TUBERCULOSIS OF THE LYMPH-PASSAGES The migrate from the adjacent mucous membranes of the digestive and respiratory passages into the lymph-spaces, while the lymph-vessels proper are only slightly irritated and rarely show the typical formation of nodules. Only in the lymph-vessels of the skin and the subcutaneous tissue do we at times observe an accumulation of nodules, which we call a tubercular infiltration of the skin (scrofulo derma) (see C. Leiner, vol. iv).
The filter-stations of the lymphatic apparatus, viz., the lymph-nodes, are, however, a favorite seat of the disease.
Tuberculous Affection of the Lymph-nodes (Lymphadenitis tuberculosa) This is one of the most frequent affections in children. A large number of the tubercle bacilli which circulate in the blood and the lymph are deposited in the nodes just as in other infections. Once a group of organs has been infected the respective regional lymph-nodes will suffer first. They enlarge, typical tubercles are formed, and these break down in the centre and form abscesses. The lymph-gland is now pierced by abscesses and cavities until it is finally one abscess surrounded by the thickened glandular capsule. This latter is slowly absorbed and perforated and the pus infects the neighboring tissues and gradually works its way through to the surface. The walling off against the healthy tissue is not as intensive as in pyfemic infection, and, as the pus itself is not highly infectious, containing only very few bacteria, the whole process is a lingering one.
The skin is pushed out tightly when the pus reaches it and then shows increasing redness and the signs of perforation.
In some cases the cheesy nodes will become encapsulated, and calci fication sets in, but they will harbor infectious material for a long time.
Tuberculosis of the glands may be observed in children either spread all over the body (polyadenitis) or confined to certain regions (bron chial, cervical, mesenteric, inguinal, axillary glands).
For us the most important is tuberculosis of the cervical which appears to be a primary affection, though it is in all probability secondary, as the glands arc located close to the mucous membranes at the entrance to the respiratory and digestive tracts (Fig. 115).
We find nodular glandular tumors along the large blood-ves sels in the neck, in front and behind the sternomastoid muscle down ward into the clavicular fossa and forward to the chin, which give to the neck and face of the children such an ugly appearance that this, together with the catarrh of the mucosm, has led to the adoption of the term serofulosis.
These glandular swellings may disappear when the process runs its course in the glandular tissue itself (restitutio ad integrant). They may become indurated when the process is encapsulated in the glandular tissue itself, or they may caseate, suppurate and break through to the surface, and thus cause disfiguring fistulm.
The glands arc usually not tender, they are well defined, the single ones either round or oval, differing in size and in consistency according to the degree of the changes.
Differential differ from the acute glandular swel lings by their course, the lack of tenderness in the beginning and the slight reaction in the neighboring tissues.
We can differentiate these from lymphosarcoma because they can be moved upon the underlying tissues and upon each other. The sarcoma grows through its capsule and makes a compact mass of the glands and the surrounding tissues.
The diagnosis of leuka'mir glands is made from the examination of the blood.
Pseudoleularmic glands are the most difficult to differentiate, though the absence of scrofulous symptoms in pseudoleuLemic lymphoma will be of assistance, and finally the excision of a piece of gland, its micro scopical examination, and animal experimentation (intraperitoneal in jection of glandular detritus into guinea-pigs) will decide the diagnosis.
The treatment of this affection has undergone many changes in the course of years. The public learned conservative treatment from ancient medicine and they continue to favor it. It was known that the tumors would often disappear when the children began to look better. Larger glands were treated with heat (poulticing), under which some "were dissolved," others formed abscesses, and a few only remained "indurated." The results were frequently persistent fistulm and dis figuring scars in the most conspicuous region of the neck.