Volume 1

A dictionary of medicine : including general pathology, general therapeutics, hygiene, and the diseases of women and children / by various writers ; edited by Richard Quain ; assisted by Frederick Thomas Roberts and J. Mitchell Bruce ; with an American appendix by Samuel Treat Armstrong.

  • Quain, Richard, 1816-1898.
Date:
1895, ©1894
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of medicine : including general pathology, general therapeutics, hygiene, and the diseases of women and children / by various writers ; edited by Richard Quain ; assisted by Frederick Thomas Roberts and J. Mitchell Bruce ; with an American appendix by Samuel Treat Armstrong. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    1244/1258 (page 1214)
    in most of the remaining cases, evidently constitute only a small part of the influences to which it is due. Hereditary transmission has not been distinctly proved. The disease is three times as frequent in males as in females. It is met with at all ages, but is most frequent in early and late adult life. It occurs, but is not specially frequent, in children under ten years; and, having regard to the numbers living, it is least frequent between the ages of forty and fifty years. Intemperance, mental depression, insufficient food, and over-exertion have been noted, in rare cases, as antecedents. Exposure to cold, in several instances, has appeared to be the exciting cause of the affection. It is doubtful whether the disease has any relation to con- stitutional syphilis. In several cases the symptoms have first appeared after child- birth. Various febrile affections have, in a few instances, preceded the affection. The exciting cause which has been noted most frequently is some local irritation, as of a decayed tooth, discharge from the ear, sore- throat, inflammation of the lacrymal sac, or eczema. In these cases the glands nearest the source of irritation first enlarged, and then more distant ones became affected. Anatomical Characteks.—The several groups of glands are affected in the following order of frequency, beginning with those most commonly diseased: cervical, axillary, in- guinal, retro-peritoneal, bronchial, mediasti- nal, mesenteric. Subsidiary adjacent glands are often enlarged together with the chief groups; and nodular growths, similar to enlarged glands, arise in the course of the lymphatics in places in which the existence of glands is not usually recognised, so that continuous chains of nodules connect the various groups. The size attained by the glands in lymphadenoma varies from that of a bean to that of a hen's egg. At first the individual glands are separate and movable one on another. Ultimately they often unite to form a conglomerate mass, in consequence, in most cases, of the perforation of the cap- sules of the glands by growth, which may also invade adjacent parts. The cervical glands are usually enlarged in both the anterior and posterior triangle; and the sub-maxillary glands may encircle the neck beneath the lower jaw. They may press on the trachea or larynx, displace the latter, compress the internal jugular vein, and cause paralysis of the recurrent laryngeal nerve. The occipital glands are usually also enlarged. The axillary glands often form a mass of very large size, and prolongations may extend beneath the pectoral muscle. The glands in the anterior mediastinum frequently suffer, and the growth may extend to adjacent structures, such as the pericardium, which may be perforated. The thymus may be involved, secondarily or primarily, or may escape. The bronchial glands are diseased more frequently than the cardiac glands, and the trachea and bronchi may be pressed upon, or the lung invaded. The retro-peritoneal glands often form a mass of large size, which may surround and compress the solar plexus, causing symptoms similar to those of Addi- son's disease. Enlargement of the mesen- teric glands is neither common nor consider- able. The inguinal group is frequently diseased, and the femoral vessels and crural nerves may be thereby compressed. The consistence of the enlarged glands may be either soft or very hard. Usually the longer the enlargement has existed, the firmer are the glands. Their section is more uniform than in health. The colour is yellowish or whitish-grey. In the firmer glands dense tracts of fibrous tissue are seen to pass in different directions. Rarely the follicles have a different appearance, being opaque and yellowish from fatty degeneration, whilst the septa are white and conspicuous, from fibroid thickening. Caseation is, however, rare, and when it occurs is commonly confined to one or two glands. The softer glands yield a juice on scraping; the firmer glands yield no juice. In the former, the only histological change is an enormous increase in the cellular elements—the lymph-corpuscles of the reti- culum ; but the relations of the septa and follicles often remain normal. Sometimes the cell-growth invades the septa, which become split up and disappear; and it may even, in a similar manner, perforate the cap- sule. The firmer glands present much fibrous tissue, which may be confined to the septa, or invade also the delicate network in the substance of the gland; and then the cells gradually disappear, and the whole substance of the gland may be transformed into a fibrous mass. The tracts of fibrous tissue may have under the microscope a peculiar vitreous aspect, especially around the arteries. The spleen is diseased in at least four- fifths of the cases, usually in consequence of disseminated growths, often irregular in shape, arising from the Malpighian cor- puscles, yellowish or greyish-white, rarely caseating, and usually corresponding in con- sistence with the glands in the same case and resembling them in structure. The splenic pulp may be normal in quantity, or may be compressed and atrophied. In some cases it is also increased in quantity, and this increase may even be the sole change. In such cases the morbid changes of lymphadenoma and splenic leucoeytha^mia coexist, and there is often a much greater increase in the white corpuscles of the blood than when the spleen is the seat of simple growths. The size attained, in the cases of nodular growths, is not great, the weight being from ten to thirty ounces. When the splenic pulp is increased, the size attained is rather greater. In the latter case the enlargement is uniform, while it may be irregular when there are