MACROCHEILIA.
While this condition is usually regarded as an expression of lymphangiectasis, it has been shown that it may be due to multiple adenopathy of the mucous glands in the lips. The lips are well supplied with such glands, which lie beneath mucous membrane in a mixture of more or less connective and vascular tissue. When the lips undergo marked hypertrophy in adult life, it is very likely that the affection may be explained by the hypertrophy of these collective glands, and this is particularly true when anything like nodular arrangement can be detected. A recognition of this cause will indicate the proper remedy, i. e., excision of the affected tissue. The writer has on more than one occasion made an elliptical incision both from the lower and upper lip and accomplished its purpose, with great improvement of appearance.
LYMPHANGIOMA.
Lymphangioma has been described in the chapter on Tumors. It seems necessary to allude to but one expression of this kind in this place, i. e., the so-called lymphangioma circumscriptum. This presents as a cutaneous area dotted with vesicles, sometimes regularly, sometimes irregularly distributed, usually in annular form, seen most commonly on the upper limbs and in the region of the shoulders. The vesicles occasionally become sufficiently large to be called bullæ, while the contained bloodvessels are dilated and discolor the area involved, which may also be more or less pigmented. Here, as in elephantiasis, there is great liability to surface infection of low grade, which may perhaps be called erysipeloid. The tissues gradually become thickened and covered with scabs or warty collections of epithelium. It is met with early in life, rather than late, and is supposed to be of congenital origin. It may be distinguished from herpes by the pronounced vascular changes and by the discharge of lymph.
Treatment.
—Treatment has been too often unsatisfactory and the trouble often re-appears after apparent recovery. If the area involved be not too large complete excision will probably prove the most satisfactory method of attack.
LYMPHANGITIS.
This term applies rather to gross and visible lesions of the larger lymphatics than to the involvement of the ultimate lymph-filled ramifications. When the smaller lymph capillaries and interspaces are involved the lesion takes the type of an erysipelas or cellulitis, but as the collected products return through the lymph channels from such an involved area they will disturb and infect the lymph vessels themselves, and this leads to what is called a lymphangitis. Formerly the term spontaneous or idiopathic was given to some of these cases. Assuming, as is done throughout this work, that there is no true inflammation that is not of microbic origin, we may expunge the term “idiopathic” and say that lymphangitis is also an expression of infection, and that the inflamed vessel represents a channel through which products of inflammation are being conveyed. Histologically the walls of these vessels become infiltrated with a coagulating exudate, which may completely occlude the vessel. The bloodvessels immediately adjoining the lymphatics also become involved, and, being engorged, give rise to the peculiar red lines or streaks which are frequently seen when cutaneous lymphatics are thus involved, this appearance being due to a perilymphangitis. The infected lymph passing through this channel is filtered out in the first lymph nodes with which it communicates, which themselves become thus infected; hence the rapidity with which these enlarge and break down, so that by their own sacrifice they may perhaps protect the rest of the body from serious infection. Under these circumstances suppuration and necrosis of these lymph nodes is to be regarded as a vicarious destruction on their own part.
Lymphangitis proceeds from the periphery toward the centre, and is followed by a certain amount of pain, with great soreness and sense of stiffness in the parts; the skin overlying the infected vessels becomes reddened in streaks, which indicate their course, or becomes more or less infiltrated and involved throughout in a form of infectious dermatitis. According to the virulence of the germ, and the susceptibility of the individual and his tissues, there will or will not occur suppuration. This may perhaps be averted by prompt treatment. Should deep tenderness and pain take the place of or be added to their more superficial expressions it may be inferred that the superficial lymphatics have now infected the deeper ones, and that there is greater danger of phlebitis and a generalized septic infection.
Constitutionally, at least, the expressions are those of septic intoxication, often of true septicemia or septic infection. Local appearances, increasing temperature, or accession of chills may indicate the presence of pus.