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vessels. In all, interruptions are formed by the lymphatic glands, and since we know that the lymphatic vessels do not pass through the glands as wide, tortuous, and interlacing canals (p. 173), but that, after they have broken up into fine branches, they enter into spaces which are filled with cellular elements, it is manifest, that no pus-corpuscle can pass a gland.
This is a very important point of view which curiously enough is generally overlooked, although it meets with the best possible confirmation in the daily experience of the practical physician. In proof of the inevitable obstruction to the passage of solid particles through the lymphatic glands, a very pretty experiment is afforded by a custom prevalent amongst the lower classes of our population, the well-known practice of tattooing the arms and occasionally other parts. When a workman or a soldier has a number of punctures made upon his arm, and arranged so as to represent letters, signs, or figures, nearly always, in consequence of the great number of punctures, some of the superficial lymphatic vessels are injured. It could not indeed well happen otherwise than that, when whole regions of skin are circumscribed by the pricks of a needle, at least some few lymphatic vessels should be hit upon. Afterwards a substance is rubbed in which is insoluble in the fluids of the body, such as cinnabar, gunpowder, or the like, and which, remaining in the parts, causes a permanent coloration of them. But in the rubbing in a certain number of the particles find their way into lymphatic vessels, are carried along in spite of their heaviness by the current of lymph, and reach the nearest lymphatic glands, where they are separated by filtration. We never find that any particles are conveyed beyond the lymphatic glands and make their way to more distant points, or that they deposit themselves in any way in the parenchyma of internal organs. No, the mass always settles in the nearest group of glands. On
DEPOSITS IN LYMPHATIC GLANDS AFTER TATTOOING. 185
examining the infiltrated glands it is easy to convince oneself that the size of the deposited particles is less than that even of the smallest pus-corpuscle.
In the object which I place before you (Fig. 67) the spot has accidentally been hit upon, at which the lymphatic vessel enters into the gland, and whence, enclosed within the trabeculae of connective tissue which are prolonged from the capsule between the follicles, it proceeds in a spiral form, and finally breaks up into its branches. Where these pass into the neighbouring follicles, which are here indeed in great part filled with connective tissue, they have poured out the whole mass of cinnabar, so that in part it
Fig. 67. Section through the cortical substance of an axillary gland from an arm, the skin of which had been tattooed. A large lymphatic vessel is seen entering from the cortical substance, gently winding and breaking up into fine branches. Round about are follicles, for the most part filled with connective tissue. The dark, finely granular mass represents the deposit of cinnabar. 80 diameters.
still lies within the intervening trabeculae, but yet in part has penetrated into the follicles themselves. The preparation comes from the arm of a soldier who had the figures Ew. 68. rubbed in in 1S09, so that the mass
has remained nearly fifty years in the same place. None of it has penetrated farther than this spot; even the next layer of follicles does not contain any. The particles are however so small, and the majority of them so minute in comparison with the cells of the gland, that they cannot at all be compared to pus-corpuscles. Now when such molecules as these are unable to pass, when such extremely minute particles cause an obstruction, it would be somewhat bold to imagine that puscorpuscles, which are relatively large, could effect a passage. This arrangement, gentlemen, by means of which the free current of fluid is interrupted in the lymphatic glands, and the coarser particles are retained there in quite a mechanical manner, admits, as may readily be conceived, of no other kind of reabsorption from the periphery through the medium of the lymphatic vessels than that of simple fluids. We should indeed be mistaken, if we were to consider the whole action of the lymphatic glands to consist merely in their being interposed like filters between the different portions of the lymphatic vessels. They have manifestly another part to play, inasmuch as the substance of the glands indubitably takes up into itself certain ingredients from the fluid mass of the lymph, retains them, and thereby also alters the chemical constitution of the fluid,
Fig. 68. Reticulum of an axillary gland filled with cinnabar, from an arm which had been tattooed (Fig. 67). a. Part of an inter-follicular trabeculawith a lymphatic vessel; b one of its larger branches entering into a follicle; c, c the anastomosing, nucleated networks of the reticulum; the dark granules are particles of cinnabar. 300 diameters.
LYMPHATIC GLANDS IN CANCER AND SYPHILIS. 187
so that it quits the gland all the more altered because it must at the same time be assumed that the gland yields up certain constituents to the lymph, which did not previously exist in it.
I will not here enter into minute details, since the history of every malignant tumour affords the best examples in support of this position. When an axillary gland becomes cancerous, after previous cancerous disease of the mamma, and when during a long period only the axillary gland remains diseased without the group of glands next in succession or any other organs becoming affected with cancer, we can account for this upon no other supposition than that the gland collects the hurtful ingredients absorbed from the breast, and thereby for a time affords protection to the body, but at length proves insufficient, nay, perhaps at a later period itself becomes a new source of independent infection to the body, inasmuch as a further propagation of the poisonous matter may take place from the diseased parts of the gland. Equally instructive examples are afforded by the history of syphilis, in which a bubo may for a time become the depository of the poison, so that the rest of the economy is affected in a comparatively trifling degree. As Ricord has shewn, it is precisely in the interior of the real substance of the gland that the virulent matter is found, whilst the pus at the circumference of the bubo is free from it; only so far as the parts come into contact with the lymph conveyed from the diseased part, do they absorb the virulent matter.
If we apply these facts to the reabsorption of pus, we are not, even in the case when it has really made its way into lymphatic vessels, at all entitled to conclude that as an immediate consequence of this irruption the blood becomes infected with the constituents of pus; on the contrary a retention of the pus-corpuscles will probably take place within the glands, and even the fluids which succeed in passing them, will during that passage lose a great part of their noxious properties. Secondary glandular swellings shew themselves in various forms after peripheral infection. How can they be explained otherwise than upon the supposition, that every contaminating (miasmatic) substance, which is to be regarded as essentially foreign or, if I may so express myself, hostile, to the body, by penetrating into the substance of the gland, produces in it a state of more or less marked irritation which very frequently increases to a real inflammation of the gland? I shall hereafter revert to the subject of irritation and enter a little more fully into the consideration of the meaning which should be attached to it, and I will therefore here only make this remark, that according to my investigations the irritation of a gland consists in its falling into a state in which there is an increased formation of cells in it—its follicles becoming enlarged, and after a time exhibiting a much greater number of cells than before. In proportion to the extent of these processes we then see the colourless elements of the blood also increase. Every considerable irritation of a gland is followed by an increase in the proportion of lymph-corpuscles in the blood, and every process therefore which is accompanied by glandular irritation, will also have the effect of supplying the blood with larger quantities of colourless blood-corpuscles, or, in other words, of producing a leucocytotic condition. If then the opinion be entertained that pus has been absorbed, and that pus is the cause of the disturbances which have declared themselves, nothing is easier than to demonstrate the presence of cells in the blood which have the appearance of pus-corpuscles and are often present in such large quantities, as to form accumulations (Fig. 58) which may be seen, in the dead body, with the naked eye, looking like minute spots of pus; or as to constitute large, continuous or granular layers on the inferior surface of the buffy coat of blood taken from ft vein (Fig. 60). Appa