396 THE LYMPH -NODES. 



This condition is very frequently seen in the lower tracheal and in the 

 bronchial nodes, apparently as a result of the lodgment in them of re- 

 spired pigment particles ; but it may occur in any nodes, either as a result 

 of repeated moderate degrees of inflammation or from causes which we 

 do not know. In some cases the nodes are greatly enlarged and the 

 new tissue contains many large cells, while in other cases the connective 

 tissue is dense and contains but few cells (Fig. 207 ).' 



Tuberculous Inflammation may be local, confined to the nodes, or it 

 may occur in connection with general acute miliary tuberculosis, or with 



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 wmP '''**** *<v' ? ' '- "* 



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FIG. 206. HYPERPLASIA OF PEYER'S PATCH IN TYPHOID FEVER. 

 Showing new-formed endothelial cells in the meshes of the reticular tissue between the blood-vessels. 



tuberculous inflammation of single organs. It may occur in single nodes, 

 or in several nodes of the same group, or in groups situated in different 

 parts of the body. In its simple and acute form there may be no evi- 

 dent change to the naked eye in the appearance of the nodes, or they may 

 be besprinkled with small, grayish-white, translucent spots. Under these 

 conditions the nodes may be reddened and soft, or swollen and denser 

 than normal. In more advanced forms of the lesion the tubercles coalesce 

 and undergo 'a greater or less degree of cheesy degeneration. Under 

 these conditions the cheesy areas are evident to the naked eye as more or 

 less sharply circumscribed, opaque, whitish or yellowish areas, frequently 

 surrounded by an irregular, more translucent, grayish zone of tubercle 

 tissue which merges insensibly into the adjacent tissue. The entire node 

 may become involved, and more or less completely converted into a 

 cheesy mass, in the periphery of which a zone of tubercle tissue may or 

 may not be evident. 



Microscopically the small nodules or miliary tubercles are seen to 

 consist of more or less circumscribed collections of small spheroidal, or 

 more frequently larger polyhedral cells, with or without well-defined 

 giant cells. They usually commence to form in the follicles and lymph 

 cords of the nodes, and from these may spread and involve the entire 

 surrounding tissue. The cheesy degeneration, which here as elsewhere is 

 apt first to involve the central portions of the tubercles, presents the 



1 Consult Ribbert, "Ueber Regeneration und Entziindung der Lymphdruseu," Zieg- 

 ler's Beitrage zur path. Anat., Bd. vi., p. 187, 1889. 



