LYMPHADENITIS. INFLAMMATION OF THE LYMPH GLANDS.
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.