Glandular Fever is an acute infectious fever, generally occurring in epidemics, and was first described by E. Pfeiffer in 1889. It usually affects children and has a tendency to run through all the children of a family. The incubation period is said to be about 7 days. The onset is sudden, with pain in the neck and limbs, headache, vomiting, difficulty in swallowing and high temperature. On the second day, or sometimes on the first, swelling of the cervical glands is noticed, and later the posterior cervical, axillary and inguinal glands become enlarged and tender. In about half the cases the spleen and liver are enlarged and there is abdominal tenderness. West found the mesenteric nodes enlarged in 37 cases. Nephritis is an occasional complication, and constipation is very usual. The disease tends to subside of itself, and the fever usually disappears after a few days; the glandular swellings may, however, persist from one to three weeks. Considerable anaemia has been noticed to follow the illness. Rest in bed while the glands are enlarged, and cod-liver oil and iron to meet the anaemia, are the usual treatment.
Status lymphaticus (lymphatism) is a condition found in children and some adults, characterized by an enlargement of the lymphoid tissues throughout the body and more particularly by enlargement of the thymus gland. There is a special lowering of the patient’s powers of resistance, and it has been said to account for a number of cases of sudden death. In all cases of status lymphaticus the thymus has been found enlarged. At birth the gland (according to Bovaird and Nicoll) weighs about 6 grammes, and does not increase after birth. In lymphatism it may weigh from 10 to 50 grammes. The clinical features are indefinite, and the condition frequently passes unrecognized during life. In most cases there is no hint of danger until the fatal syncope sets in, which may be after any slight exertion or shock, the patient becoming suddenly faint, gasping and cyanosed, and the heart stopping altogether before the respirations have ceased. The most trifling causes have brought on fatal issues, such as a wet pack (Escherich) or a hypodermic injection, or even a sudden plunge into water though the head is not immersed. The greater number of deaths occur during the administration of anaesthetics, which seem peculiarly dangerous to these subjects. When an attack of syncope takes place no treatment is of any avail.
Virchow, West and Goodhardt have described a form of asthma in adults which they ascribe to a hypertrophied thymus gland and term “thymic asthma.”
Diseases of the Spleen.—Physiological variations and abnormalities and absence of the spleen are so rare as to require no comment. The most usual pathological condition which gives rise to symptoms is that of wandering spleen, which may or may not be secondary to a wandering left kidney. It may produce symptoms of dragging and discomfort, dyspepsia, vomiting and abdominal pain, and sometimes jaundice (Treves), or the pedicle may become twisted, producing extremely severe symptoms. The treatment is entirely surgical. Abscess in the spleen occasionally occurs, usually in association with infective endocarditis or with general pyaemia. The spleen may be the seat of primary new growths, but these are rare, and only in a small portion of cases does it share in the metastatic reproduction of carcinoma. Infection of the spleen plays a prominent part in many diseases, such as malaria, typhoid fever, lymphadenoma and leucaemia.
Diseases of the thyroid gland (see [Goitre]) and Addison’s disease (of the suprarenal glands) are treated separately.
(H. L. H.)
[1] It has recently been stated that stomata do not exist in the peritoneum.
[2] For further details of the pelvic glands see “Seventh Report of the Committee of Collective Investigation,” Journ. Anat. and Phys. xxxii. 164.
