and absorption by means of gradual softening of the cheesy masses is
perhaps a reasonable hypothesis. But even if either of these processes
was an occasional termination of the disease, it could only lessen its
gravity and prolong life, with an incomplete recovery, in those few
cases in which the tuberculous or scrofulous changes were confined to a
less number of glands than was necessary to maintain the nutrition of
the body. For while there is no serious obstacle to the flow of chyle
through the glands in the condition of simple hyperplasia, it is
completely obstructed in those transformed into cheesy masses or
purulent collections. The channels through the glands must sooner or
later be obliterated by the presence of the abundant cell-proliferation
which characterizes the initial stage of change in this disease. For if
the compression is sufficient to cut off the supply of blood, it must
prove equally destructive to the complex system of lymph-paths. To the
impermeability of the glands must the emaciation and exhaustion which
mark the course of the disease, to a greater or less degree according
to the number of glands involved, be due.
If the investigations of Schüppel should be verified, and the primary
tubercle-formations be accepted as the initial stage of change, the
prognosis will be less favorable, but a distinct line of demarcation
may be established between two classes of cases in each of which cheesy
transformation may occur, but in one the tubercle-formations may be
primary, and in the other secondary. In the latter class the prognosis
may be more favorable, because treatment may be effective if commenced
prior to the beginning of the retrogressive metamorphosis.
COURSE, DURATION, AND COMPLICATIONS.--When tabes is a complication of
pulmonary or bronchial phthisis, or when either of the latter {1193}
diseases appears as an intercurrent affection during the course of a
primary localized tuberculosis of these glands, the glandular
degeneration runs a more rapid course. When it appears as an extension
of external scrofulous affections or finds its cause in
gastro-intestinal irritation, its course is usually less rapid. The
number of glands involved greatly influences its duration. The
mechanical impediment to nutrition offered by a large number of
impermeable glands promotes rapid emaciation and exhaustion. The
condition of the mucous coat of the alimentary tract offers many
considerations that affect its course and duration. Follicular
enteritis hastens, and tuberculous ulceration of the mucous membrane
speedily brings, the case to a fatal termination.
Some of the older authors refer to the frequent complication of rickets
with tabes mesenterica, and the writer in numerous post-mortem
examinations of the bodies of children dying of rickets has invariably
found cheesy mesenteric glands. In view of the fact that rickets is
constantly associated with disturbance of the alimentary tract, it
should not be a surprise to find the glands in such close contiguity
to, and having vascular communication with, the diseased mucous surface
in a condition of hyperplasia. Simple hypertrophy is probably a common
complication in cases which terminate by recovery, but there must be
some element of cause, other than inflammation of the mucous membrane
of the intestines, that determines the retrogressive metamorphosis.
Several of the older authors have classed rickets in the category of
strumous diseases, and it may be that in the fatal cases tuberculosis
of the mesenteric glands is a local expression of this diathesis.
TREATMENT.--The treatment consists, for the most part, in methods of
prevention and palliation. The tendency to disease of the lymphatic
glands in scrofulous children is so constant that it is important to
remove all sources of irritation and to combat all influences likely to
hasten or promote the localization of the constitutional condition. All
chronic discharges and diseases of the skin and mucous membrane, the
continuance of which might produce glandular complications, should be
cured as speedily as possible, slight colds should receive prompt
attention, and catarrhal inflammations of the respiratory organs should
be arrested as quickly as the resources of science will permit. The
alimentary tract demands constant and careful observation. Trivial
disorders should not be neglected: the causes should be ascertained and
removed. Digestion and nutrition should be maintained at a healthy
standard. The hygiene of person, dwelling, and sleeping apartments
merits constant and intelligent supervision.
As stated above, tabes of the mesenteric glands is so frequently
secondary to other diseases of a scrofulous nature that the danger lies
in the failure to arrest or cure such affections. It is unfortunately
too true that some of them are often beyond the resources of medical
skill, but in many cases the initial manifestations of the strumous
diathesis are either entirely neglected or inappropriately treated. In
many such cases the final and fatal complication of mesenteric phthisis
could be prevented. The treatment of these affections belongs properly
to the subjects of tuberculosis and scrofula, to be found in other
parts of this System of Medicine.
