116 CLINICAL DIAGNOSTICS. 



vessels of the submaxillar)' glands, these 

 organs become secondarily diseased. The 

 primary disease usually has its seat in the mucous membrane 

 of the nasal passages or sinuses. An examination of the 

 glands, therefore, is of great significance in determining the 

 pathological condition of these mucous membranes. 



In making the examination the following points are to be 

 considered : 



a. Is one o r both glands enlarged? In acute 

 infectious catarrhs the glandular swelling is generally bilat- 

 eral; in glanders frequently unilateral, and in tumors in the 

 nasal passages, bad teeth and chronic catarrh of the sinuses, it 

 is, as a rule, unilateral. 



b. Size and form of the glandular swell- 

 ing. Many or a few of the lobules may be enlarged to the 

 size of a bean, pigeon or hen's egg, depending upon the pri- 

 mary disease in the mucous membranes. Acute swellings are 

 smooth; chronic swellings lobulated (nodular), which is espe- 

 cially marked in glanders. 



Well marked, clearly defined, smooth enlargements of 

 individual lobules are observed in leucemia (a hyperplasia), 

 and when malignant tumors are developing in the glands. 



c. Consistency of the swollen glands. The 

 swelling is soft in serous, tense and firm in cellular infiltration 

 of the glands. Acute diffuse swellings (stran- 

 gles) often lead to suppuration (ab- 

 scess) , which can be determined by fluctuation. In 

 glanders diffuse abscess formation never occurs in the glands ; 

 only rarely does a small purulent focus (farcy bud) appear in 

 the skin over the gland. Firm, hard enlargements 

 are always due to some chronic irritation and consist of con- 

 nective tissue proliferations. Such attend chronic glanders, 

 catarrhs and dental fistulae. 



d. Temperature and sensitiveness. When 

 the glands are hot and tender (inflamed), the morbid con- 



