ly those in the neck, axilla, and
groin, are greatly enlarged.

TUMOURS OF LYMPH GLANDS

#Primary Tumours.#--_Lympho-sarcoma_, which may be regarded as a sarcoma
starting in a lymph gland, appears in the neck, axilla, or groin as a
rapidly growing tumour consisting of one enlarged gland with numerous
satellites. As the tumour increases in size, the sarcomatous tissue
erupts through the capsule of the gland, and infiltrates the surrounding
tissues, whereby it becomes fixed to these and to the skin.

[Illustration: FIG. 82.--Lympho-Sarcoma removed from Groin. It will be
observed that there is one large central parent tumour surrounded by
satellites.]

The prognosis is grave in the extreme, and the only hope is in early
excision, followed by the use of radium and X-rays. We have observed a
case of lympho-sarcoma above the clavicle, in which excision of all that
was removable, followed by the insertion of a tube of radium for ten
days, was followed by a disappearance of the disease over a period which
extended to nearly five years, when death resulted from a tumour in the
mediastinum. In a second case in which the growth was in the groin, the
patient, a young man, remained well for over two years and was then lost
sight of.

#Secondary Tumours.#--Next to tuberculosis, _secondary cancer_ is the
most common disease of lymph glands. In the neck it is met with in
association with epithelioma of the lip, tongue, or fauces. The glands
form tumours of variable size, and are often larger than the primary
growth, the characters of which they reproduce. The glands are at first
movable, but soon become fixed both to each other and to their
surroundings; when fixed to the mandible they form a swelling of
bone-like hardness; in time they soften, liquefy, and burst through the
skin, forming foul, fungating ulcers. A similar condition is met with in
the groin from epithelioma of the penis, scrotum, or vulva. In cancer of
the breast, the infection of the axillary glands is an important
complication.

In _pigmented_ or _melanotic cancers_ of the skin, the glands are early
infected and increase rapidly, so that, when the primary growth is still
of small size--as, for example, on the sole of the foot--the femoral
glands may already constitute large pigmented tumours.

[Illustration: FIG. 83.--Cancerous Glands in Neck secondary to
Epithelioma of Lip.

(Mr. G. L. Chiene's case.)]

The implication of the glands in other forms of ca