Localized tuberculosis of the mesenteric glands is so often, either
{1194} directly or indirectly, connected with catarrhal inflammations
of the gastro-intestinal mucous membrane that the cure of these
affections cannot be too strongly insisted upon as an effective method
of prevention. This is especially true with children exhibiting the
physical signs of the strumous diathesis. When it is inherited from a
diseased mother, it may be necessary to resort to artificial feeding
before the proper time for weaning has been reached. In such cases no
uniform rule can be arbitrarily followed. The condition of both mother
and child must be considered, and cases will occur which will demand
the exercise of the most cautious discretion and diligent observation.
When the disease has become established but little can be accomplished.
In such cases the treatment refers to the palliation of symptoms and
the maintenance of nutrition. Pain, when present, must be relieved--if
necessary by anodynes, either given internally or applied in the form
of cataplasms. Most often it is due to the coexisting disease of the
intestinal mucous membrane or to the ingestion of unsuitable foods. The
diet should be regulated and limited to nutritious and easily-digested
articles. Sometimes, even in cases of advanced degeneration of the
glands, great benefit may be temporarily obtained by attention to the
diet. Diarrhoea should be controlled, but when dependent upon
tuberculous ulcerations of the intestinal mucous membrane but little
can be done toward delaying the fatal termination. When a large number
of glands are affected, it will be necessary to limit the diet to such
nutrient fluids as may be absorbed from the stomach.
The medical treatment is confined to a few remedies. Faulty nutrition
is the predominant factor, and the drugs employed should be directed to
the improvement of the assimilative functions. The lacto-phosphate of
iron in the form of syrup, or the phosphates in the form of the
compound syrup, sometimes prove valuable tonics. The lacto-phosphate
may be given in combination with cod-liver oil. This latter, either
internally or by inunction, is the most valuable and universally
applicable of all remedies. The mistake is very frequently made of
giving too large quantities. Few children can digest as much as a
drachm administered three times a day. In Washington it is usually
given in the form of the phosphatic emulsion, and has proved in the
service of the Children's Hospital a valuable and effective remedy in
the nutritional disorders of children. Of the chalybeates, the syrup of
the iodide of iron is by far the most valuable; this may be given alone
or in combination with cod-liver oil. It is specially indicated when
anæmia is a marked characteristic. Some recent reports favor the
employment of pancreatized foods. The ointment of the iodide of lead
has been highly extolled as a local application to the belly. The
nature of the disease should be constantly borne in mind, and all
depressing agencies should be sedulously avoided.
{1195}
INDEX TO VOLUME II.
A.
Abdomen, enlargement of, in rachitis, 153
state of, in ascites, 1176
in cancerous peritonitis, 1169
in cirrhosis of liver, 994
in cholera morbus, 722
in chronic peritonitis, 1162
in dysentery, 796, 804
in enteralgia, 661
in intestinal catarrh, 679, 706, 707
in tabes mesenterica, 1190
in tape-worm, 940
tetanic spasm of, in dilatation of stomach, 595
tenderness of, in tubercular peritonitis, 1165, 1166
Abdominal bandage, use of, in dilatation of stomach, 609
belt, use of, in constipation, 654
distension, in acute peritonitis, 1141
glands, disease of, 1182
swelling, in intestinal indigestion, 627
tenderness, in intussusception, 848
veins, abnormal anastomoses of, in thrombosis and embolism of portal
vein, 1096
prominence of, in ascites, 1177
Abortions, frequent, significance, in diagnosis of hereditary
syphilis, 310
Abortive treatment of acute gout, 134
Abscess in acute pancreatitis, 1118
in local peritonitis, 1159, 1160
