resolution takes place, as is usual in all forms of simple
lymphangitis, the gland or ganglion will be restored to its normal
condition, though not infrequently some enlargement and firmness will
remain for a considerable time, which favor recurrences from very
trivial causes. It often happens, however, that structural changes
occur. Exudation and suppuration may take place. Suppuration begins in
the centre, and sooner or later the whole gland-structure is converted
into a pus-cavity. Buboes are usually associated with periglandular
abscesses. In fact, the latter are very frequently present when the
glands do not suppurate, but have assumed a condition of chronic or
subacute inflammation, which subsides very slowly and is subject to
recurring acute exacerbations from some continuous or repeated
irritation. Glands may be devastated or rendered wholly or partially
impermeable, thus forming permanent and irremediable obstacles to the
lymph-stream. Inflamed and swollen glands are not necessarily
impermeable, but the flow of the lymph through them is undoubtedly
impeded. The subacute or chronically inflamed glands may become
adherent to and imbedded in a mass of indurated connective tissue, and
may finally undergo calcareous or caseous degeneration.
Lymphangitis sometimes extends by contiguity of tissue to the synovial
membrane of joints, most frequently the knee-joint. So likewise may
synovitis and other joint affections set up a lymphangitis. In either
case the tendency to suppuration is imminent.
DIAGNOSIS.--The diagnosis of the forms of simple lymphangitis is very
easy. The red, wavy, corded, and irregularly-knotted lines following
the course of lymphatic vessels readily distinguish it from phlebitis.
These lines lead to a gland, which soon also becomes tender and
swollen. Oedema soon takes place. An inflamed lymphatic vessel is much
smaller and more tender to the touch than an inflamed vein, and usually
lies between the injured locality and an inflamed gland. Fever is more
constantly present and higher than in phlebitis.
{989} Reticular lymphangitis is usually a circumscribed inflammation,
with more or less oedema, located in the region of a lymphatic network.
It invades the integumental structures. It is not necessary to
distinguish it from an erythema, for the latter can scarcely ever be
present without implication of the lymphatic radicles. Tubular
lymphangitis and lymphangiectasia, which are so frequently associated
conditions and attended with oedema, present objective appearances very
similar to those present in oedema from phlebectasis. Phlebectasis is
excluded by the absence of pain, of dilatation of the superficial vein,
and of changed color, and of a single hard cord along the course of the
varicose vein; by the non-appearance of oedema in the neighborhood of
the ankle and on the dorsum of the foot during the earlier stages of
the disease, and its gradual extension upward. The infiltration in
phlebectasis results from increased transudation in consequence of
increased blood-pressure in the venous radicles, and their dilatation,
or from interrupted venous circulation. The accumulated fluid is
consequently watery, poor in solid constituents, and the resulting
swelling presents all the characteristics of ordinary oedema.
Absorption may be normal or perhaps increased, and with rest of the
limb the intumescence will probably diminish or disappear. In
consequence of the poverty of the transuded fluid the changes in
nutrition are very slow, and the enlargement partakes more of the
nature of an anasarca than of an hypertrophy; and, finally,
phlebectasis is usually connected with some constitutional affection or
distant local disease, and attacks the most distal parts, where the
circulation is least supported by the muscles. Lymphangiectasis is most
often found in circumscribed localities where the networks of
lymph-capillaries are most numerously distributed. The swelling is more
diffused, and is not in the form of single hard cords. It is more
resistant, and the color of the surface is unchanged. It usually
extends downward, and is not so much influenced by continued rest and
posture. The accumulated fluid results from diminished absorption or
interrupted lymph-circulation, and consists of the normal pre-existing
parenchymatous fluids, the nutritive juices continually conveyed
thither, and the fluids consumed by the functions of the parts
saturated with organic débris. It is, however, more abundantly supplied
with organic elements from both progressive and retrogressive
metamorphosis. It also contains more albumen and fibrinous substances
than the accumulated fluid in phlebectasis and ordinary oedema. The
swelling or enlargement is formed of more consistent, coagulable, and
partly organizable material, possesses greater consistence, and is
nearly compact to the touch, which increases as the fluid undergoes the
changes due to its retention in the parts. The development is peculiar,
and not altogether unlike phlegmasia. The pus-formations which
sometimes ensue partake of the nature of cold abscesses, and are
located in the connective tissue. The pus-formations in phlebectasis
usually begin in the venous thrombi within the dilated and enlarged
veins, are associated with acute symptoms, and result, usually, in
purulent absorption.
