THE LYMPH-NODES. 



397 



usual appearances. Tubercle bacilli may be found in the edges of the 

 cheesy areas or in the tubercle tissue about them. 



Simple inflammatory changes regularly occur in the periphery of the 

 tubercles. There is an increase of cells in the lymph sinuses and follicles, 

 and a more or less marked swelling, and apparently a proliferation of the 

 cells of the reticular tissue of the node. In cases in which the process is 

 chronic there is often marked increase of the connective tissue of the 

 nodes, the reticular tissue becomes dense and fibrous, and the trabeculse 

 and capsule are thickened. The tubercles themselves, instead of under- 

 going cheesy degeneration, may become fibrous or be converted into a 

 hyalin material. 



The cheesy material may dry and shrink, and become enclosed by a 

 capsule of dense connective tissue and become calcified ; or it may soften, 

 and thus cavities be formed iu the nodes, filled with grumous material ; 

 or inflammatory changes may be induced in the vicinity of the nodes, 

 leading to abscesses. On the other hand, hyperplastic inflammation iu 



FIG. 207. CHRONIC INFLAMMATION OF BRONCHIAL LYMPH-NODE. 



Showing obliteration of the lymph sinuses and atrophy of the lymph-nodules by the new-formed connective 



tissue. 



the periphery of the affected nodes may result iu their becoming bound 

 together into a dense nodular mass. 



SCROFULA. Tuberculous inflammation of the lymph-nodes, especially 

 in those of the cervical, 1 bronchial (Plates iii. and xi. ), and nieseuteric 

 groups, often occurs in children, particularly in those who are ill-nour- 

 ished. Northrup and Bovaird found iu an analysis of 200 cases of tu- 

 berculosis in children that the lungs and brouchial lymph-nodes were 



1 For bibliography of cervical tuberculous Ivmph-nodes see Doicfl, Annals of Sur- 

 gery, May, 1899. 



