Inflammation of' the Lymphatic Glands (Adenitis, front Greek aden, a gland).—As has been pointed out in the preceding paragraphs, this is a frequent result of inflammation of lym phatic vessels, owing to the same substance that irritates and inflames the vessels being carried to the gland. Of course, in such cases, the cause of the glandular affection is obvious, because there is the preceding inflammation of the vessels. In many cases, however, a gland may become inflamed and swell without any pre vious indications of the disease proceeding on wards in the track of the vessels. They have conveyed material to the gland which has irritated it, while they themselves have escaped. Thus swellings of glands are common in chil dren in the neighbourhood of the jaw, behind the ear, and towards the back of the head. These are frequently due to the chronic irritation of eruptions about the face or head, running ears, or scabs and sores on the head. In some cases a row of hard enlarged glands behind the ear towards the back of the neck is the first indica tion of sores on the head to which no attention has been paid. Lymphatic glands rimy, how ever, become inflamed from other causes than these. Injury may be the cause. Again, the glands may inflame in the course of other diseases, such as measles, scarlet fever, &c.; while affections of the lymphatic glands are the troublesome occurrences in scrofula (king's evil), and such constitutional diseases.
Symptoms.—The disease occurs in au acute and a chronic form, and the symptoms vary accordingly.
In the acute attack there is some fever, pre ceded by shivering, the gland becomes swollen, hard, hot, and painful, and the surrounding parts usually also become swollen and tender. If matter forms, the hardness yields, and the gland gives to the fingers a peculiar feeling that indicates fluid matter within it.
In the chronic variety the pain and heat are less, perhaps absent, the surrounding parts are unaffected, and the noticeable feature is the presence of the hard, enlarged gland (kernel) freely movable under the skin.
Treatment.—It ought to be perfectly clear that the first thing to be done is to discover, as exactly as possible, what is the cause of the inflamed gland. It is of the utmost conse quence to find out if the inflammation is due to irritating matter being carried to it from some neighbouring part. Because if this is the cause it is useless to treat the gland so long as the irritation is not removed. The probability is that if the supply of the substance producing the mischief is cut off, the gland will begin at once to recover itself. It becomes, therefore, a very important thing to notice from what parts of the body certain lymphatic glands, which are most commonly affected, receive their sup plies by lymphatic vessels, so that when any of these glands is affected, the whole district of the body in connection with it may be scrutin ized to find if any source of irritation be pre sent. To aid in this search the following cuts have been introduced. Fig. 128 shows the glands of the head and neck. [Distinction must be made between the lymphatic glands of this region and the salivary glands, which have been described on p. 197, and their positions indi cated in Fig. 103, inflammation of which is called mumps (p.
213). ] The glands in the im mediate neigh bourhood of the ear and those at the back of the head are to be noticed, as well as those under the chin and the chain of glands passing down the neck. This chain communi cates with those of the arm-pit (Fig. 129), so that a diseased condition of the former may be passed down to the arm - pit. Now if glands near the ear be affected, examine the ear and parts in front for the cause; if those at the back of the head, carefully investigate the state of the head up to the crown for scabs, sores, &c. Eruptions on the head are almost certain to he attended by swelling of these glands. If those under the chin are inflamed, examine the mouth, the condition of the teeth, and so on. Attention to a discharging ear, cleaning sores on the head, removing scabs by warm applications, bathing with warm water, treating any skin eruption that may be present, removal of decayed teeth, &c., may be quite sufficient to arrest the affec tion of the gland and promote its recovery. Fig. 129 shows the lymphatic vessels and glands of and arm-pit. Note that time lymphatic vessels of the hand and arm pass to glands at the back fold of the arm-pit, while the fold towards the chest has a row of glands con nected with the chest. If any of the former is affected, see that any bad condition of the • arm, hand, or fingers is attended to. An irrit able finger-nail may be the whole cause of the trouble. In Fig. 130 are exhibited the glands of the groin. There is a double row of them, one in the line of the groin, the other below them in time upper part of the thigh. The latter receive lymphatic ves sels from the leg and foot.