In view of later anatomical and pathological researches, it must be
admitted that phlegmasia dolens is occasionally a lymphangitis, having
its origin in inflammation of the vessels or areolar tissue. Some
pathologists have advanced the theory that, as seen in lying-in women,
it is a parametritis commencing in the cellular tissue in the immediate
vicinity of the womb and extending to remoter parts. The writer saw
recently, in consultation with J. Taber Johnson, a case of puerperal
pelvic cellulitis associated with a firm, resistant, diffuse, painful,
and tender swelling involving the inner aspect of both thighs, and
extending from the groin on each side downward below the middle third
of the thigh. The pelvic inflammation appeared first in the left iliac
fossa, and was associated with the swelling before described on the
thigh. This subsided, and was immediately followed by a similar
condition {990} in the right iliac fossa, accompanied by a precisely
similar intumescence on the right thigh. At no time could any enlarged,
hard, or corded veins be discovered. The swellings presented the usual
objective and tactile characteristics of those inflammatory affections
so frequently supervening within areas abundantly supplied with lymph
networks, in communication with the original lymphangitis and
lymph-thrombosis. In this case the swellings were located in a region
specially rich in lymph capillary networks. With the subsidence of the
pelvic cellulitis the thigh intumescence on either side gradually
disappeared.
Tubular lymphangitis is readily distinguished from erysipelas by the
presence of the knotted and corded lymphatic vessels. Reticular
lymphangitis is characterized by fine, closely-arranged red lines
limited to a circumscribed area, and is usually associated with and
starts from some injury. In erysipelas the redness is uniform. It does
not follow the course of the lymphatic vessels, nor extend from a wound
in the direction of and to a gland or ganglion of glands. The fever is
usually higher and of longer duration. The inflamed surface is marked
by the appearance of blebs.
PROGNOSIS.--Simple lymphangitis is usually unattended with danger
unless complicated with suppurating arthritis. The disease, as a rule,
runs a rapid course to recovery. It is more favorable the nearer the
inflammation lies to the surface.
TREATMENT.--The treatment is both constitutional and local. The first
indication is to remove the cause. The wound should be cleansed and
disinfected. For this purpose solutions of carbolic or acetic acid may
be employed, or it may be cauterized with caustic potash or chloride of
zinc. The fever should be controlled by the employment of antipyretics.
One or more full doses of the sulphate or hydrochlorate of quinia,
administered at shorter or longer intervals according to the quantity
given at each dose and the intensity of the fever, may be sufficient.
Antipyrin is a very valuable remedy. It will reduce the fever more
speedily and decidedly than the salts of quinia. If the fever is
reduced and kept under control by the judicious administration of this
remedy in moderate doses, the tendency of the inflammation to extend is
very greatly diminished, and may be arrested. Its antipyretic effect
is, however, less durable than that of the salts of quinia, but is
unattended with the cerebral disturbances usually associated with the
employment of quinia salts. The bowels should be kept solvent by the
use of saline cathartics. The diet should be restricted during the
pyrexial stage. After the acute stage has passed, tonics and improved
diet may become necessary; especially will this be the case in those
previously debilitated. In healthy, robust subjects it is not probable,
under proper and prompt treatment, that the disease will continue long
enough to endanger convalescence by serious exhaustion. When needed,
iron, cod-liver oil, and the salts of quinia may be resorted to. But,
after all, a good appetite and a sufficient supply of nutritious and
easily-digested foods constitute the best and most available tonics.
Rest of the affected part is very important, and the posture should be
such as to remove pressure and relieve tension.
