Tuberculosis of the lymphatic glands is next to that of the lungs and the intestinal canal, the most frequent form of tuberculous disease, and more especially affects some portions of the lymphatic system, as the bronchial and mesenteric glands, and those of the neck and lumbar region. Children are peculiarly liable to this affection.

Experience yields the following facts in reference to the form in which tubercle occurs in the lymphatic glands.

a. Sometimes we find scattered through the lymphatic glands, ramifying or grouped together, or confluent, roundish, grayish, semi-transparent or turbid, opaque masses of the size of a poppy or millet-seed. Some of these masses present a yellow color and a relaxed texture. There is no doubt that this is the same structure to which, in other places, and especially in the lungs, we apply the name of gray, crude tuberculous granulations.

b. In other cases, and more frequently, the lymphatic glands are plugged up with large roundish or irregular ramifying, greenish-yellow, yellow lardaceo-caseous, hard, although brittle, cleft and gaping, caseo-purulent, fusing masses, into which the lymphatic glands appear to have actually degenerated: the glands, in this case, form tumors, which vary from the size of a hazel-nut to that of a hen's egg, or may be even larger. The glandular substance sometimes, and most commonly, surrounds the adventitious matter, forming, as it were a capsule round it; while sometimes it traverses the latter in the form of stripes, in considerable accumulations. In each form it sometimes appears vascularized, relaxed, and here and there penetrated by one or other of the above-named granulations or smaller yellow, caseous masses, and sometimes it is thickened, indurated, or atrophied. We observe swollen lymphatic glands, arranged like a knotted rope along the jugular veins in the neck, in the mesentery, and along the trunks of the vessels on the lumbar vertebrae, crowded over one another into nodular heaps around the cysterna lumbalis, the head of the pancreas, the biliary ducts, the bronchi, etc.

The question now arises, whether these two forms are only various stages or different degrees of development of one and the same adventitious product. We are convinced that, in the lymphatic glands, in the same manner as in other parenchymatous structures - as, for instance, the lungs - the gray tuberculous granulations may be so accumulated, that they at length run together into considerable and apparently homogeneous masses, and, as they become yellow, constitute the cheesy nodules which are described under 2. But we do not believe that this view holds good for all cases; we are rather of opinion that the tubercle of the second form is the (tuberculous) product of an inflammation of the lymphatic glands. In favor of this view we may notice:

1. The analogy of the adventitious mass with the tuberculous exudation in other tissues.

2. The coincidence of this tuberculosis with tuberculous inflammation - as, for, instance, tuberculosis of the mesenteric glands with tuberculous inflammation of the follicular apparatus of the intestines; tuberculosis of the bronchial glands, with a similar disease of the bronchial mucous membrane, with pneumonic pulmonary tubercle, etc.

3. The homogeneous character of the adventitious product throughout its mass, as well as -

4. In a large number of lymphatic glands, in addition to the absence of tubercle, in the form of gray granulations, or at most to its presence in very inconsiderable quantity.

5. Finally, the painfulness of the diseased gland, at all events at the beginning, and the accompanying fever.

Each of these forms of tubercle of the lymphatic glands not unfre-quently undergoes the softening metamorphosis, giving rise to tuberculous caverns and ulcers of the lymphatic glands, or tuberculous phthisis of the lymphatic glands. The caverns, according to their position, open into the serous cavities, into the intestinal canal, or into the bronchi, in cases of mesenteric or bronchial glandular disease, and very often externally after suppuration of the general investments, as in tuberculosis of the cervical glands.

Sometimes, and especially in the bronchial and mesenteric glands, the tubercle undergoes the process of cretefaction. Its place in the gland is then occupied by a roundish, solid, or partially hollow, always uneven, nodular, tuberose, often ramifying concretion, corresponding to it in size, form, and arrangement; this concretion is often enclosed as in a capsule, and traversed by atrophied, callous, indurated parenchyma, or by a portion of gland still capable of performing its normal functions.

Tuberculosis of the lymphatic glands may be primary, in which case it is either confined to a certain section of the system - as, for instance, the mesenteric glands, or is diffused over nearly the whole system - as, for instance, the glands of the body generally. In the first case it is not unfrequently perfectly isolated and independent, although it is more commonly associated with tuberculosis of the organs in the immediate vicinity of the diseased glands; thus, for instance, we have tuberculosis of the mesenteric glands with tuberculosis of the small intestine, and tuberculosis of the bronchial glands with tuberculosis of the bronchial mucous membrane and the lungs. We regard this combination in most cases, and especially in intense cases, as an original one, - that is to say, we believe that the two structures, as, for instance, the intestinal mucous membrane and the mesenteric glands, are simultaneously affected.

Or the tuberculosis of the lymphatic glands may be secondary, and dependent on tuberculosis of some other organ. The above-named combinations may serve as illustrations; thus, for instance, tuberculosis of the mesenteric glands is often associated with tubercle, and especially with ulcerating tubercle of the intestinal mucous membrane. In such cases we see the lymphatics proceeding from the intestine, and especially from the seat of the ulcer, filled with yellow cheesy tuberculous matter.

Tuberculosis of the lymphatic glands frequently acts as a starting-point for other tuberculoses, and especially for those of the serous membranes.

With the exception of pulmonary tuberculosis, when limited to the apices of the lungs, no tuberculosis becomes healed so frequently as the form we are now considering, when limited to one of the smaller groups of glands. The cure is effected by the suppuration (phthisis) of the gland, and the discharge of the pus externally (as, for instance, in the neck), or by cretefaction of the tubercle (as, for instance, in the bronchial and mesenteric glands).

When, however, tuberculosis of the lymphatic glands is very widely diffused, it may prove fatal, either of itself, or in connection with other pre-existing, simultaneous, or consecutive tuberculoses through tabes, before undergoing the above-named metamorphoses.

The special seat of tuberculosis of the lymphatic glands - regarding it as a secretion from the capillary vessels - is the parenchymatous structure; it is, however, not improbable that the second form of tubercle is exuded into the interior of the lymphatics, and effects their occlusion. The same may happen when tuberculous masses are absorbed by the lymphatics, and transferred to the gland.