An irritable toe - nail may irritate them. The former are connected with the private parts, the geni tal organs, and the region of the anus. Hacks or sores about these partsreadily cause enlargement and inflamma tion of the glands of the groin.
This is the first part of the treatment — re move any source of irritation to the gland. If the disease be but beginning, do nothing else ; in partiOniar, dP. not, rub the gland, otherwise id nay be worried into producing matter; only let the part be kept moderately warm and protected From all rough usage by rubbing, fingering, or otherwise. Should the inflammation develop, still do not rub, nor apply any stimulating ments to the part. That can only increase the inflammation. Soothing applications must be the rule. For this purpose apply cloths wrung out of warm water. Give the patient a dose of seidlitz, or citrated magnesia vescing), so as to open the bowels freely. Light nourishing diet, particularly milk food, is proper. The inflammation may lessen and promise to pass off without matter being formed. Aid this result by keeping the person quiet, by applying the warm cloths occasionally, and by putting on a light flannel cloth between the times of using the warm applications, and by still an occasional dose of medicine. Often, however, matter is produced, and an abscess formed in the gland. This must be opened by a surgeon. to let the matter out. Let no mistake be made about this. Very many people strongly object to an abscess about the face or neck being opened by a surgeon. They prefer to let it burst. They seem to imagine that, if opened with a surgeon's lancet, it will take longer to heal or leave a worse mark than if it is poulticed and allowed to open by its own processes. It would be difficult to discover any reason for this idea, which, it ought to be said plainly, is utterly false and absurd. Suppose it is necessary to make an opening in a sheet of glass, nobody would be mad enough to imagine that the safest way was to dash his fist through it, or to throw a stone through it, or to break the hole in it by a strong pressure against it from one side. Everyone would at once say, let a glazier be got, and let him cut the piece out with a diamond. In that way a clean cut would be made, while in any other way there would be the certainty of a star-shaped or ragged hole, and the risk of destruction of the glass. Now it is precisely the same with the collection of matter in the gland. It must be got out. If it is left to burst, the matter goes on ing; it cannot at once break through healthy skin. More and more collects until the skin is stretched, and itself becomes more or less inflamed with the pressure on it from within. By and by the skin becomes undermined and thinned, and at last, when it has become so injured by the pressure and inflammatory cess, and so softened that it cannot hold against the pressure any longer, it gives way, and, instead of a clean opening, a ragged, irregular tear is produced. Matter comes oozing away for a considerable time, and at last, when it heals, an ugly livid scar is left to mark the place. If, however, as soon as matter forms, a clean cut is made through the still healthy skin, the matter thoroughly cleaned out, and the wound properly closed, no further trouble should arise, and a fine line, which might be a wrinkle in the skin, should alone remain, a scarcely noticeable sign of what has been done. It is quite true that doctors often open such abscesses without getting them to heal quickly. From the wound matter proceeds for days and weeks, and finally a bad mark is left. The parents or friends of the child complain loudly, blame the doctor, and on the basis of their small experience assert the abscess ought never to have been opened. But in the majority of cases the reason is that the doctor has not been consulted early enough. The parents or guar dians have tried their own hand first, and usually only after delay, and after the part has been worried by the attempts made to set it right, is the case brought to a surgeon. If the inflamed gland is to be treated with success it must be properly treated from the first; and if an abscess is to leave no mark, the matter must be afforded a way of escape as soon as it has formed. Besides, if a surgeon be consulted early enough, he may be able, having made a clean cut through the skin, to dissect out the gland entire without opening into it, an un opened sac or bag of matter. If so, no matter escapes to infect the wound, which can then be quite closed by fine stitches, and in time this leaves no mark beyond a fine line resembling a crease in the skin.
The treatment for chronic cases consists in treating the scrofular or other constitutional condition which maintains the gland affection. The treatment is mainly good nourishing food, sea-bathing if possible, and the use of cod-liver oil, chemical food, or syrup of the iodide of iron,. of which half a tea-spoonful is an ordinary dose. In such cases applications to the gland itself are not desirable. Often, however, the gland is quite destroyed and its place occupied by masses of cheesy matter, or unhealthy-looking ulcers are the result of the disease. All such unhealthy material should be scraped away by a surgeon.