GENERAL DISORDERS OF NUTRITION 



erably firm consistence. No foreign elements can be detected in them 

 under the microscope. They are the product of simple hypertrophy, 

 or, rather (since it is the cells that are multiplied, and not the tissue of 

 the stroma), of a " cellular hypcrplasia." But, as the number of cellu- 

 lar elements contained in a lymphatic gland, even during health, is a 

 very variable one, the complete subsidence of the enormously enlarged 

 glands of scrofulous subjects, which enlargement is entirely due to an 

 excessive accumulation of cells, will not seem extraordinary. Never- 

 theless, the gradual diminution of the tumor, with its final return to its 

 normal dimensions, is not the sole termination of this form of glandular 

 affection. Sometimes the tumors, which at first were the result of 

 mere hyperplasia, sooner or later become inflamed. The surrounding 

 areolar tissue takes part in the inflammation, after which, it is no 

 longer practicable to distinguish the individual glands in the general 

 mass. The skin becomes adherent to the tumor, and cannot be made 

 to glide over it. Suppuration and the formation of abscesses generally 

 follow slowly and gradually upon the inflammation, and the skin, hav- 

 ing become extremely attenuated, is perforated by the pus, leaving a 

 sinuous ulcer, with undermined edges. In other instances, inflamma- 

 tion and suppuration only take place at a solitary point in the tumor ; 

 and the matter formed at this spot does not burst through the capsule 

 of the gland, but thickens, and undergo escaseous metamorphosis. In 

 such a case, if the swelling subside, the caseous mass projects above 

 the surface of the gland, giving it an irregular shape. A partial or 

 complete caseous degeneration may also take place in the hyperplastic 

 mass, without any previous inflammation or suppuration, the over- 

 crowded cells drying up, and suffering " anaemic necrosis " (necro- 

 biosis). Such an occurrence at circumscribed points likewise renders 

 the contour of the gland irregular and angular. The caseous deposit 

 may subsequently become calcified, but, since it acts as an irritant upon 

 surrounding parts, like any other foreign body, it may subsequently 

 give rise to an obstinate inflammation and suppuration. When an 

 entire gland underwent caseous metamorphosis, the process used for- 

 merly to be called infiltrated glandular tuberculosis. If, on the other 

 hand, the deposit of caseous matter was limited, the gland was sup- 

 posed to be affected by miliary tuberculosis, although there were no 

 miliary tubercles to be found in it. The most frequent seat of scrof- 

 ulous hyperplasia of the lymphatic glands, like that of scrofulous in- 

 flammation, is in the neck, especially behind the ear, and under the 

 lower jaw, extending thence to the shoulder. The bronchial and me- 

 senteric glands are also very often the seat of scrofulous hyperplasia, 

 with all its consequences, as above described. The terms scrofulous 

 catarrh of the bronchi or intestines is perfectly appropriate to bronchial 



