TUBERCULOSIS OF THE LYMPHATIC GLANDS. 179 



nosis was between malignant lymphoma and tuberculous adenitis. 

 During the further course of the disease bronchial breathing in 

 both lungs appeared. Heart, liver, and spleen appeared to be nor- 

 mal. Urine normal, but increase of temperature and respirations 

 took place during this time. Death occurred in less than five 

 months. At the autopsy the lungs were found congested and oede- 

 matous, with red hepatization of the lower lobes, and a few miliary 

 tubercles. The spleen contained many miliary tubercles the size 

 of the head of a pin, and most of them in a state of cheesy degen- 

 eration. The mesenteric glands were much enlarged ; and a few 

 of them in a condition of cheesy degeneration and calcification. In 

 the cheesy masses bacilli were found. All the cervical glands were 

 affected with softening and cheesy degeneration in the centre. The 

 calcification of mesenteric glands pointed to an earlier affection. 

 The disease remained latent and recurred in the same glands, and, 

 later, extended to the cervical glands. This case resembles the 

 cases described by Hilton-Fagge and Pye-Smith. Next to the cer- 

 vical glands the glands of the axilla are most frequently affected. 

 In my experience the operative treatment of tuberculosis of the 

 axillary glands has yielded more satisfactory results than when the 

 same operation was made under similar conditions on the glands of 

 the neck. Tuberculosis of the inguinal glands is an extremely 

 rare affection, and when present is usually associated with primary 

 tuberculosis of the genital organs. From a practical standpoint 

 the following two papers are of great importance. 



Friinkel (" Zur Histologie, Aetiologie und Therapie der Lym- 

 phomata Colli," Prager Zeitschriftf. Jleilkunde, 1885, Hefte 2 und 

 3), for three years, made it his duty to study the histological struc- 

 ture of all lymphatic tumors which were extirpated in Billroth's 

 clinic. As the result of his observations he classified all primary 

 tumors of the lymphatic glands examined into two classes : 1 . 

 Lymphatic tuberculosis; 2. Lympho-sarcoma. He also described 

 a simple hyperplasia of the glands, which present under the micro- 

 scope only healthy glandular tissue. In the tubercular glands he 

 found the histological structure of tubercle perfect, and never failed 

 in detecting the bacillus of tuberculosis. In persons between fifteen 

 and thirty years of age he found local tuberculosis of the lymphatic 

 glands as a quite frequent affection. In his paper he gives the 

 clinical histories of 1 48 cases of glandular tuberculosis. Only in 

 15 of this number were the lungs affected. In 18 the patients were 

 weak and badly nourished ; while in 72 the general health was 

 unimpaired. The age of the patients varied from nine to fifty-one 

 years. On an average the duration of the disease was from three 

 to four years; the shortest time was two months, and the longest 

 thirty years. Of special etiological interest is the case of a woman, 



