CHAPTER XV. 



Acute Inflammations of the Subepithelial 

 Lymphatic Glands. 



All the subepithelial lymphatic glands share a 

 common liability to attacks of acute inflammation. 

 The evidence marshalled below shows that the initial 

 lesion in almost all cases is inflammation commencing 

 in one of the lymphatic nodules and not, at first, an 

 ulceration of the mucus membrane. A lymphadenitis 

 is the starting point of appendicitis as well as of ton- 

 silitis, of pyloric ulcer as well as of the ulcers of enteric 

 fever. 



In the case of tonsilitis the mucous membrane is red- 

 dened and the whole organ swollen. Each crypt becomes 

 choked with glandular lymphcocytes and sometimes 

 polymorphonuclear cells and bacteria, which may over- 

 flow to appear on the surface as a projecting white spot. 

 If ulceration occurs it comes later. 



Peptic ulcers occur for the most part in the adjacent 

 parts of the stomach and duodenum, just where the 

 greater number of lymph nodules are found. The acid 

 gastric juice doubtless accelerates ulceration which has 

 once started, but the commencement of the whole pro- 

 cess is probably an inflammation of the subepithelial 

 lymphatic nodules, going on to suppuration with break- 

 ing down of the overlying epithelium. Landsdown 

 and Williamson have advanced evidence in this 

 direction. 



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