CHRONIC LYMPHADENITIS. 237 



with the morbid state as a -whole — the constitutional taint of the 

 alFected person. Those primary lesions are sometimes charac- 

 terised hj their destructive tendency, as in the lungs and the 

 osseous system ; sometimes too, they exhibit no special charac- 

 ters whatever. It is among the latter group that the glandular 

 affection takes a prominent place, receiving the name of scrofu- 



losis KaT i^ox^jv. 



§ 204. The tissue-chano-es which result in scrofulous enlar ere- 

 ment of glands may be regarded in the light of a partial over- 

 growth of the gland-substance, in so far as they consist, not in 

 a uniform increase in bulk of all its structural constituents, but 

 in a multiplication and enlargement of the cells only^ which make 

 up the "enchyma" of the gland. I lay emphatic stress on the 

 enlargement of the individual elements w^hich accompanies their 

 increase in number, because it appears to me that this enlarge- 

 ment is not only a constant phenomenon, but one which stands 

 in an intimate relation to the numerical increase. For in the 

 interior of the enlarged lymph-corpuscles a nuclear proliferation 

 and endogenous cell-development take place, like that which we 

 have already seen in the cells of tubercle, and that with which 

 we shall hereafter become acquainted in the "typhous" deposit. 

 It is interesting to trace the sequence of the morbid changes in 

 the interior of a gland. We find that the first parts to become 

 affected are those which are on the immediate brink of the stream 

 of lymph, and which are consequently the first to be exposed to 

 the pathological irritant brought from the peripheral seat of 

 mischief. At a very early stage, the stellate corpuscles which 

 traverse the lymph-sinus (across which they may be said to be 

 stretched) begin to take part in the process by division of their 

 nuclei and proliferation of new elements ; this occurs partly at 

 the circumference of the gland round the terminal nodules 

 (Endkolben) partly in its medullary substance ; in either case 

 we have an infiltrated material of soft consistency, which appears 

 of a dull-grey or reddish-grey hue to the naked eye, and which 

 is present in largest amount, where, under normal conditions, a 

 system of intercommunicating lacunse separatees the constituent 

 parts of the gland from one another. As a result of this, the 

 limits of contiguous lymphatic nodules (Lymphkolben) in the 

 cortical substance, and of contiguous lymphatic trabecula3 in the 

 medullary substance, are wholly obliterated ; and in proportion 