of joints in gout, 116
of liver, 1002
discharge of, into neighboring organs, 1007
influence on causation of acute peritonitis, 1138
in dysentery, 801
of rectum, a cause of fistula in ano, 897
of tonsils, 383
peri-anal and peri-rectal, 703, 895
Abscesses, number, in suppurative hepatitis, 1006
peritoneal, in perforation of simple ulcer of stomach, 499
seat of, in acute peritonitis, 1136
in typhlitis and perityphlitis, 817
Acanthocephali, the, 949
Acaris autumnalis of anus, 892
Acetate of lead, use of, in hemorrhage from bowels, 834
in purpura, 193
in simple ulcer of stomach, 526
Acetonæmia in diabetes mellitus, 205, 206
Acetone and alcohol in diabetic urine, 209
Acid, lactic, theory of origin of acute rheumatism, 23
nitrate of mercury, use of, in anal fissure and ulcer of rectum, 912
in cancrum oris, 343
salicylic, use of, in acute rheumatism, 51-59
uric, theory of origin of gout from, 112, 113
Acini of pancreas, anatomy, 1113
Acne complicating gout, 121
Aconite, use of, in acute intestinal catarrh, 689
in acute pharyngitis, 397, 398
in acute rheumatism, 64
in parenchymatous glossitis, 364
in tonsillitis, 388
Actual cautery, use of, in cancrum oris, 343
Acupuncture in hydatids of liver, 1109
Acute yellow atrophy of liver, 1023
Addison's disease, influence on causation of chronic intestinal
catarrh, 700
Adenomata of stomach, 578
Adhesions, formation of, in abscess of liver, 1007
in gastric cancers, 566
peritoneal, in chronic intestinal catarrh, 703
Age, influence of, on causation of abscess of liver, 1003
of acute yellow atrophy of liver, 1024
of amyloid liver, 1041
of ascites, 1176
of biliary calculi, 1063
of cancrum oris, 339
of carcinoma of liver, 1034
of catarrhal stomatitis, 322
of cholera morbus, 720
of cirrhosis of liver, 990
of cirrhosis of stomach, 612
of constipation, 639
of diabetes mellitus, 203
of dilatation of stomach, 592
of functional dyspepsia, 438, 439
of entero-colitis, 732
of fatty liver, 1047
of fistula in ano, 897
of gastric cancer, 534
of gout, 110
of intestinal cancer, 869
of acute intestinal catarrh, 670
of chronic intestinal catarrh, 699
of intestinal indigestion, 623
of intestinal obstruction, 847
of macroglossia, 350
of muscular rheumatism, 74, 75
of organic stricture of oesophagus, 423
of diseases of pancreas, 1114
of parenchymatous glossitis, 360
of phosphorus-poisoning, 1030
of prolapse of rectum, 881
of pseudo-membranous enteritis, 764
of rachitis, 141
of rheumatism, 20
of rheumatoid arthritis, 141
of scrofula, 233
of scurvy, 169
of simple ulcer of stomach, 483
of spasmodic stricture of oesophagus, 419
of aphthous stomatitis, 326
of stomatitis ulcerosa, 336
of tabes mesenterica, 1184
of thrush, 332
of tonsillitis, 380
of typhlitis, 815
Agnew's rectal chemise in hemorrhage from rectum, 927
Air, impure, influence on causation of acute intestinal catarrh, 670
of rachitis, 143
of scurvy, 170
of scrofula, 232
vitiated, influence on causation of entero-colitis, 728-730
of tabes mesenterica, 1185, 1186
Albumen in urine of jaundice, 978
Albuminoid degeneration of pancreas, 1128
Albuminuria complicating gout, 123
in diabetes mellitus, 208
in intestinal indigestion, 628
in gastric cancer, 551
influence of, on causation of acute peritonitis, 1138
Alcohol, abuse of, influence on causation of enteralgia, 660
of gout, 111
of gastric cirrhosis, 612
of acute chronic gastritis, 470
of intestinal indigestion, 625
of chronic oesophagitis, 416
of diseases of pancreas, 1114, 1121
of simple gastric ulcer, 488
influence on causation of abscess of liver, 1005
of biliousness, 966
of cirrhosis of liver, 991
of lithæmia, 969
of acute oesophagitis, 410
of organic stricture of oesophagus, 423
of chronic pharyngitis, 402
of acute and chronic intestinal catarrh, 671, 672, 700
use of, in acute yellow atrophy of liver, 1030
in cholera morbus, 725
in cholera infantum, 761
in dysentery, 810
in functional dyspepsia, 439
in entero-colitis, 761
in hemorrhage from bowels, 834
in intestinal ulcerations, 829
in acute pancreatitis, 1120
in acute pharyngitis, 398
in acute rheumatism, 69
