Lyi/iphadoiitis. InjJaiiiniation of the Lymph Glands. 401 



from \.\\z skin but liaving a distinct envelope of soft pitting exu- 

 date which tends to increase in a downward direction. There 

 may or may not be a corded feeling of the afferent lymphatic 

 trunks. As the pasty swelling increases, it extends into sur- 

 rounding parts, binds the gland to the skin and adjacent .struc- 

 tures, and may even conceal the gland in the excess of its invest- 

 ing engorgement. This is especially frequent in strangles. As 

 the process advances softening may take place in the centre and 

 extend toward the circumference, and this may burst like an 

 ordinary abscess. In some cases the softening is very limited 

 and tardy, and the pus may be pent up and inspissated, or it 

 may appear to be entirely reabsorbed while the gland is in pro- 

 cess of induration. Fever which may run high during the pro- 

 cess of suppuration, moderates when that has been accomplished. 



In the case of glands too deeply situated to be clearly felt the 

 occurrence of purulent fluctuation in their vicinity suggests abscess. 

 of the glands, an important induction as the maturation and 

 healing are usually slow in the gland tissue. 



Lesions. At the outset the glands are visibly enlarged, softened, 

 and of a dark red hue, with spots of a brighter red. The 

 changes, mainly in the medullary layer, consist in a great pro- 

 liferation of spheroidal cells in the follicles and also of polyhediral; 

 cells in the lymph sinuses. The endothelial cells are swollen,,, 

 the blood vessels gorged, and extravasations of blood into the^ 

 follicles and sinuses are frequent. Abscess or fibroid hyperplasia 

 with induration may follow. Much depends on the particular 

 infection (tuberculosis, glanders, carcinoma, etc.) as the special 

 product of each disease will be found in the affected gland. 



Treatment is in the main as advised for lymphangitis and will 

 vary with each specific causative disease. Locally antiseptics,, 

 astringents, deobstruents, emollients, and vesicants will be 

 requisite in different cases. As soon as pus can be distinctly 

 diagnosed it should as a rule be evacuated, and the cavity treated 

 antiseptically. General treatment may at first be antiphlogistic 

 and febrifuge, but must usually embrace tonics and stimulants in 

 the end. 



Chronic Adenitis may be a sequel of the acute, or it ma}- 

 arise independently. In the latter case it is u.sually the result of 

 some other disease (tuberculosis, glanders, carcinoma, sarcoma 

 26 



