I 



PATHOLOGY 75 



result of repeated infectious diseases such as pertussis, 

 measles, scarlatina and coryza, and also tend to hyper- 

 trophy in insanitary and unhealthy conditions, whether 

 of the patient's general surroundings, or locally of the 

 nose and throat (Chapter XVI.). A swollen condition of 

 the Peyer's patches occurs in cases of obstruction of the 

 small intestine. A limited septic infection may lead 

 to a limited enlargement of the adjacent subepithelial 

 lympathic gland. The following case illustrates this 

 point. 



H. W., age 18, an engine cleaner, had had left 

 otorrhoea " as long as he can remember." He thought 

 it followed scarlet fever. The left tonsil was very much 

 enlarged, while the right tonsil was about normal in 

 size. 



I have on several other occasions seen this unilateral 

 tonsillar enlargement follow an otorrhoea on the same 

 side. 



General increase of lymphatic structures, particularly 

 of the subepithelial variety, signifies prolonged bac- 

 terial assaults, and may be accompanied by a toxin- 

 weakened heart — the so-called status lymphaticus. 



It may also be observed that a lymphocytosis is 

 characteristic of pertussis, measles, variola, mumps, 

 infantile gastro-enteritis, some cases of tuberculosis, 

 malaria, rickets, and syphilis, and even typhoid fever 

 (Gulland and Goodall). Increase in the number of 

 leucocytes, charactjerised by a relative gain in the 

 lymphocytes and eosinophils, usually develops during 

 the reactionary fever following the injection of tuber- 

 culin (Da Costa). Of course, the interstitial lymphatic 

 glands and possibly the marrow share with the sub- 

 epithelial lymphatic glands in the production of lympho- 

 cytes, but when it is borne in mind that in many of 

 these diseases some of the subepithelial glands show 

 activity, it is reasonable to suppose that they play no 