In the beginning of the acute stage cold applications may be employed,
but, as a rule, the local treatment should be confined to the assiduous
application of hot soothing and emollient fomentations, to which opium
or belladonna may be added. By these means the tension of the swollen
and inflamed parts, and consequently the pain, are assuaged. It is
rarely necessary to employ internally any anodyne to relieve the pain;
but in occasional cases, occurring in persons keenly susceptible to
pain, an opiate or some less powerful anodyne may be administered. Some
advise the local abstraction of blood by leeching, but it is admissible
only when the pain is very acute and confined to a limited and defined
area. After the subsidence {991} of the fever and acute inflammatory
stage the remaining oedema and indurations may be treated with the
local application of the tincture of iodine, inunction with mercurial
ointment, bandaging, massage, and rest.
For the oedematous condition, which is sometimes very persistent,
pressure is the most available and potential remedy. This should be
secured by systematic bandaging either with a flannel or an elastic
bandage. In such cases passive movement and massage or kneading of the
part constitute an important and valuable auxiliary to pressure.
To allay itching, which is sometimes almost intolerable even after the
acute inflammation has subsided, the part may be painted with a
solution of nitrate of silver or collodion. If these fail, an alcoholic
solution of benzoic acid, twenty grains to the ounce, may be employed.
If suppuration takes place, the abscess should be promptly and
effectually incised. It should be thoroughly evacuated and dressed
antiseptically. When this occurs a more or less tonic and supporting
treatment is necessary. Iron, cod-liver oil, quinia, and stimulants may
be, according to circumstances, administered. The devastating effects
of suppurating cavities should be controlled by the liberal use of the
appropriate remedies to arrest exhaustion and to rebuild waste.
In occasional instances the initial stage, consentaneous with the
receipt of the injury, such as the sting of an insect, is marked by
violent shock and threatening collapse. The writer has witnessed two
such cases occurring in robust, healthy men stung by honey-bees on the
forearm, where great exhaustion and alarming collapse, with violent
retching, profuse diarrhoea, and agonizing pain, were accompanied by
rapidly-developed inflammation and swelling at the locality of the
puncture. In such cases the free administration of alcoholic stimulants
seems imperatively demanded.
The general plan of treatment of acute simple lymphangitis is
antiphlogistic, by the employment of remedies to reduce inflammation
and promote resolution. The danger of suppuration should not be
overlooked or underestimated. A single suppurating focus may widely
diffuse disease and impair the entire organism. A single and apparently
trivial inflammation of lymphatic tissue may be the initial stage of a
fatal pyæmia or septicæmia.
{992}
{993}
INDEX TO VOLUME III.
A.
Abdominal aneurism, 821
viscera, lesions, in catarrhal pneumonia, 358
Abscess, diffuse splenic, 962
embolic, of spleen, 963
of the lung, 296
of the mediastinal space, 861
termination of croupous pneumonia in, 311, 332
Abscesses, seat and nature, in suppurative endocarditis, 604
Accidents during tracheotomy, 156
Acephalocysts, expectoration of, in pulmonary hydatids, 469
Aconite, locally, in chronic laryngitis, 127
use, in exophthalmic goitre, 767
Acupuncture, use, in thoracic aneurism, 820
Acute general diseases, resemblance of croupous pneumonia to, 317
miliary tuberculosis, 472
