THE SCROFULOUS GLANDS Diseased cervical lymphatic glands are very frequently observed and most easily diagnosticated (see Plate 39). At first enlargement of a single or several glands takes place at the angle of the jaw, before or behind the sternocleidomastoid muscle. This swelling spreads more and more until an entire chain of glands is involved.
The hypertrophy extends gradually and without much pain. It may become so extensive that large tumors are formed on both sides of the neck. This disfigurement along with the chronic inflammatory swellings of the face changes the countenance, giving it the peculiar appearance of a pig (see Plate 39). The tumors formed often remain firm for a long time, but on the other hand they frequently soften and suppurate. They may, through an inflammatory process become hard and adhere to one another, and to the skin. The skin over the softened glands becomes oedematous, tense, then shows a bluish discoloration, gets thinner and at last the gland discharges.
Fistulas may form from which there is a discharge of a whitish flaky and purulent fluid, mixed with curdy material. The fistulas are apt to develop into ulcers, which resemble tuberculous ulcers and stub bornly resist treatment. Similar phenomena may appear in all other glandular regions although they are less frequently found in other localities.
The nature of the glandular infection is still to be considered.
There is hardly any doubt to-day that all scrofulous glands are infected with tubercle bacilli. It is by no means necessary that every infected gland should show changes which are anatomically of a tuberculous nature. Recent researches, particularly Weichselbaum's, have taught us that virulent tubercle bacilli may be present in the medullary sub stance of the swollen glands. As a matter of fact because of the chronic eczema still other bacteria may penetrate to the glands and cause abscesses. However this is only accidental and has nothing to do with the scrofulous process proper. Of course we see in cases of chronic eczema, especially in eczema of the face and scalp of nurslings, consid erable swelling of the regional glands; but they never manifest the changes described above. They hypertrophy and undergo a process of involution, or if they soften, they simply merge and form a simple glandular abscess. Nobody would call such glands scrofulous, for they are in every case liable to infection; and this is true not only in children, but in adults.
If one would regard every case of chronic young children as scrofula, then he might likewise call these glands scrofulous, but the whole conception of scrofula would be shifted thereby.