Alcoholism, influence on causation of fatty liver, 1047
Alimentation, hypodermatic, in simple ulcer of stomach, 525
rectal, 928
in organic stricture of oesophagus, 425
Alkalies, use of, in amyloid liver, 1045
in diabetes mellitus, 229
in functional dyspepsia, 458
in enteralgia, 666
in fatty liver, 1050
in gout, 132
in intestinal disorders of rachitis, 161
in acute intestinal catarrh, 693
in lithæmia, 972
in muscular rheumatism, 77
in acute oesophagitis, 416
in acute rheumatism, 60
in scrofula, 252
in simple ulcer of stomach, 527
and salicylates, combined use of, in acute rheumatism, 61
Alkaline carbonates, use of, in chronic gastritis, 477
Almond food, use of, in rickets, 223
Aloes, use of, in constipation, 655
in functional dyspepsia, 458
in hemorrhoids, 923
Alopecia, circumscribed, in rachitis, 156
Alum, use of, in constipation, 656
in enteralgia, 665
in hemorrhage from bowels, 834
in acute intestinal catarrh, 696
Alvine discharges of cholera morbus, 722
Amenorrhoea, in simple ulcer of stomach, 495
Ammonia, use of, in suppurative pylephlebitis, 1101
Ammonium chloride, use of, in chronic pharyngitis, 406
Amphistomum hominis, 949
Amyloid degeneration, gastric, influence on causation of dilatation of
stomach, 590
Amyloid degeneration of mucous membrane in chronic intestinal catarrh,
705
Amyloid liver, 1040
Anæmia in chronic articular rheumatism, 71
in chronic intestinal catarrh, 709
in gastric cancer, 552
in intestinal indigestion, 629
in tabes mesenterica, 1189
influence of, on causation of chronic gastritis, 471
of functional dyspepsia, 439
of gastralgia, 460
of gastric hemorrhage, 582
of intestinal indigestion, 623
of simple ulcer of stomach, 487
pernicious, influence of, on causation of hemorrhage from bowels,
832
Anæmic murmurs in acute rheumatism, 36
Anasarca, in cirrhosis of liver, 995
Anastomoses of veins, abnormal, in cirrhosis of liver, 996
of abdominal veins, abnormal, in embolism and thrombosis of portal
vein, 1096
Anatomy of pancreas, 1112
of rectum and anus, 879
Anatomical peculiarities of scrofulous tissue, 238
Anchylostomum duodenale, 955
Aneurism of gastric vessels in simple ulcer of stomach, 511
Aneurisms, miliary, of stomach, 579
Angina, 390
Angiocholitis from biliary concretions, 1077
Ankylosis following gonorrhoeal rheumatism, 106
from chronic articular rheumatism, 71
in general rheumatoid arthritis, 81
Annular form of dilatation of oesophagus, 431, 432
of gastric cancer, 562
Anomalies in form and position of stomach, 617
Anodyne applications in rheumatoid arthritis, 100
Antimony-poisoning, as a cause of cirrhosis of the liver, 991
influence of, on causation of fatty liver, 1047
Antiphlogistic treatment of acute gout, 133
Antiseptics, use of, in stomatitis ulcerosa, 338
Antispasmodics, use of, in enteralgia, 665
Anal fissure as a cause of hemorrhage from bowels, 830
fistula, 897
openings, abnormal, 880
Anus, abscess of, 880
imperforate, 877
and rectum, cancer of, 902
fissure of, 888
scrofulous and tuberculous affections of, 901
spasm of, 909
syphilis of, 900
ulceration of, 893
Aorta, aneurismal dilatation from pressure in pancreatic diseases,
1116
Aperient, mineral waters, use of, in functional dyspepsia, 458
Appendix vermiformis, lesions of, in entero-colitis, 738
Appetite, capricious, in cirrhosis of liver, 993
in tabes mesenterica, 1189
impaired, in carcinoma of liver, 1038
in catarrh of bile-ducts, 1053
in catarrhal stomatitis, 323
in cholera infantum, 742
in cirrhosis of stomach, 613
in constipation, 646, 647, 853
in dilatation of stomach, 543
in dysentery, 796, 804
in chronic gastritis, 473
in gastric cancer, 538
in chronic intestinal catarrh, 707
in intestinal ulcer, 826
in simple ulcer of stomach, 494
in stomatitis ulcerosa, 339
in typhlitis and perityphlitis, 818, 819
state of, in diabetes mellitus, 204
in acute rheumatism, 27
in muscular rheumatism, 76
in rheumatoid arthritis, 83
in scurvy, 177
Aphthous stomatitis, 325
ulcerations in morbid dentition, 373
Armies, prevalence of dysentery among, 785, 786
Arseniate of sodium, use of, in jaundice, 982