ADDISON'S DISEASE, 939
Definition, synonyms, and history, 939
Diagnosis, 947
Duration, 941
Etiology, 939
Morbid anatomy, 942
Nervous system, lesions, 944
Spleen, lesions, 943
Suprarenal capsules, lesions, 942, 943
Pathology, 944
Theories regarding origin, 945-947
Symptoms, 940
Anæmia and hemorrhages, 940
Bronzing of skin, seat and characters, 940
Dyspnoea, 941
Gastro-intestinal disorders, 941
Nervous symptoms, 941
Pain, characters and seat, 941
Pulse in, 941
Urine, condition, 941
Treatment, 948
Adductors of vocal cords, paralysis of, 81
Adenitis, in lymphangitis, 988
Adherent pericardium, 785
Adhesions, pericardial, seat and characters, 785
Adults, grave form of catarrhal pneumonia in, 360
Adventitious products of the heart, 637
Ægophony, significance, in pleurisy, 510
Aërial fistula, following tracheotomy, 163
After-treatment of tracheotomy, 159
Agaricus, use, in pulmonary phthisis, 438
Age, influence on aortic obstruction, 655
on causation of acute catarrhal laryngitis, 93
of acute miliary tuberculosis, 478
of angina pectoris, 759
of aortic regurgitation, 655
of asthma, 190
of bronchitis, 157
of cardiac thrombosis, 722
of catarrhal pneumonia, 353
of croupous pneumonia, 314
of exophthalmic goitre, 764
of fatty degeneration of the heart, 613
of fibroid phthisis, 441
of fibro-serous pleurisy, 492
of gangrene of lung, 301
of hæmoptysis, 275
of hay asthma, 212
of Hodgkin's disease, 922
of laryngismus stridulus, 70
of leukæmia, 909
of mediastinal tumors, 871
of mitral regurgitation, 671
of mitral stenosis, 666
of pernicious anæmia, 899
of phthisis, 396
of pneumothorax, 576
of pseudo-membranous laryngitis, 101
of purulent pleurisy, 540
of simple lymphangitis, 986
of thoracic aneurism, 802
Air, compressed, use, in bronchial asthma, 208
moist, use, in acute catarrhal laryngitis, 97
rarefied, exhalation into, in emphysema, 246
Albuminoid expectoration following thoracentesis, 535
Alcohol, abuse, influence on causation of chronic laryngitis, 121
of the caisson disease, 858
influence on causation of fatty cardiac degeneration, 612
use, in acute miliary tuberculosis, 481
in bronchial asthma, 205
in catarrhal pneumonia, 370
in croupous pneumonia, 348, 349, 351
in endocarditis, 651
in gangrene of the lung, 305
in parenchymatous degeneration of the heart-muscle, 611
in pseudo-membranous laryngitis, 108
in pulmonary phthisis, 435
Alcoholism, influence on causation of chronic myocarditis, 607
of pleurisy, 493
of croupous pneumonia, 314
Alkalies, use, in pseudo-membranous laryngitis, 105
in rheumatic pericarditis, 783
in prevention and treatment of pulmonary embolism, 389, 390
Alkaline sprays, use, in chronic laryngitis, 125, 127
Allen's nasal forceps, 54
Altitude, influence on causation of hæmoptysis, 277, 278
Alum, use, in laryngismus stridulus, 73
Ammonium, carbonate, use, in cardiac thrombosis, 745
in croupous pneumonia, 349
in prevention of pulmonary embolism, 389
and chloride of, use, in catarrhal pneumonia, 370, 371
chloride, use, in chronic laryngitis, 124, 125
Amphoric respiration in pulmonary phthisis, 417
Amyl nitrite, use, in angina pectoris, 760
in bronchial asthma, 204
in chronic endarteritis of the coronary artery, 830
in fatty cardiac degeneration, 616
Amyloid degeneration of heart-muscle, 616
of suprarenal bodies, 949
ANÆMIA, 887
Albumen, continuous loss of, influence on causation, 887
Blood, changes in, 890, 891
Bone, spleen, lymph-glands, enlargement of, and relation to
production of blood-corpuscles, 888-894
Hemorrhage, influence on causation, 887
Inanition, influence on causation, 889
Toxic causes of, 889
Anæmia in Addison's disease, 940
in exophthalmic goitre, 763
in pulmonary phthisis, 406
ANÆMIA, PROGRESSIVE PERNICIOUS, 898
