Page:EB1911 - Volume 17.djvu/183

 Haemolymph glands are present in mammals and birds, but have not been seen lower in the scale, though S. Vincent and S. Harrison point out the resemblance of the structure of the head kidney of certain Teleostean fishes to them (Journ. Anat. and Phys. vol. xxxi. p. 176).

For further details see ''Comparative Anat. of Vertebrates'', by R. Wiedersheim (London, 1907).

Diseases of the Lymphatic System and Ductless Glands.

Lymphadenitis or inflammatory infection of the lymphatic glands, is a condition characterized by hyperaemia of and exudation into the gland, which becomes redder, firmer and larger than usual. Three varieties may be distinguished: simple, suppurative and tuberculous. The cause is always the absorption of some toxic or infective material from the periphery. This may take place in several of the acute infectious diseases, notably in scarlet fever, mumps, diphtheria and German measles, or may be the result of poisoned wounds. The lymphatic glands are also affected in constitutional diseases such as syphilis. Simple lymphadenitis usually subsides of its own accord, but if toxins are produced in the inflamed area the enlargement is obvious and painful, while if pyogenic organisms are absorbed the inflammation progresses to suppuration.

Tuberculous lymphadenitis (scrofula) is due to the infection of the lymph glands by Koch’s tubercle bacillus. This was formerly known as “King’s Evil,” as it was believed that the touch of the royal hand had power to cure it. It occurs most commonly in children and young adults whose surroundings are unhealthy, and who are liable to develop tuberculous disease from want of sufficient food and fresh air. Some local focus of irritation is usually present. The ways in which the tubercle bacillus enters the body are much disputed, but catarrh of the mucous membranes is regarded as a predisposing factor, and the tonsils as a probable channel of infection. Any lymphoid tissue in the body may be the seat of tuberculous disease, but the glands of the neck are the most commonly involved. The course of the disease is slow and may extend over a period of years. The earliest manifestation is an enlargement of the gland. It is possible in this stage for spontaneous healing to take place, but usually the disease progresses to caseation, in which tuberculous nodules are found diffused throughout the gland. Occasionally this stage may end in calcification of the caseous matter, the gland shrinking and becoming hard; but frequently suppuration follows from liquefaction of the caseating material. Foci of pus occur throughout the gland, causing destruction of the tissue, so that the gland may become a single abscess cavity. If left to itself the abscess sooner or later bursts at one or several points, leaving ulcerated openings through which a variable amount of pus escapes. Temporary healing may take place, to be again followed by further breaking down of the gland. This condition, if untreated, may persist for years and may finally give rise to a general tuberculosis. The treatment consists mainly in improving the general health with good diet, fresh air (particularly sea air), cod-liver oil and iron, and the removal of all sources of local irritation such as enlarged tonsils, adenoids, &c. Vaccination with tuberculin (TR) may be useful. Suppuration and extension of the disease require operative measures, and removal of the glands en masse can now be done through so small an opening as to leave only a very slight scar.

In Tabes mesenterica (tuberculosis of the mesenteric glands), usually occurring in children, the glands of the mesentery and retroperitonaeum become enlarged, and either caseate or occasionally suppurate. The disease may be primary or may be secondary to tuberculous disease of the intestines or to pulmonary phthisis. The patients are pale, wasted and anaemic, and the abdomen may be enormously enlarged. There is usually moderate fever, and thin watery diarrhoea. The caseating glands may liquefy and give rise to an inflammatory attack which may simulate appendicitis. Limited masses are amenable to surgical treatment and may be removed, while in the earlier stages constitutional treatment gives good results. Tuberculous peritonitis frequently supervenes on this condition.

Lymphadenoma (Hodgkin’s Disease), a disease which was first fully described by Hodgkin in 1832, is characterized by a progressive enlargement of the lymphatic glands all over the body, and generally starts in the glands of the neck. The majority of cases occur in young adults, and preponderate in the male sex. The first symptom is usually enlargement of a gland in the neck, with generally progressive growth of the glands in the submaxillary region and axilla. The inguinal glands are early involved, and after a time the internal lymph glands follow. The enlargements are at first painless, but in the later stages symptoms are caused by pressure on the surrounding organs, and when the disease starts in the deeper structures the first symptoms may be pain in the chest and cough, pain in the abdomen, pain and oedema in the legs. The glands may increase until they are as large as eggs, and later may become firmly adherent one to another, forming large lobulated tumours. Increase of growth in this manner in the neck may cause obstructive dyspnoea and even death. In the majority of cases the spleen enlarges, and in rare instances lymphoid tumours may be found on its surface. Anaemia is common and is secondary in character; slight irregular fever is present, and soon a great and progressive emaciation takes place. The cases are of two types, the acute cases in which the enlargements take place rapidly and death may occur in two to three months, and the chronic cases in which the disease may remain apparently stationary. In acute lymphadenoma the prognosis is very unfavourable. Recovery sometimes takes place in the chronic type of the disease. Early surgical intervention has in some cases been followed by success. The application of X-rays is a valuable method of treatment, superficial glands undergoing a rapid diminution in size. Of drugs arsenic is of the most service, and mercurial inunction has been recommended by Dreschfeld. Organic extracts have of late been used in the treatment of lymphadenoma.

