ace within the area drained by them. Tuberculous infection
may supervene in glands that are already enlarged as a result of chronic
septic irritation. While any of the glands in the body may be affected,
the disease is most often met with in the cervical groups which derive
their lymph from the mouth, nose, throat, and ear.

_The appearance of the glands on section_ varies with the stage of the
disease. In the early stages the gland is enlarged, it may be to many
times its natural size, is normal in appearance and consistence, and as
there is no peri-adenitis it is easily shelled out from its
surroundings. On microscopical examination, however, there is evidence
of infection in the shape of bacilli and of characteristic giant and
epithelioid cells. At a later stage, the gland tissue is studded with
minute yellow foci which tend to enlarge and in time to become
confluent, so that the whole gland is ultimately converted into a
caseous mass. This caseous material is surrounded by the thickened
capsule which, as a result of peri-adenitis, tends to become adherent to
and fused with surrounding structures, and particularly with layers of
fascia and with the walls of veins. The caseated tissue often remains
unchanged for long periods; it may become calcified, but more frequently
it breaks down and liquefies.

#Tuberculous disease in the cervical glands# is a common accompaniment
or sequel of adenoids, enlarged tonsils, carious teeth, pharyngitis,
middle-ear disease, and conjunctivitis. These lesions afford the bacilli
a chance of entry into the lymph vessels, in which they are carried to
the glands, where they give rise to disease.

The enlargement may affect only one gland, usually below the angle of
the mandible, and remain confined to it, the gland reaching the size of
a hazel-nut, and being ovoid, firm, and painless. More commonly the
disease affects several glands, on one or on both sides of the neck.
When the disease commences in the pre-auricular or submaxillary glands,
it tends to spread to those along the carotid sheath: when the posterior
auricular and occipital glands are first involved, the spread is to
those along the posterior border of the sterno-mastoid. In many cases
all the chains in front of, beneath, and behind this muscle are
involved, the enlarged glands extending from the mastoid to the
clavicle. They are at first discrete and movable, and may even vary in
size from time to time; but with the addition