Course, 903
Definition and history, 898
Diagnosis, 905
Etiology, 899
Age and sex, influence on causation, 899
Hygiene, bad, influence on causation, 899
Loss of blood, chronic discharges, etc., 900
Mental worry and anxiety, 900
Pregnancy and parturition, 900
Morbid anatomy, 904
Bones, changes in, 905
Lymph-glands, changes in, 905
Spleen, changes in, 905
Pathology, 905
Prognosis, 906
Symptoms, 900
Blood and blood-corpuscles, changes in, 901
Gastro-intestinal disorders, 903
Hæmic heart-murmurs, 902
Hemorrhages in, 901-903
Oedema in, 901
Onset, mode of, 900
Skin, changes and color of, 901
Temperature, 903
Urine, changes in, 903
Treatment, 906
Arsenic, use, 907
Diet in, 907
Iron, use, 907
Milk, injection of, 908
Transfusion of blood, 907
Anæmic necrosis of heart-muscle, 610
Anæsthesia of larynx, 65
Anæsthetics, use, in laryngismus stridulus, 73
Anatomy of tracheal region, 146, 147
ANEURISM, ABDOMINAL, 821
Diagnosis, 822
Symptoms, 821
Treatment, 822
Compression of aorta, good results of, 822
Aneurism, diagnosis of, from mediastinal tumors, 876
ANEURISM, THORACIC, 801
Definition, 801
Diagnosis, 814
From abscess, 814
From tumors, 814
Duration, 815
Etiology, 802
Age and sex, influence on causation, 802, 803
Occupation, influence on causation, 803
Syphilis and gout, influence on causation, 803
Morbid anatomy, 801, 802
Symptoms, 803
Auscultation in, 811
Bone, signs of pressure upon, 807
Bruit, characters, 811
Cyanosis and oedema, 807
Dysphagia in, 806
Dyspnoea in, 805
Frémissement cataire, frequency, 808
Inspection, 807
Localization of tumors, 812
Myosis in, 805
Of varicose form, 813
Oral whiff of Drummond, significance, 812
Pain, characters, 804
Palpation in, 808
Percussion in, 812
Physical signs in, 807
Pressure signs, 804-807
Pulse, peculiarities of, 808-810
Thrill in pulse, 809
Veins, signs of pressure upon, 807
Voice, modifications of, 806
Terminations, 815
Treatment, 816-820
Acupuncture, use, 820
Barwell's operation of ligation, 818, 819
Ergotin, hypodermic use, 816
Electrolysis, method of applying, 819, 820
Opiates, use, 817
Potassium iodide, 818
Pressure, use, 816
Starvation method, 816
Tufnell's method of rest and diet, 816, 817
Wire, introduction of, into sac, 816
Aneurism of the coeliac axis, 841
of the coronary artery, 830
of the heart, 636
of the hepatic artery, 840
of the interior mesenteric artery, 839
of the superior mesenteric artery, 836
of the pulmonary artery, 833
Aneurismal form of hæmoptysis, 284
Angina, in anæmic necrosis of heart-muscle, 610
ANGINA PECTORIS, 755
Death, cause of, 760
Definition, 755
Diagnosis, 757
Etiology, 758
Morbid anatomy, 758
Prognosis, 759
Symptoms, 755-757
Treatment, 760
Amyl nitrite, use, 760
Chalybeates, use, 760
Digitalis and nux vomica, 761
Opium and morphia, use, 760
Preventive, 760
Stimulants, 760
Angina pectoris in aortic regurgitation, 661
Anginoid attacks in chronic myocarditis, 608, 609
Anomalies, congenital, of heart and great vessels, 687
of blood-vessels of tracheal region, 147
of suprarenal bodies, 949
Ante-mortem heart-clots, character, 737
Anthracosis, appearance of lungs in, 458
Antimony, use, in bronchitis, 179, 180
in croupous pneumonia, 347
Antipyrin, use, in acute miliary tuberculosis, 480, 481
in simple lymphangitis, 990
Antiseptics, use, in croupous pneumonia, 352
Antispasmodics, use, in functional heart disease, 754
in laryngeal oedema, 116
in laryngismus stridulus, 73
in spasm of the glottis, 74
Anxiety, in cardiac thrombosis, 731
Aorta, atheroma of, 800
disease of, influence on causation of hypertrophy of the heart, 620
diseases of, 800
occlusion of, 824, 825
perforation of, 824
rupture of, 823
stenosis of, 825
Aortic arch, localization of aneurism of, 812
