Result of lesions of tributary tissues. Arrest in glands of microbes
and other irritants. Trauma of gland. Inflammation. Symptoms,
swelling, stiffness, gland tender, hot, pitting envelope, corded lymph
vessels, abscess, fever. Lesions. Treatment, antiseptics, astringents,
emollients, vesicants, lancing, antiseptics, antiphlogistics,
antithermics. Chronic adenitis. Symptoms, enlarged glands without
engorgement, if simple affects a single gland, if infectious, a group.
Lesions, gland swelling, induration, shrinking, follicular distension,
pigmentation, growth of lymphocytes, caseation, calcification.
Treatment, antiphlogistic, antiseptic, iodine, chloride of calcium,
iodide of potassium.
Apart from traumatic lesions lymphadenitis virtually implies some lesion
of the tissues from which the different vessels of the glands proceed.
The glands however have been referred to as filtering agents on the
course of the lymph vessels and in this partial view of their functions
we find abundant reason why irritants carried in the lymph stream,
should be arrested with pathogenic results in the glands. A particle of
pigment gaining entrance to the lymph vessels tends to be arrested among
the trabeculæ of the gland, and contributes to the pigmentation so
common in old animals. Cells and granules from malignant tumors, and
bacteria from an infection-atrium are arrested in the glands and make
these the great centres of infection-lesions.
_Traumatic_ inflammation comes from bruises, punctures or incisions
directly implicating the glands. There result swelling, tenderness and
the other general signs of inflammation, and in the case of an open
wound possibly lymphorrhagia.
_Acute inflammation_ more commonly supervenes on inflammation in the
area drawn upon by the afferent vessels of the gland. In inflammations
generally the adjacent lymphatic glands become congested. In
lymphangitis it is so in a marked degree. In external parts we can
follow this by careful observations during life, in internal organs we
often find the glandular enlargement after death.
_Symptoms_ consist in swelling and perhaps stiffness in the region of
the gland. Manipulation shows tenderness and heat, the gland being felt
abnormally large, round, or oval, tense, loose from the skin but having
a distinct envelope of soft pitting exudate which tends to increase in a
downward direction. There may or may not be a corded feeling of the
afferent lymphatic trunks. As the pasty swelling increases, it extends
into surrounding parts, binds the gland to the skin and adjacent
structures, and may even conceal the gland in the excess of its
investing engorgement. This is especially frequent in strangles. As the
process advances softening may take place in the centre and extend
toward the circumference, and this may burst like an ordinary abscess.
In some cases the softening is very limited and tardy, and the pus may
be pent up and inspissated, or it may appear to be entirely reabsorbed
while the gland is in process of induration. Fever which may run high
during the process of suppuration, moderates when that has been
accomplished.
In the case of glands too deeply situated to be clearly felt the
occurrence of purulent fluctuation in their vicinity suggests abscess of
the glands, an important induction as the maturation and healing are
usually slow in the gland tissue.
_Lesions._ At the outset the glands are visibly enlarged, softened, and
of a dark red hue, with spots of a brighter red. The changes, mainly in
the medullary layer, consist in a great proliferation of spheroidal
cells in the follicles and also of polyhedral cells in the lymph
sinuses. The endothelial cells are swollen, the blood vessels gorged,
and extravasations of blood into the follicles and sinuses are frequent.
Abscess or fibroid hyperplasia with induration may follow. Much depends
on the particular infection (tuberculosis, glanders, carcinoma, etc.) as
the special product of each disease will be found in the affected gland.
_Treatment_ is in the main as advised for lymphangitis and will vary
with each specific causative disease. Locally antiseptics, astringents,
deobstruents, emollients, and vesicants will be requisite in different
cases. As soon as pus can be distinctly diagnosed it should as a rule be
evacuated, and the cavity treated antiseptically. General treatment may
at first be antiphlogistic and febrifuge, but must usually embrace
tonics and stimulants in the end.
=Chronic Adenitis= may be a sequel of the acute, or it may arise
independently. In the latter case it is usually the result of some other
disease (tuberculosis, glanders, carcinoma, sarcoma melanosis inveterate
disease of the skin, chronic fistula, abscess, or mucous inflammation).
The _symptoms_ are those of enlarged glands with no material surrounding
engorgement. In the infections of tuberculosis and glanders it shows a
tendency to affect the whole group, whereas in simple abscess or in
suppuration of the nasal sinuses it may implicate one gland only, the
remainder appearing normal.
_Lesions._ The gland often becomes indurated and even shrunken, the
connective tissue elements undergoing a steady increase at the expense
of the follicles and lymphoid cells. This is a common condition of
tuberculous glands (perl-knoten, grapes) of cattle, but may result from
the entrance of pigment or other cause of mild irritation. In other
cases pigment entering from without or developed from blood in the
congested gland, finds permanent lodgment in its tissue and may give it
a gray mottled or quite black aspect. In still other cases, there is a
great increase of the round lymphoid and larger polyhedral cells, many
of which degenerate becoming strongly refracting, stain feebly, or not
at all, and pass into a cheesy degeneration. This is a common condition
in tuberculosis and glanders, and the caseous centres beginning as
multiple miliary centres may coalesce to form masses of six or twelve
inches in their greatest diameter as in bovine tuberculosis. In other
cases the caseating mass becomes the seat of calcareous deposit and the
necrotic and caseated gland becomes in part calcified. Other
degenerative changes such as atrophy, amyloid, and hyaline are met with
but have received little attention.
_Treatment_ will be subordinated to the primary cause. If that is a
simple local inflammation or irritation its removal will entail a speedy
improvement in the gland, and, in the absence of too extensive
structural change, a speedy recovery. The infectious cases on the other
hand are likely to prove as inveterate as the disease on which they
depend. In case the enlargement or congestion of the gland persists
after the removal of its primary cause local deobstruents especially the
preparations of iodine are usually effective. Tincture of iodine with
soap, iodide of lead, and mercurial ointment have been severally used
with advantage. Injection of a weak solution of iodine into the gland
will at times succeed. The internal use of chloride of calcium or iodide
of potassium will often hasten recovery.