176 CLINICAL FORMS OF SURGICAL TUBERCULOSIS. 



of tuberculosis of the lymphatic glands the disease attacks the 

 glands of the neck, as the scalp, face, and mouth are parts of 

 the body frequently the seat of slight injuries and superficial 

 lesions, and consequently often exposed to tubercular infection. 

 The lymphatic glands are filters for the microbes which enter the 

 body through the lymphatic vessels The pathological conditions 

 which are produced in the interior of a lymphatic gland by the 

 presence of pathogenic microorganisms are well calculated, for the 

 time being, at least, to limit the affection. The lymphadenitis 

 which is produced blocks the lymph spaces with the products of a 

 specific inflammation which temporarily at least mechanically fixes 

 the microbes in their location. Primary infection of a lymphatic 

 gland by the bacillus of tuberculosis in many instances attacks dif- 

 ferent portions of the gland from the very beginning, as a number 

 of independent centres of tissue-proliferation are established around 

 each microbe which has become arrested on its way through the 

 gland. These separate nodules soon become confluent and form a 

 mass of considerable size, which soon implicates the entire paren- 

 chyma of the gland. Local diffusion of the bacillus of tubercu- 

 losis in the interior of the gland is accomplished by the assistance 

 of the lymph stream as long as the bacillus remains free, and 

 through the medium of cells as soon as it has become mtra-cellular. 

 Local infection is not limited to the lymphatic glands on the proxi- 

 mal side of the primary focus, as during the course of the disease 

 we often observe that lymph glands become involved which are 

 not in the direct course of the lymphatic circulation. As the 

 bacillus of tuberculosis is non-motile, we can only explain its trans- 

 portation in a direction opposite the lymph current by its convey- 

 ance in such a direction by migrating cells. The usual course of 

 infection along the lymphatic channels is, however, in the direction 

 of the lymph current. The course of the disease is almost charac- 

 teristic. A lymphatic gland in the submaxillary or parotid region 

 becomes enlarged, and from this centre the infection invades suc- 

 cessively gland after gland, until the whole chain of lymphatics 

 from the lower jaw to the clavicle has become involved. Another 

 interesting feature is observed in reference to the regional diffusion 

 of the tuberculous process, as the course of infection usually corre- 

 sponds to the location of the gland first affected. If the infection 

 has involved primarily one of the deep glands of the neck, the 

 glands subsequently invaded belong to the deep lymphatics which 

 follow the large vessels of the neck. If, on the other hand, the 

 primary infection is located in one of the superficial glands which 

 are being irrigated by the lymph which flows through and from 

 this gland become the seat of successive infection, showing again 

 that regional infection usually takes place in the direction of the 



