TUBERCULOSIS OF LYMPHATIC GLANDS. 



697 



depression marginating the lower jaw is filled up, the sub-atloid space 

 disappears, the sub-glossal glands occupy the space beneath the tongue, 

 and in cases where the lesions are very pronounced the cesophagus 

 and larynx may even be pushed downwards. 



Swallowing is difficult, in consequence of compression of the upper 

 part of the oesophagus, and, as the 

 laryngeal nerves may be included in 

 the swelling, dyspnoea or roaring not 

 uncommonly results. 



By palpation with one or both 

 hands it is easy to identify the glands 

 and detect enlargement, hardness and 

 sensitiveness. In exceptional instances 

 the caseous masses they contain 

 undergo softening and conversion into 

 purulent material. 



When the cervical lymphatic glands 

 are attacked the jugular furrows dis- 

 appear, and the whole of the pre- 

 tracheal and lateral regions of the 

 neck exhibit' doughy swellings. 



These swellings are rarely sym- 

 metrical, a fact which admits of this 

 condition being distinguished from 

 lesions due to lymphadenitis, without 

 examining the blood. 



The prescapular glands are rarely 

 attacked, but those at the entrance 

 to the chest, which may be found on 

 either side of the trachea by passing 

 the fingers between the two first ribs, 

 are frequently enlarged to the size of 

 a fowl's egg. 



Tuberculosis of the Mediastinum. 

 — Whenever the lungs are much in- 

 volved, the bronchial glands are also 



invaded, though the glands of the anterior and posterior mediastina 

 may escape. On the other hand, the mediastinal glands are some- 

 times much involved, whilst the lung remains intact. 



The lymphatic glands, particularly those of the mediastinum, may 

 be enormously enlarged, and the various accidents which result are 

 due as much to mechanical interference with the functions of adjacent 

 organs as to the lesions themselves. 



Fig. 277. — Lesions in retro-pharyn- 

 geal tuberculosis. T, Trachea ; 

 (E, cesophagus ; P, pharynx ; 

 H, hyoid bone ; E, epiglottis ; 

 L, tongue ; G, tuberculous retro- 

 jiharyngeal glands. 



