ssory thyreoid, are less likely to be confused with
tuberculous glands. Calcified tuberculous glands give definite shadows
with the X-rays.

Enlargement of the cervical glands from secondary cancer may simulate
tuberculosis, but is differentiated by its association with cancer in
the mouth or throat, and by the characteristic, stone-like induration of
epithelioma.

The cold abscess which results from tuberculous glands is to be
distinguished from that due to disease in the cervical spine,
retro-pharyngeal abscess, as well as from congenital and other cystic
swellings in the neck.

_Prognosis._--Next to lupus, glandular disease is of all tuberculous
lesions the least dangerous to life; but while it is the rule to recover
from tuberculous disease of glands with or without an operation, it is
unfortunately quite common for such persons to become the subjects of
tuberculosis in other parts of the body at any subsequent period of
life.

_Treatment._--There is considerable difference of opinion regarding the
treatment of glandular tuberculosis. Some authorities, impressed with
the undoubted possibility of natural cure, are satisfied with promoting
this by measures directed towards improving the general health, by the
prolonged administration of tuberculin, and by repeated exposures to the
X-rays and to sunlight. Others again, influenced by the risk of
extension of the disease and by the destruction of tissue and
disfigurement caused by breaking down of the tuberculous tissue and
mixed infection, advocate the removal of the glands by operation.

The conditions vary widely in different cases, and the treatment should
be adapted to the individual requirements. If the disease remains
confined to the glands originally infected and there are no signs of
breaking down, "expectant measures" may be persevered with.

[Illustration: FIG. 79.--Tuberculous Axillary Glands (cf. Fig. 78).]

If, on the other hand, the disease exhibits aggressive tendencies, the
question of operation should be considered. The undesirable results of
the breaking down and liquefaction of the diseased gland may be avoided
by the timely withdrawal of the fluid contents through a hollow needle.

_The excision of tuberculous glands_ is often a difficult operation,
because of the number and deep situation of the glands to be removed,
and of the adhesions to surrounding structures. The skin incision must
be sufficiently extensive to give access to the whole