398 THE LYMPH -NODES. 



involved in 148. ' Such persons, in addition to the lesion of the lymph- 

 nodes, are very liable to suffer from chronic tuberculous and other in- 

 flammations of the mucous membranes, skin, periosteum, joints, and the 

 subcutaneous and other connective tissues. This general condition is 

 known as scrofula, and the lesion of the nodes is sometimes called scrofu- 

 lous inflammation. 



While in many cases the portal of entry of the tubercle bacilli is not 

 evident, and the lesions often present the appearance of hyperplasia of 

 the lymphoid tissue with cheesy degeneration and the formation of more 

 or less dense fibrous tissue rather than the typical characters of tubercu- 

 lous tissue, nevertheless, miliary and other forms of tuberculous inflam- 

 mation are often present in so-called scrofula, and tubercle bacilli, while 

 sometimes absent, are often present and virulent. 2 



The necrotic portions of such cheesy lymph-nodes in scrofula may 

 soften and break down, and by the establishment of purulent and necrotic 

 inflammation about them abscesses may form which may open externally. 

 These abscesses may heal ; but usually the healing is difficult and slow, 

 and long-continued suppurations, frequently with the development of 

 fistulae, are very common. Instead of softening, the cheesy material in 

 the nodes may become dry and hard and undergo calcification. 



GENERALIZED TUBERCULOUS LYMPHADENITIS. Several cases have 

 been recorded of extensive tuberculous hyperplasia of the lymph-nodes 

 in various parts of the body, the lesion resembling in its gross characters 

 that of pseudo-leukemia. While in some of these cases the morphology 

 of the lesions is characteristic of tuberculosis, in others the new tissue is 

 diffuse and consists largely of new-formed small spheroidal and poly- 

 hedral cells with large multimiclear cells and of fibrous tissue. The new- 

 formed cells may undergo necrosis. Thus the tuberculous nature of the 

 lesion is not always plain even on microscopic examination. Animal 

 inoculations are often necessary for the establishment of the nature of 

 such cases. 3 



Syphilitic Inflammation. The lesions of the lymph-nodes which occur 

 in connection with syphilis vary greatly, depending upon the stage of the 

 disease. In the primary stage the nodes in the region of the seat of in- 

 fection are apt to present the lesions of an ordinary acute inflammation, 

 frequently with suppuration. 



In the secondary stage of the disease the nodes of other regions, neck, 

 elbow, axilla, etc., are often swollen and hard. On microscopic exam- 

 ination there may be an increase of connective tissue in the capsule and 

 trabeculse, but the chief change is in the accumulation in the follicles and 

 lymph sinuses of larger and smaller spheroidal and polyhedral cells. 



1 For a consideration of the significance of tuberculous bronchial lymph-nodes in 

 children, consult Nortlirup, New York Medical Journal, February 21, 1891; also 

 Bovaird, ibid., July 1, 1899. See further, reference to Marfan, p. 443. 



3 For a full bibliography of scrofula see Corn-et, in Nothnagel's " Specielle Pathologic 

 u. Therapie," Bd. xiv., Th. iv. For a study of variations in virulence in tubercle ba- 

 cilli in scrofulous aad other tuberculous lesions see Lartigau, Jour. Exp. Med., vol. vi. 



3 For a study of this form of tuberculosis, consult Crowder, New York Medical 

 Journal, September 15th and 22d, 1900, bibl. 



