LYMPHADENITIS.
Acute and subacute lymphadenitis being almost always due to the intro duction of septic organisms through a wound or abrasion, the cocci finding their way along the lymph stream till blocked by the nearest glands, the first indication for treatment will be found in the disinfection of the wound and the relief of pain and pyrexia. Endeavour should be made to prevent suppuration ; the part containing the acutely inflamed gland must be put into a state of rest as complete or absolute as possible. The best routine application to the gland is a warmed antiseptic solution, as Carbolic lotion (r in 4o), Saturated Boric Acid solution or Spirit lotion (r in 4), and these should be covered over with oiled silk and bandaged lightly under wool, the idea being to give the region all the advantages of an internal part and so increase the natural resistance by diminishing tension and bringing a fuller blood-supply to the inflamed gland. Upon the same principles Bier's method of inducing passive hyperaemia by the pressure of an elastic bandage or by Klapp's suction-bell is employed by some surgeons.
Various old-fashioned methods appear to act in a similar manner, such as counter-irritation by Iodine or Iodised Phenol, strong Nitrate of Silver, Pcrnitrate of Mercury, and even by blistering, but no application necessitat ing friction or rubbing should ever be employed. Some surgeons prefer to employ counter-irritation in the form of the thermo-cautcry passed lightly over the skin in order to prevent suppuration.
The plan of injecting a few minims of Carbolic Acid or Tincture of Iodine, b'enzoate of Mercury, &c., into the gland and surrounding tissue is advo cated, and may be employed where the infection is a dangerous one as in bubonic plague, but suppuration is more liable to be determined than prevented by such measures.
Strong Iodine Tincture applied in a broad line over the inflamed lymphatic vessels between the wound and the gland always gives satisfactory results, and frequently relieves pain in a marked manner and diminishes the lymphangitis.
The best abortive remedy is a cream made of Ichthvul or Green Extract of Belladonna and Glycerin. (See also under Abscess and Bubo.) Hot and cold applications have each their advocates, and the same result—i.e., resolution without suppuration—may be secured by either. By ice, evaporating lotions, cold compresses, or Leiter's tubes the tension and arterial supply are soon markedly lessened, and the inflammation as evidenced by pain, heat, redness and swelling soon diminishes or disappears. When hot or warm compresses or poultices are applied, the capillaries of the collateral circulation are dilated and the current is diverted from the inflamed vessels. lip to a certain point both methods of treatment tend to prevent suppuration; and the writer has satisfied himself that, contrary to the popular notion, warm poultices prevent suppuration by reducing the tension of an inflamed gland if applied at an early stage, the general relaxation of the tissues sometimes speedily relieving the tension which is fatal to the life of the organ. At a later stage, by keeping up a continuous
moist warmth and reducing the tension of the skin, poultices hasten the pointing of the abscess.
Compresses at a very high temperature are recommended by He drops several plies of linen into boiling water, squeezes them out quickly, and applies them directly over the inflamed gland and envelops the part for 15 minutes in a thick pad of cotton-wool. A large sponge squeezed out of very hot water and covered with mackintosh makes a good application. The best guide to the selection of hot or cold applica tions is the sensation of comfort or pain produced, the application from which the patient derives the greatest ease being always preferred.
Once the pus has formed there should be no delay in its evacuation. If the collection of matter is large, as when a group of glands and their loose surrounding tissue are converted into an abscess, a free incision should be made and the blades of a dressing forceps inserted deeply and opened to secure free evacuation without the danger of wounding large vessels as in the axilla or neck (Hilton's method). Warmed spirit lotion or boric compresses may be applied to the open wound.
A free incision usually does away with the necessity of inserting a drainage-tube, but where a small wound is necessary to avoid visible scarring, as when the adenitis follows some irritation about the jaws, the incision should be as limited as possible compatible with evacuation, and a fine drainage-tube or a few shreds of carbolised tow or horsehair will establish the removal of all pus as it is secreted. (See under Abscess, where the aseptic treatment of acute abscesses is detailed.) After the free removal of pus and the application of spirit lotion under oiled silk, the cavity may be syringed out with weak Sublimate Solution from time to time as it heals up from the bottom, or it may be packed with sterilised gauze.
Some surgeons prefer to aspirate and inject the abscess cavity with Iodoform Emulsion, but this is more suitable for chronic cases. Whilst others make an incision just large enough to admit a fine spoon, with which they scoop out any remaining portion of the gland which has not become converted into pus. Curettage is, however, not a safe proceeding in acute inflammations.
Upon the whole, the best routine for glands about the neck is to make a small incision with a tcnntomv knife and then to apply a Klapp's suction-bell over the wound. The bell may he used 2 or 3 times a day till the cavity is thoroughly cleansed, the wound being dressed every 3 hours with Boracic Fomentations; healing is rapid under this treatment, and the scar is small.
In recurring septic lymphadenitis Vaccine treatment should be re sorted to.