—Recognition of the status lymphaticus during life is somewhat difficult, nevertheless there are certain suggestive features which should arouse suspicion. Of these the close relation between the status lymphaticus and rickets, already alluded to, furnishes a hint, and, when recognized, a positive warning. Widespread enlargement of the lymph nodes may furnish another. Adenoid growths in the nasopharynx accompanied by enlargement of the spleen should be regarded as a suspicious combination; and when an area of dulness is discovered over the thymus, or when it can be detected by palpation, the diagnosis may be regarded as established. Moreover, children who are subject to this condition usually have a pasty complexion and an anxious facies. Besides showing evidences of rickets they are anemic, with liability to spasm of the glottis. The thyroid is often enlarged. In young adults the condition may simulate cretinism, in that they are retarded in growth and infantile in appearance, while sexual development is incomplete.
Treatment.
—In well-marked instances of status lymphaticus there should be ordinarily no operative intervention; yet when the nose and pharynx are obstructed it is advisable to give free channels for breathing purposes.
Assuming that the result of experimental injection of thymic juice shows it to have a depressing and pressure-lowering effect, an effort should be made to ward off danger by the use of adrenalin, which should be given previous to the commencement of the anesthesia. These are cases where it is best to treat the surfaces to be operated with a spray of mild cocaine solution, in order to deaden liability to those impressions which may produce secondary and reflex cardiac disturbances if conveyed to the brain. When operation is necessary for glottic spasm or laryngismus stridulus it may be commenced with a tracheotomy, with the use of a long trachea tube. When operation is required for the relief of thymic enlargement, a preliminary tracheotomy should be made, with the use of a long tube. The improvement which results after the completion of the surgical treatment, for instance after removing adenoids from the nasopharynx, is gratifying.
The most reliable measures have proved to be adrenalin and artificial respiration, used as described in the chapters on Blood Pressure and Shock and Anesthetics.
CHAPTER XV.
SURGICAL ASPECTS AND SEQUELS OF OTHER INFECTIONS AND DISEASES.
As a result of the conditions which two centuries ago and more so distinctly separated the barber surgeon from the practitioner of medicine, there has been evolved an artificial separation of surgery from so-called internal medicine. The consequence has been a more or less deep-rooted feeling that medical cases were to be treated exclusively by non-operative measures, and that surgical cases could scarcely be expected to present any perplexities that were not to be solved by an operating surgeon. It has been no small part of the benefit resulting from modern teachings that these imaginary boundaries and limitations have been swept away; and one of the lessons which this text-book is intended to inculcate is that broad principles underlie disease conditions, and that their bearings must be appreciated thoroughly in order to practise either medicine or surgery successfully. In order better to inculcate this teaching a chapter with the above general heading has been inserted, in order to impress the statement that any of the so-called internal diseases may present at almost any time indications for distinctly surgical intervention.
Some of the surgical sequels of the exanthematous and continued fevers are well known and commonly recognized: for example, orchitis following mumps, suppurative inflammation of the middle ear after scarlatina, and bed-sores after typhus and typhoid. These are easily recognized. Moreover, scarlatiniform eruptions occasionally follow various operations and give rise to great perplexity.[4]
[4] Medical News, February 20, 1897, p. 234.