If chains of glands are tuberculous, the latter inflame alternately and dis charge their contents in the same order, a series of abscesses being thus formed.
When the contents of the gland arc discharged, the skin may become ulcer ated in the neighborhood, form fistulae, and a depressed, adherent, violet cicatrix finally form.
In some cases a fistula may form and last for years; the skin may be under mined, and disfiguring cicatrices may be formed.
Cretaceous transformation occurs at times in the deeper glands, but rarely in the superficial ones. Some caseous glands undergo a process which trans forms them into a cyst-like cavity con taining a serous liquid.
Chronic adenitis may assume various forms.
1. General Tuberculous Adenitis. This presents itself especially in negroes. Organs other than the glands are but little affected, and continuous fever exists. The retroperitoneal, bronchial, and mesenteric glands are the most en larged. It resembles, in many ways, an acute attack of Hodgkin's disease.
2. Local Tuberculous Adenitis. — (a) Cervical. This form is usually met with in children, and begins in the submax illary glands, which are generally more enlarged on one side.
(b) Bronchial. This form is thought to be always secondary to a focus in the lungs, by some authors, but this opinion is contested by many others, Osler among them. Local lung-infection, pericardial infection, and general infection are to be feared, however.
(c) Peribronchial. In this form we must realize the importance of lesions resulting from caseation. There is a softening of the lymphatic glands situ ated around the lower end of the trachea and main bronchi. Evidence from per cussion is of doubtful value; alterations in breath-sounds are much more impor tant, especially when unilateral; divided respiration, with prolonged expiration, is found unaccompanied by any adven titious sounds. In cases in which the
enlarged glands ulcerate through the air tubes, the breath has a very offensive odor, and co-existence of fcetor with bmmoptysis and evidence of pulmonary consolidation are suggestive. When vomiting of blood and its passage by the bowel is added, the diagnosis of glands rupturing into bronchus and oesophagus is the most likely one. The annexed colored plate distinctly shows the ana tomical relations of the peribronchial glands.
(d) Mesenteric. This form may be primary, and is thus very common in children, or secondary to local intestinal tuberculosis. The sufferers are ' usually weak and wasted; the abdomen is en larged and tympanitic, and diarrhoea is a common symptom. Some fever is usu ally present. This form may exist in adults. (Osler.) The majority of children presenting symptoms of tuberculosis also have gen eral adenitis, the swollen glands being felt everywhere; they never change in size or consistence. Suddenly a bron chitis develops, followed by a broncho pneumonia, from which the child dies. Microscopical examination reveals ea seous spots and the presence of tubercle bacilli throughout the affected glands. The name of "generalized peripheral adenitis" suggested for this condition. Grancher and Marinescu (L'Union Dec. 2, '90).
Diagnosis. — Chronic adenitis is gen erally limited to one or two glands; when the glands are tuberculous, chronic adenitis is apt to affect an entire mass. The former is often associated with an external simple lesion; the tuberculous form is apt to be more frequent in chil dren, young soldiers, and negroes.
LYMPEADENOMA.—This variety of tu mor is usually more voluminous and is not suppurative. The diagnosis, how ever, is exceedingly difficult.