al
glands in the severer forms of sore throat associated with diphtheria
and scarlet fever. The most acute suppurations result from infection
with streptococci.

Superficial glands, when inflamed and suppurating, become enlarged,
tender, fixed, and matted to one another. In the glands of the groin the
suppurative process is often remarkably sluggish; purulent foci form in
the interior of individual glands, and some time may elapse before the
pus erupts through their respective capsules. In the deeply placed
cervical glands, especially in cases of streptococcal throat infections,
the suppuration rapidly involves the surrounding cellular tissue, and
the clinical features are those of an acute cellulitis and deeply seated
abscess. When this is incised the necrosed glands may be found lying in
the pus, and on bacteriological examination are found to be swarming
with streptococci. In suppuration of the axillary glands the abscess may
be quite superficial, or it may be deeply placed beneath the strong
fascia and pectoral muscles, according to the group of glands involved.

The _diagnosis_ of septic lymphadenitis is usually easy. The indolent
enlargements are not always to be distinguished, however, from
commencing tuberculous disease, except by the use of the tuberculin
test, and by the fact that they usually disappear on removing the
peripheral source of irritation.

_Treatment._--The first indication is to discover and deal with the
source of infection, and in the indolent forms of lymphadenitis this
will usually be followed by recovery. In the acute forms following on
pyogenic infection, the best results are obtained from the hyperaemic
treatment carried out by means of suction bells. If suppuration is not
thereby prevented, or if it has already taken place, each separate
collection of pus is punctured with a narrow-bladed knife and the use of
the suction bell is persevered with. If there is a large periglandular
abscess, as is often the case, in the neck and axilla, the opening may
require to be made by Hilton's method, and it may be necessary to insert
a drainage-tube.

[Illustration: FIG. 77.--Tuberculous Cervical Gland with abscess
formation in subcutaneous cellular tissue, in a boy aet. 10.]

#Tuberculous Disease of Glands.#--This is a disease of great frequency
and importance. The tubercle bacilli usually gain access to the gland
through the afferent lymph vessels, which convey them from some lesion
of the surf