One of the prominent reactions which was almost constantly present as the inflammatory reaction involving the lymphatic system of the chest. The lymph glands within the chest responded to a marked degree in hyperplasia and commonly showed enlargement quite out of proportion to what is usually observed in lobar pneumonia. These reactions were in direct relation to the inflammatory processes of the lung and appeared to be involved in proportion to the inflammation occupying the tissues drained by them. Elsewhere in the body the lymph glands responded but slightly, and often no change was observed in the lymphatics of the abdomen, axilla and lower extremities. The systemic intoxication thus had no effect upon distant lymph glands, and even the presence of micro-organisms in the circulation did not appear to cause responses in these tissues other than in the neighborhood of the chest. Within the chest the lymphatic system became involved through the presence of the various bacteria migrating along the lymphatic channels as well as through its activity in removing products of inflammation.
The response of the thoracic lymphatics, including those within the lung and mediastinum, is observed in all stages of pneumonia. But in epidemic influenza the reaction was much more prompt, appearing in the early stages and rapidly developing tissue changes along the channels and in the lymph nodes. The lymph channels during the period of the early serous pneumonia became dilated and filled with fluid with relatively few cells. The stroma immediately surrounding became œdematous, so that in the gross specimen the connective tissue between the lobules of lung were sometimes easily seen as gray strands. At this time this tissue was not increased in quantity and did not project above the level of the cut lung. The fibrous tissue remained soft and pliable, but formed quite wide strands. When the pulmonary reaction became hemorrhagic, red blood cells, leucocytes and large mononuclears were found mixed with the fluid in the lymphatics. We had no way of determining the direction of the lymph flow from the pulmonary tissues, but it was assumed that as there was no excessive loss of serous fluid from the lung and the lymphatics beneath pleura into the chest cavities that the fluid was draining through the channels lying about the bronchi and vessels. The further evidence of the direction of flow was seen in the rapid and comparable responses which occurred in the lymph glands along these routes. The glands about the bronchi and at the hilus became enlarged, red and succulent. The glands were often two and one-half centimeters in diameter. Their capsule was thin and stretched and the gland was quite soft. Many of them when cut open were almost diffluent.
