The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
Enlargement of the lymphoid tissue in the wall of the alimentary canal
also occurs, and in those rings of adenoid tissue which mark the site
of the embryonic canals. This tissue may be seen around the origin
of the appendix, while its most conspicuous illustrations are seen
about the pharynx, where not only the faucial, but the lingual and the
pharyngeal tonsils are enlarged. In many of these cases there are the
so-called “adenoids” of the throat specialists, while, of still greater
interest to the surgeon, the deaths that have occurred from the status
lymphaticus have happened repeatedly in operations for these growths
within the nasopharynx. Furthermore, the yellow marrow of the bones
seems to be replaced by red marrow, but whether this is due to the
anemia which always accompanies the condition is not known.
Kaposi some years ago described under the name _lymphodermia
perniciosa_ a rare condition characterized by a scaly and itching
skin, exuding fluid, with later a diffuse and doughy condition of the
affected parts, and then by nodules which sometimes ulcerate, lymph
nodes and spleen being also enlarged, and the general health impaired.
While some have held that this is a variety of mycosis fungoides, it is
supposed that it is only another expression of lymphatism.
Another variety of this condition occurs in young people, in which
coma comes on suddenly, followed by death in twelve to eighteen hours.
Vomiting may occur during the coma, but it is convulsions and spasm of
the glottis that cause the death of the patient.
_Thymic asthma_ has been called _laryngismus stridulus_. Whether the
latter can ever occur without the former is not definitely known, but
doubtless the asthma is very frequently the cause of the obstruction
and the difficulty in breathing.
Medicolegal questions arise in this connection which are of interest.
Death occurs, except under anesthesia, after a series of convulsions,
yet it may happen almost instantly. Some claim that death may take
place as the result of pressure of an enlarged thymus upon the vessels,
and especially upon the nerves, while others claim it to be due to a
sudden arrest of heart action by reflex activity.
Convulsions of any character in adolescent individuals and young
children should raise a suspicion of this condition, and, of greater
importance for the surgeon, all possibility of existence of the
condition should be eliminated before operation is undertaken. Deaths
occurring during anesthesia are often attributable to the anesthetist;
nevertheless there are instances where he is absolutely blameless, and
where death may occur as by a flash of lightning.
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