chain of abscesses form along the course of the lymphatic vessels and glands. In other cases, after the disappearance of the in flammatory symptoms, a state of chronic and rather solid oedema (lymphcedema) is left, giving rise to a species of false hy pertrophy (see ELEPHANTIASIS). More rarely death results from erysipelas, py mmia, or from secondary abscesses, espe cially in patients with impaired constitu tion, in whom the disease has been ex tensive and has become associated with low cellulitis.
— Lymphangitis being a septic disease, the treatment should be conducted on antiseptic lines. The orig inal wound, through which the septic virus has gained entrance into the lym phatic circulation, should he thoroughly cleansed and disinfected. The affected limb should he elevated and kept quiet. Free incision will relieve any tension, and is advised even before the appearance of suppuration. All foci of suppuration should be evacuated by incision, disin fected, and drained. Compresses wet with an aqueous solution of bichloride of mercury (1 to 2000) should be laid upon the affected parts, the compresses being remoistened as they begin to dry, and re applied until the inflammation has en tirely disappeared. The constitutional symptoms usually demand more or less attention, especially in the direction of support and free elimination. Opiates may be needed to relieve pain, but their use should he avoided if possible, as they diminish the secretions. Quinine and strychnine are valuable in tonic doses. The mineral acids and bitters are useful, as digestion is usually impaired. Nour ishing food should be freely adminis tered, and stimulants in the more severe cases. Bandaging and massage will best overcome any oedema which may be left after the acute symptoms have subsided.
Lymphadenitis and Inflammation of the Glands. See ADENITIS.
Lymphangiectasis and Lymphangioma. —The lymphatic vessels, like the veins, are subject to varicosities and dilatations, which are called lymphangiectasis, or varix of the lymphatics; when these dila tations are large or when several of these dilatations unite to form a distinct tumor, it is known as lymphangioma. Lym phangiectasis has been observed in the superficial and deep lymphatic net-works and in the lymphatic trunks. The inner side of the thigh is the favorite location for this disorder, but it has also been seen in the anterior abdominal walls, about the ankle- and elbow- joints, and on the pre puce. In the superficial lymphatics this condition appears first as small elevations, giving the skin an appearance like the rind of an orange; subsequently it ap pears as small vesicles covered with a thin layer of epidermis. The larger lymphatic trunks are, at the same time, frequently affected in like manner. The vessel may either be dilated cylindrically into round, beaded enlargements, often semitrans parent, and but slightly compressible, or ampullae may be formed on them, giving rise to more or less soft swellings, fluct uating under the finger (Erichsen). There is usually some oedema (lymphoe dema) either from obstruction of the lymphatics or from the impeded flow of the lymph; the affected parts may be come swollen by a hard, compact, brawny oedema which is not reducible by position or pressure (lymphcedema). This condi tion leads up to elephantiasis (see ELE PHANTIASIS).
In a majority of recorded cases a dis charge of lymph (lymphorrhagia) has been observed, caused by a rupture of the vesicles. This flow of lymph is of vari able amount and duration, and is apt to be intermittent in character. There is
another form of lymph-discharge which occurs normally from all wounds as a re sult of rupture or incision of the lymph radicles or smaller trunks; this is known as lymphorrhcea. An excessive dis charge of lymph in either manner pro vokes symptoms of general debility like those induced by haemorrhage. Rupture of a dilated lymphatic along the urinary tract and the consequent lymphorrhagia produce chyluria. If the tunics vaginalis testis be the seat of a lymphorrhagia, chylocele results. Varicose swelling of the lymphatics in the inguinal regions may simulate hernia. Dilatations of the blood-vessels may co-exist with those of the lymphatics, producing a mixed tu mor. When such mixed growths occur in the tongue, they produce an enlarge ment of the organ known as "macroglos sia"; when occurring in the lips, this en largement is known as "macrocheilia." A large proportion of cases of lym phangieetasis are congenital in their origin. These cases may be due to vicious development of unknown character or to obstructions to the lymph-stream of a mechanical or inflammatory nature dur ing intrauterine life. Inflammation and thrombosis are the usual causes of the acquired variety, resulting in a dilatation of the radicle and primary channels, with lymph-stasis and oedema of all the tissues supplying the narrowed or occluded ves sels. Cicatricial contraction, pressure by tumors, or occlusion of the lymph-chan nels by tuberculous or cancerous material may also be etiological factors in produc ing this condition. In a large class of cases occurring in tropical regions, the presence of the Filaria sanguinis honzinis in certain lymphatic vessels has been shown to be the cause of lymph-throm bosis and inflammation. (See PARA SITES.) — Circumscribed dilata tions and isolated cystic enlargements may be removed by the knife. ?Massage, the elastic bandage, and support in an elevated position will give relief in the I diffused dilatations and cedcma due to persistent obstructive causes, in cases in which collateral lymphatic circulation may become sufficiently developed to re lieve the stasis; when such collateral cir- ' culation is not developed and stasis is not relieved, these means will not suffice. If all other means fail, ligation of the main artery of supply to the limb would be justifiable. In a few recorded cases rapid improvement has followed; in others none. Amputation may be done, if the condition is confined to an extremity and causes serious annoyance. Similar tu mors involving the genitals should be ex cised, care being taken to preserve the penis and testes by dissecting them out of the diseased mass. The use of the elastic bandage about the base of the growth will prevent hemorrhage during the opera tion and facilitate the dissection (Keen and White).
Lymphadenoma. or simple lymphoma, is a tumor composed of tissue exactly resembling the cortical sub stance of a lymphatic gland—the so called "adenoid tissue of His"; in fact, the change is purely an hyperplasia of normal gland-elements. (See TUMORS.) Malignant Lymphoma (Hodgkin's Dis ease; Pseudoleuktemia). (See PSEUDO LEUK2E3IIA.) Sarcoma of Lymphatic Glands, or Lymphosarcoma.—This is a condition 1,1 which sarcoma attacks a lymphatic gland. In the early stages it differs little from other glandular hypertrophies, but later it manifests its malignant character by involving adjacent tissues and by the ap pearance of secondary deposits in the various internal organs. In its early de velopment it may be excised, together with the surrounding tissue. If return occurs and the tumor be on one of the limbs, immediate amputation is impera tive.