A. Inflammation

Inflammation of the Lymphatic Glands [Lymphadenitis) especially when it depends on the absorption from within of heterogeneous substances into the lymphatic vessels, is of frequent occurrence in comparison with lymphangioitis. These substances may either be inflammatory products, or different contagious or deleterious matters, originating in inflammation; a distinction on which is based the difference existing between consensual inflammation of the lumbar glands and syphilitic bubo in chancre. Substantive inflammation of a group of lymphatic glands, or of a single gland, is rarely independent of the above-named modes of origin, although some exceptions present themselves in the case of various specific inflammations, more especially when of a typhous character.

The lymphatic glands far exceed the lymphatics in the readiness with which they absorb heterogeneous substances, in consequence, perhaps, of the vascularity of the former, and of the manner in which their whole structure is permeated by the bloodvessels and the lymphatics; and, lastly, in consequence of the transference of matter occurring between these two systems of vessels.

A lymphatic gland presents the following alterations when in a condition of recent acute inflammation.

The gland is injected, and presents various shades of redness; it is swollen, relaxed, soft, and lacerable; its tissue is uniformly permeated by a serous, fibrinous, purulent exudation, or is suffused at individual points with large quantities of the same fluid. The original redness is thus variously altered, and in some cases the gland even appears as if its reddened structure were interspersed with different spots and stripes, in consequence of the absorption at individual centres of a coagulable exudation. Considerable hemorrhage is sometimes observed to occur in the glands during the continuance of the inflammatory process, and, in that case, they are found to present variously sized centres filled with blood in different stages of coagulation and discoloration. The cellular bed of the gland participates in the process when it exhibits any considerable degree of intensity; and the former is then injected, reddened, and infiltrated, that is to say, inflamed, and the gland becomes adherent to it. It is, moreover, not unfrequently ecchymosed by small extravasations of blood.

This inflammation terminates in various modes, very commonly in resolution; even large quantities of solidified exudation may be readily absorbed. It not unfrequently terminates in induration, in which case the copiously deposited exudation becomes converted into a fibroid callus, whilst the glandular substance is either partially or wholly atrophied. Finally, intense inflammations may result in suppuration of the gland - abscess - phthisis of the lymphatic gland.

Chronic Lymphadenitis is in reality a protracted inflammation of moderate intensity, with occasional acute relapses, in which the swelling of the lymphatic gland is commonly not so considerable as might be expected, in consequence of the resorption of the exudation which occurs during the remissions. It terminates in resolution through the suspension of the processes by which it had been maintained, and not unfrequently in induration with atrophy of the glandular parenchyma. The cellular bed in which the gland lies is more or less affected by the induration.

Inflammation of a gland, or of a group of glands, may readily give rise to inflammation of the adjacent glands, by the transmission of the products taken up by resorption; in this case, however, even if there is suppuration of the glands, it is seldom that the blood becomes so affected as to lead to a fatal termination.

As inflammations with a special product we must especially notice inflammation with tuberculous exudation - typhous inflammation. We shall treat of the former in our remarks on adventitious products; and the latter is fully described in our observations on Intestinal Typhus. We must, however, here especially notice the following points:

Typhous inflammation of the lymphatic glands occurs amongst us [at Vienna] as inflammation of the mesenteric glands, associated with the typhous process on the mucous membrane of the ileum, or, strictly speaking/ on its follicular apparatus. It forms an integral part of ileotyphus. It particularly attacks the chain of lymphatic glands which corresponds to the affected part of the intestine, and extends from the lowest portion of the ileum till it implicates the glands of the lumbar plexus. We have here the very important question to decide - Is the inflammation of the mesenteric glands, which occurs in ileo-typhu3, and is characterized by its peculiar product, an affection dependent on and secondary to that of the intestinal follicles, like the inflammation of the lymphatic glands in chancre and in certain diseases of the scalp, or is it an independent and substantive localization of the general process?

The former view would seem to derive confirmation from this circumstance alone, that the typhous disease of the mesenteric glands is, at first, subordinate in intensity to the degree of disease affecting the follicular apparatus, and that the typhous metamorphosis of the mesenteric glands only in exceptional cases precedes that of the typhous structure in the intestine. The latter view of the question is, on the other hand, supported by several circumstances.

a. The typhous matter cannot be traced in the lymphatics during its transference from the intestine to the lymphatic glands, nor from its coagulability does it admit of such a transference in the more intense degrees of typhus; but, notwithstanding this, the mesenteric glands are already infiltrated before the loosening and softening of the typhous placque in the intestine.

b. In anomalous forms of typhus, the mesenteric glands are obviously in a typhous condition (together with the spleen), although indeed in an inconsiderable degree, while the contiguous intestinal mucous membrane is entirely exempt.

c. In many of the more rare cases, the local process extends with excessive intensity to the mesenteric glands, without in any way affecting the mucous membrane of the intestine.

d. In bronchial typhus, the mucous membrane of the bronchi, like that of the intestines, is entirely exempt from the production of the typhous structures; for, while the typhous process is here limited to the stage of congestion and typhous catarrh, it is exhibited, in a very highly developed form, in the bronchial glands.

e. In the Oriental Plague, even the lymphatic glands, which are in no way connected with the mucous membranes (as, for instance, with that of the intestines), are diseased.

We are led to conclude, from the above considerations, that the disease of the mesenteric glands in ileo-typhus is a substantive affection, on the one hand from the near relation exhibited by our own typhus to the lymphatic system - a relation which is so obviously manifested in the highly developed form of plague; and on the other, from the affinity between the true follicular apparatus of the intestines and the lymphatic system.

Next in order to typhous inflammation of the lymphatic glands, we proceed to consider: