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 oesophagus 



and larynx may even be pushed downwards. 



Swallowing is difficult, in consequence of compression of the upper 



part of the tesophagus, and, as the 



laryngeal nerves may be included in 



the swelling, dyspncea 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 lymjDhatic 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. 1^77. — I.esioiiK in retro-pharyn- 

 geal tuberculosis. T, Trachea ; 

 (E, oesophagus ; P, pharynx ; 

 H, hyoid bone ; E, epiglottis ; 

 L, tongue ; G, tuberculous retro- 

 pharyngeal glands. 



