THE LYMPH -NODES. 395 



cells of the nodules (" follicles ") and cords, and especially the eudothelial 

 cells of the lymph spaces (Fig. 204), which may increase in number and 

 exfoliate to such an extent as to fill and largely distend the lymph 

 sinuses. These endothelial cells often contain red blood cells, leucocytes, 

 and fragments of other cells (Fig. 205). In typhoid fever, as well as in 

 many other infectious diseases, necrosis of the hyperplastic tissue is com- 

 mon (see p. 229). 



After simple hyperplasia of the lymph-nodes, resolution readily oc- 

 curs. But if necrosis have taken place, such areas may be replaced by 

 fibrous tissue. 



This form of lesion of the lymph-nodes is common. It may occur in 

 the cervical nodes with many forms of angina; in the inguinal nodes in 

 connection with acute infec- 

 tious processes in the external 

 genital organs; in the axilla 

 with infectious processes in the 

 hand, arm, or breast; in the 

 mesenteric nodes with infection 

 or intoxication of intestinal or 

 other origin. Similar lesions 

 occur in the solitary lymph 

 nodules and Peyer's patches of V 

 the intestine (Fig. 206). $L** 



111 EXUDATIVE Or SlUWUra- FlG - 205. ENDOTHELIAL CELLS IN HYPERPLASIA OF 

 .... ,. r, / THE LYMPH-NODES. 



live forms of inflammation of 



,, -. , , . , ,.,. The exfoliated cells contain red blood cells, fat droplets, 



the lymph-nodes, 111 addition and masses of blood pigment. 



to the simple hyperplastic 



changes just described, there are emigration and collection of leucocytes, 

 with the formation of more or less fibrin in the lymph sinuses as well 

 as in the interstices of the nodules. The capsule of the nodes may be 

 infiltrated with exudate. With these changes there may be necrosis and 

 softening of the tissue of the nodes and the development of abscesses. 

 Small abscesses may coalesce, and thus a considerable part of the node 

 is converted into a suppurating necrotic mass bubo. Such a bubo may 

 open externally or into the surrounding tissue and heal by granulation 

 tissue and cicatricial tissue ; its contents may be absorbed or become 

 dry and dense and calcified, and surrounded by fibrous tissue. Suppu- 

 rative inflammation of the lymph-nodes often occurs in connection with 

 suppurative processes elsewhere, in pyaemia, venereal infection, etc. 



The lymph-nodes of children are, as a rule, more readily involved in 

 infectious processes of other parts than are those of adults. 



Chronic Inflammation. This is characterized by the increase of the 

 connective-tissue elements of the node, with a gradual and commensurate 

 disappearance of the lymphoid cells. The reticulum of the follicles and 

 sinuses becomes thickened and fibrous, and in the trabeculse and capsule 

 new connective tissue is formed, until, in advanced cases, the entire node 

 may be more or less extensively converted into a mass of fibrous tissue. 