Glandular Fever is an acute infectious fever, generally occurring in epidemics, and was first described by E. Pfeiffer in 1889. It usually affects children and has a tendency to run through all the children of a family. The incubation period is said to be about 7 days. The onset is sudden, with pain in the neck and limbs, headache, vomiting, difficulty in swallowing and high temperature. On the second day, or sometimes on the first, swelling of the cervical glands is noticed, and later the posterior cervical, axillary and inguinal glands become enlarged and tender. In about half the cases the spleen and liver are enlarged and there is abdominal tenderness. West found the mesenteric nodes enlarged in 37 cases. Nephritis is an occasional complication, and constipation is very usual. The disease tends to subside of itself, and the fever usually disappears after a few days; the glandular swellings may, however, persist from one to three weeks. Considerable anaemia has been noticed to follow the illness. Rest in bed while the glands are enlarged, and cod-liver oil and iron to meet the anaemia, are the usual treatment.

Status lymphaticus (lymphatism) is a condition found in children and some adults, characterized by an enlargement of the lymphoid tissues throughout the body and more particularly by enlargement of the thymus gland. There is a special lowering of the patient’s powers of resistance, and it has been said to account for a number of cases of sudden death. In all cases of status lymphaticus the thymus has been found enlarged. At birth the gland (according to Bovaird and Nicoll) weighs about 6 grammes, and does not increase after birth. In lymphatism it may weigh from 10 to 50 grammes. The clinical features are indefinite, and the condition frequently passes unrecognized during life. In most cases there is no hint of danger until the fatal syncope sets in, which may be after any slight exertion or shock, the patient becoming suddenly faint, gasping and cyanosed, and the heart stopping altogether before the respirations have ceased. The most trifling causes have brought on fatal issues, such as a wet pack (Escherich) or a hypodermic injection, or even a sudden plunge into water though the head is not immersed. The greater number of deaths occur during the administration of anaesthetics, which seem peculiarly dangerous to these subjects. When an attack of syncope takes place no treatment is of any avail.

Virchow, West and Goodhardt have described a form of asthma in adults which they ascribe to a hypertrophied thymus gland and term “thymic asthma.”

Diseases of the Spleen.—Physiological variations and abnormalities and absence of the spleen are so rare as to require no comment. The most usual pathological condition which gives rise to symptoms is that of wandering spleen, which may or may not be secondary to a wandering left kidney. It may produce symptoms of dragging and discomfort, dyspepsia, vomiting and abdominal pain, and sometimes jaundice (Treves), or the pedicle may become twisted, producing extremely severe symptoms. The treatment is entirely surgical. Abscess in the spleen occasionally occurs, usually in association with infective endocarditis or with general pyaemia. The spleen may be the seat of primary new growths, but these are rare, and only in a small portion of cases does it share in the metastatic reproduction of carcinoma. Infection of the spleen plays a prominent part in many diseases, such as malaria, typhoid fever, lymphadenoma and leucaemia.

Diseases of the thyroid gland (see ) and Addison’s disease (of the suprarenal glands) are treated separately.

LYNCH, PATRICIO (1825–1886) Chilean naval officer, was born in Valparaiso on the 18th of December 1825, his father being a wealthy Irish merchant resident in Chile, and his mother, Carmen Solo de Saldiva, a descendant of one of the best-known families in the country. Entering the navy in 1837, he took part in the operations which led to the fall of the dictator, Santa Cruz. Next, he sought a wider field, and saw active service in the China War on board the British frigate “Calliope.” He was mentioned in despatches for bravery, and received the grade of midshipman in the British service. Returning to Chile in 1847 he became lieutenant, and seven years later he received the command of a frigate, but was deprived of his command for refusing to receive on board his ship political suspects under arrest. The Spanish War saw him again employed, and he was successively maritime prefect of Valparaiso, colonel of National Guards, and, finally, captain and minister of marine in 1872. In the Chile-Peruvian War a brilliant and destructive naval raid, led by him, was