Symmetrical lymphomata of the lacrimal and salivary glands (Mikulicz's disease) / by S. Lewis Ziegler.

  • Ziegler, S. Lewis (Samuel Lewis), 1861-1926.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Symmetrical lymphomata of the lacrimal and salivary glands (Mikulicz's disease) / by S. Lewis Ziegler. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    provement. Free nasal breathing was reestablished and the physical condition improved. The first retrogressive symp- tom noted was the softening of the lacrimal and submaxil- lary glands, which began to be apparent about the time he was discharged from the hospital, May n, 1908. The paro- tids still maintained their fibrous hardness, although the swelling was somewhat reduced. /Etiology.—The setiological factors which most writers have recorded in these cases are: 1. Infec- tion from buccal or conjunctival bacteria: 2, glandu- lar irritation from some toxic agent in the blood or lymph stream causing lymphatic hyperplasia; and 3, some idiopathic origin. Mikulicz and Kummel favor the theory of “an infectious or parasitical pro- cess in the widest sense of the word,” but do not explain the origin of their belief. No specific bac- teria have been demonstrated in these cases, the mi- croscope usually revealing lymph cell infiltration of the interstitial tissue, which Mikulicz considers wholly responsible for the enlargement of the gland. Although bacterial infection is usually accom- panied by an acute inflammatory process, no inflam- mation has been noted in these cases. Granting the possibility of infection, whence would it originate— from the eye, the mouth, or the nose? It has been stated that trachoma of the fornix has caused lacri- mal adenitis (Baquis). By analogy it is deduced that buccal bacteria might be transmitted through Steno's duct and thus infect the parotid (Hanau). I think it is much more probable, however, that the source of infection is nasal, and the means of transmission through the lymphatic capillaries. It certainly seems possible that a steady stream of toxic, bacteria laden secretions could be absorbed from the accessory sinuses (chiefly antrum) and carried directly to these contiguous glands. If, however, the origin is an infection from neighbor- ing parts, why should the course of this disease be so sluggish and the condition remain unchanged for months and even years? On the other hand, may this not be a chronic hyperleucocytosis strictly lo- calized to these enlarged lymph glands? How can we explain the retrogression of these glandular swellings during the course of an acute intercurrent disease, and their recrudescence in some cases soon after convalescence? Kummel has reported such an occurrence during pneumonia, Mikulicz during appendicitis, Haeckel through a se- vere enteritis, Delens after an attack of cholera,