ABNORMAL ANATOMY OF THE LYMPHATIC SYSTEM. 



233 



absorbent glands; and, thirdly, will) respect to 

 the nature of the contents of the system 



Inflammation of the absorbent vessels has 

 long been known to practical men. A number of 

 red lines appearing through the skin, and giving 

 to the touch the sensation of round and hard 

 cords immediately underneath the skin, taking 

 the direction and occupying the position of the 

 superficial lymphatics, are seen to proceed from 

 some point of irritation, as a poisoned wound 

 or a syphilitic sore, towards the nearest set of 

 absorbent glands. There are much tenderness 

 and pain on the least pressure in the whole 

 course of these lines, and the glands to which 

 they go are more or less swollen, and the skin 

 over them is of a reddish colour. These lines 

 correspond to the inflamed absorbents, which, 

 at first isolated, soon excite inflammation in 

 the surrounding cellular tissue, and the hard 

 cords above described are lost in the thickened 

 and infiltrated subcutaneous tissue. When an 

 incision is made into such an inflamed surface, 

 the lymphatics, according to Gendrin, are seen 

 upon the margins of the incision as red fibres, 

 having the irregular, knotted appearance which 

 those vessels exhibit when injected with mer- 

 cury and converging towards the inflamed 

 tissue of a gland. 



It may be fairly presumed that the anatomi- 

 cal characters of these vessels in a state of 

 inflammation are the same as those of the 

 inflamed thoracic duct, examples of which 

 have occurred to Gendrin and Andral. The 

 vessels of its coats (vasa vasorum) are much 

 injected, and the coats themselves thickened 

 and rendered friable the inner coat red, soft, 

 and swollen sometimes with lymph poured 

 out upon it, which tends to obstruct and 

 obliterate the canal, giving rise to dilatation 

 below the obstructed point, or with pus effused, 

 which also occasions the vessels to be dilated. 

 Sir A. Cooper found adhesion and ulceration 

 of the valves of the thoracic duct in a body in 

 which he could not succeed in injecting that 

 vessel. 



In the body of a phthisical patient Andral 

 found the lacteal vessels on the surface of the 

 intestine, corresponding to the situation of an 

 ulceration of the mucous membrane, remark- 

 ably white and hard, and so dilated at intervals 

 as to resemble a string of rounded nodules. 

 On examination these nodules were found to 

 be caused by thickening of the coats of the 

 lacteal vessels. 



Irregular dilatations or varicosities of the 

 absorbent vessels, but especially of the thoracic 

 duct, have been very frequently observed. 

 These most frequently arise from some pres- 

 sure impeding the circulation of the fluid in 

 them, as a tumour or aneurism pressing on 

 the thoracic duct in some part of its course. 

 Mr. Cruikshank delineates a thoracic duct, 

 remarkable for its great size. It was found in 

 a man 40 years of age, but the cause of the 

 dilatation was not apparent, as no obstruction 

 existed either at the entrance of the vessel into 

 the veins or in any part of its course. The 

 great trunks of the absorbents accompanying 

 the large arteries in the extremities were en- 



larged also, but the cutaneous absorbents were 

 of their usual size. The case referred to by 

 Dr. Baillie, in which the duct is said to be as 

 large as the vena azygos, is probably the same. 

 The morbid changes of the absorbent glands 

 are much more familiar to us than those of the 

 lymphatics themselves, as being more appreci- 

 able if not of more frequent occurrence. In- 

 flammatory states of these bodies are very often 

 met with, either in conjunction with inflamed 

 lymphatic vessels or alone. In inflammation 

 the absorbent glands become enlarged, very 

 vascular, and painful to the touch, and the 

 surrounding cellular tissue participates in the 

 inflammation, so that if several glands be 

 inflamed a tumour of some size and hardness 

 will be formed. The tissue of the absorbent 

 glands themselves is not prone to run into sup- 

 puration, but pus will often speedily form in 

 the surrounding and connecting cellular tissue, 

 which by-and-bye accumulates, forms an ab- 

 scess, is discharged, and leaves the glands, 

 with the intervening cellular tissue, dissected 

 away by the suppurative and sloughing process. 

 It is thus that a bubo will originate from one 

 or more inflamed inguinal or axillary glands, 

 and when the constitution is enfeebled and fa- 

 vourable to a phagedenic action, we frequently 

 find these glands exposed by the destruction of 

 the skin and cellular tissue. Sometimes, how- 

 ever, little collections of pus form in the glands 

 themselves, and, according to Gendrin, the 

 fluid in the glands differs remarkably from that 

 in the cellular tissue, the latter being thick, 

 opaque, viscid, and of a greenish hue, whilst 

 the former is clear, transparent, and almost 

 colourless. Gendrin infers from his observa- 

 tions that the lymphatics which permeate the 

 inflamed glands become obliterated ; but Dr. 

 Bocher, a German anatomist, quoted by Andral, 

 affirms that he repeatedly injected with mercury 

 lymphatic ganglions presenting different forms 

 of morbid alteration, and that he invariably 

 found the injection pass freely through all the 

 convolutions of vessels, whence he concludes 

 that in diseases of these ganglions the lesion is, 

 at least in the great majority of cases, confined 

 to the cellular tissue that unites the convolu- 

 tions of the vessels, or to the coats of the ves- 

 sels, but that there is no obstruction of their 

 cavity. The lymphatic glands are also liable to 

 be chronically inflamed, or to be hypertrophied, 

 and under both conditions put on the same 

 anatomical characters, viz. redness, increased 

 size, induration. In children, of both sexes, 

 the glands at the angle of the jaw and those of 

 the neck frequently afford examples of these 

 morbid states. The bronchial and mesenteric 

 glands likewise present similar enlargements. 

 Atrophy of the absorbents occurs very com- 

 monly in old persons. 



Various deposits are met with in the absor- 

 bent glands. Of these the most frequent is 

 tubercle, or a cheesy curdy matter of a yel- 

 lowish hue, which bears much resemblance to 

 tubercle. This matter is deposited in isolated 

 spots in the glands, or else appears to be infil- 

 trated throughout their substance. In phthisical 

 subjects, in scrofulous patients, these deposits 