Arsenic, effect of, on rectum, 910
use of, in amyloid liver, 1046
in catarrh of bile-ducts, 1057
in constipation, 654
in diabetes mellitus, 227
in dilatation of stomach, 609
in enteralgia, 665
in functional dyspepsia, 457
in gastralgia, 462
in hepatic glycosuria, 975
in chronic intestinal catarrh, 715
in lithæmia, 973
in organic stricture of oesophagus, 425
in pseudo-membranous enteritis, 775
in chronic articular rheumatism, 74
in rheumatoid arthritis, 98
Arsenic-poisoning as a cause of cirrhosis of liver, 991
influence of, on causation of fatty liver, 1067
Arteries, increased width of, in rachitis, 139
Arthritis deformans, 84
gonorrhoeal, 102
rheumatoid, 78
Articular symptoms of chronic gout, 121
Articulations, lesions of, in acute rheumatism, 46
condition of, in scurvy, 179
Artificial feeding, influence of, on causation of entero-colitis, 731
production of gastric ulcer, 514
Ascaris lumbricoides, 952
mystax, 954
vermicularis, 950
Ascites, 1173
in cancerous peritonitis, 1169
in carcinoma of liver, 1037
in carcinoma of pancreas, 1126
in cirrhosis of liver, 995
in cirrhosis of liver, treatment, 1001
in echinococcus of liver, 1104
in Filaria sanguinis, 964
in gastric cancer, 553
in hyperæmia of liver, 987
in local peritonitis, 1161
frequency in amyloid liver, 1044
sudden development of, in thrombosis and embolism of portal vein,
1096
Aspirator, use of, in abscess of liver, 1022
in hydatids of liver, 1107
Astringents, use of, in mercurial stomatitis, 348
in stomatitis ulcerosa, 338
Atmospheric changes, influence of, on causation of tonsillitis, 380
Atonic dyspepsia, 436
Atrophy, acute yellow, of liver, 1023
of abdominal viscera in dilatation of stomach, 600
of gastric walls in dilatation of stomach, 599
of hepatic cells in cirrhosis, 992, 993
of intestinal walls in chronic intestinal catarrh, 704
of kidneys in cirrhosis of liver, 999
of liver in hydatids of, 1102
of liver from occlusion of biliary passages, 1088
of nerve, as a cause of paralysis of oesophagus, 429
of oesophagus in organic stricture, 424
of stomach, 566, 616
of testes in diabetes mellitus, 202
of tongue in chronic parenchymatous glossitis, 367
Auscultatory percussion in ascites, 1174
B.
Bacteria and micrococci in deposits of tonsillitis, 384
influence of, on causation of acute intestinal catarrh, 673
significance of, in cholera infantum, 744
Bandage, use of, in perihepatitis, 990
Bands and loops, formation of, in acute peritonitis, 1153
Bathing in biliary calculus state, 1079
in treatment of constipation, 651, 653
necessity of, in lithæmia, 971
value of, in scrofula, 250
Baths, use of, in diabetes mellitus, 225
in chronic intestinal catarrh, 714, 716
in intestinal indigestion, 632
in gout, 130
in gonorrhoeal rheumatism, 107
cold, use of, in acute gastritis, 470
hot, use of, in hepatic colic, 1082
in muscular rheumatism, 77
in rachitis, 163
in rheumatoid arthritis, 99
hot sand, use of, in local treatment of rheumatoid arthritis, 101
local vapor, use of, in rheumatoid arthritis, 100
mineral, use of, in rheumatoid arthritis, 99
mud, in rheumatoid arthritis, 100
warm and cold, use of, in acute intestinal catarrh, 692
salt, in rachitis, 163
Beading of ribs in rachitis, 152
Beef-essences, use of, in intestinal indigestion, 633
Beef-tea, use of, in entero-colitis and cholera infantum, 754
in rachitis, 161
Beef tape-worm, 933
Belladonna, use of, in cancerous peritonitis, 1122
in constipation, 458, 654
in enteralgia, 665
in spasmodic stricture of oesophagus, 421
Benzoate of sodium, use of, in intestinal indigestion, 636
Benzoic acid, use of, in acute rheumatism, 62
Bifid tongue, 349
Bile, action of, in digestion, 621
composition of, 1062
in pus of hepatic abscesses, 1007
in urine, tests for, 978
Bile-ducts, catarrh of, 1051
Biliary calculi, 1058
seat, 1066
origin and development, 1061-1063
number, shape, and composition, 1059-1061
impaction of, 1074
treatment of, 1079
fistulæ, 1068, 1074
form of intestinal indigestion, diagnosis, 631
passages, affections of. See _Liver, Diseases of_.
occlusion of, 1082
Biliousness, 965
Bill of fare for diabetics, 221
Bilharzia hæmatobia, 948
Bismuth subnitrate, use of, in entero-colitis and cholera infantum,
759
in acute yellow atrophy of liver, 1030
in cancer of stomach, 576
in cholera morbus, 725
in functional dyspepsia, 457
in gastralgia, 463
in chronic gastritis, 478
in acute intestinal catarrh, 693
in vomiting of abscess of liver, 1021
in simple ulcer of stomach, 523
Bitartrate of potassium, use of, in ascites, 1179
Bitter waters, use of, in intestinal indigestion, 636
Black pepper, use of, in hemorrhoids, 923
in proctitis, 919
in intestinal ulcer, 827
stools in cancer of stomach, 550
tongue. See _Glossitis parasitica_.
Bladder and kidneys, influence of, on causation of gastralgia, 460
Bleeding, use of, in intestinal obstruction, 864
Blindness in scurvy, 181
Blisters, use of, in acute rheumatism, 63, 68
in cirrhosis of liver, 1002
in rheumatoid arthritis, 100, 101
Blood, alterations of, in diabetes mellitus, 206
coagulable state of, as a cause of thrombosis and embolism of portal
vein, 1095
lesions, in acute yellow atrophy of liver, 1029
in cholera morbus, 721
in gout, 115
in acute rheumatism, 31
in scurvy, 173
extravasation of, into skin in scurvy, 178
presence of fat in, in diabetes mellitus, 206, 207
watery condition of, in cirrhosis of liver, 995
Bloodletting, use of, in acute intestinal catarrh, 690
in acute peritonitis, 1145
Blood-vessels, disease of, as a cause of hemorrhage from bowels, 832
lesions of, in diabetes mellitus, 200
in gout, 117
in acute peritonitis, 1133
Bloody stools in chronic intestinal catarrh, 708
Boiled-sago matter in stools of dysentery, 803
Boils, complicating diabetes mellitus, 205
and carbuncles in jaundice, 980
Bones, disease of, in hereditary syphilis, 286
lesions of, in rheumatoid arthritis, 87
in scurvy, 172, 179
of extremities, curvature of, in rachitis, 155
of face, alterations of, in rachitis, 150
rachitic, composition of, 138
Borborygmi in chronic intestinal catarrh, 706
in intestinal indigestion, 627
Bothriocephalus cordatus, 939
cristatus, 939
latus, 938
Bougies, use of, in cancer of rectum, 914
in non-malignant rectal stricture, 917
in organic stricture of oesophagus, 425
in spasmodic stricture of oesophagus, 422
in sphincterismus, 916
Bowels, compression and contraction of, as a cause of intestinal
obstruction, 857
hemorrhage from, 830
increased weight of, as a cause of acute intestinal strangulation,
841
irregular, in cancer of intestines, 869
in pseudo-membranous enteritis, 765
in suppurative pylephlebitis, 1100
state of, in biliousness, 966
in catarrh of bile-ducts, 1054, 1055
in cirrhosis of liver, 993
in enteralgia, 661
in lithæmia, 970
in chronic intestinal catarrh, 706
Brain, condition of, in dysentery, 804
disease, organic, distinguished from lithæmia, 917
lesions of, in acute yellow atrophy of liver, 1026
in entero-colitis, 740
in acute intestinal catarrh, 677
in chronic intestinal catarrh, 706
in scurvy, 172
and membranes, lesions of, in acute rheumatism, 39
and meninges, condition of, in rachitis, 148, 149
and spinal cord, organic disease of, influence on causation of
enteralgia, 658
Bran bread, use of, in diabetes mellitus, 223