conus, defects of, in cyanosis, 708
obstruction, 654
regurgitation, 659
stenosis and regurgitation, treatment, 683
trunk, narrowing, in cyanosis, 708
and mitral orifices, defects of, in cardiac malformations, 690
Aortitis, acute, 800
Apex-beat, in dilatation of the heart, 634
in hypertrophy of the heart, 625, 627
normal position of, 654
significance of position of, in diagnosis of functional heart
disease, 750
Apex of lung, tendency to tuberculous deposit in, 408
Aphonia, in paralysis of adductors of vocal cords, 82
in pulmonary phthisis, 403
Apomorphia, use, in catarrhal pneumonia, 371
in acute catarrhal laryngitis, 97, 98
Apoplexy of suprarenal bodies, 949
pulmonary, 293
Appetite, impaired, in pulmonary phthisis, 406
Arch of aorta, localization of aneurisms of, 812
Arsenic, use, in acute miliary tuberculosis, 482
in Addison's disease, 948
in atrophic nasal catarrh, 49
in bronchial asthma, 207
in carcinoma of larynx, 131
in chronic congestion and enlargement of the spleen, 959
in chronic laryngitis, 125
in dilatation of the heart, 636
in Hodgkin's disease, 931
in leukæmia, 921
in pernicious anæmia, 907
in pulmonary phthisis, 436
Arterio-sclerosis of the coronary artery, 828
of the pulmonary artery, 833
Artery, coronary, diseases of, 828
hepatic, aneurism of, 840
pulmonary, diseases of, 833
inferior mesenteric, diseases of, 834
superior mesenteric, diseases of, 836
Arytenoideus, paralysis of, 84
Aspiration in pericardial effusion, 776, 780
of the pleura, dangers of, 596
history, etc., 593-596
Aspirators in thoracentesis, varieties, 530, 532
Asthenic pneumonia, treatment, 351
ASTHMA, BRONCHIAL, 184
Definition, 184
Diagnosis, 198
From dyspnoea of bronchitis and cardiac disease, 198
of laryngeal affections, 199
From embolism of pulmonary artery, 200
From emphysema, 198
From spasm of diaphragm, 199
Duration, 189
Etiology, 190
Age and sex, influence on causation, 190
Cold and damp, influence on causation, 192
Enlarged bronchial glands, 191
Heredity, influence on causation, 190
Pollen of plants, vapors, gases, etc., 192
Uterine, nasal, and stomachic irritation, 193
History, 184
Morbid anatomy, 197
Pathology, 193-197
Prognosis, 200
Sequelæ, 189
Synonyms, 184
Symptoms and course, 185
of intervals, 184
paroxysms, description, frequency, and time of onset, 185-187
heart-circulation, state of, during, 188
physical signs of, 187, 188
Physiognomy of asthmatics, 186, 190
Treatment, 201
Hygienic and dietetic, 206
Locality, change of, 206
Of intervals, 206
Of paroxysms, 201
Use of arsenic, 207
of belladonna and stramonium, 203
of chloroform, 202
of cigarettes, medicated, 203, 207
of compressed air, 208
of electricity, 205
of emetics, 204
of lobelia and tobacco, 204
of morphia and chloral hydrate, 201, 202
of nitrite of amyl, 204
of nitro-glycerin, 208
of potassium bromide, 204
iodide, 207
nitrate, 203
of stimulants, 205
Asthma complicating emphysema, 239
hay, 210
Astringents, use, in chronic laryngitis, 125, 126
in laryngeal oedema, 116
Atelectasis, influence on causation of bronchial dilatation, 228
Atelectasis. See _Lung, Collapse of_.
Atheroma of the aorta, 800
of the coronary artery, 828
of the pulmonary artery, 833
Atmospheric causes of goitre, 977
Atomizer, use, in hyper- and paræsthesia of the larynx, 64
Atresia of the pulmonary artery, 702
Atropia, use, in profuse expectoration of bronchiectasis, 231
in pulmonary phthisis, 438
in the caisson disease, 858
Atrophic form of chronic nasal catarrh, 47
lobar emphysema, 248
Atrophy of suprarenal bodies, 949
of the heart, 618
Auricles of the heart, hypertrophy of, 627
Auriculo-ventricular orifice and tricuspid valve, defects of, 689
rings, condition, in cardiac dilatation, 633