(SCROFULA)
=Scrofula= is a true tuberculosis of the lymphatic glands. The virus is
less virulent than that from other sources, which accounts for the slow
development and milder course of tuberculosis of the glandular system.
=Tuberculous Adenitis= may occur at all ages, but is most common
in children and young adults. It is rarely congenital. Catarrhal
inflammation of the mucous tissues weakens the resisting power of the
lymph tissue, thus allowing the bacilli to develop, and is an important
predisposing cause. The glands most frequently affected are those of
the neck; more rarely there is involvement of all the lymphatic glands
of the body. Invariably lesions of the upper and middle cervical
vertebræ and upper dorsals and corresponding ribs are found, as well as
lesions to the lymphatics at various points along the spinal column and
ribs. These lesions affect the innervation to the lymph glands, as well
as mucous membranes, and thus predispose to the disease. In all cases
anatomical derangements are found in the region of the innervation to
the involved gland.
In =general tuberculous adenitis= all the lymph glands of the body are
more or less involved, while the other organs and tissues are rarely
affected. All the visible glands are found to be swollen, tender and
painful. There is more or less protracted fever, with wasting and
debility. This is a rare affection.
In =local adenitis= the glands of the neck are most frequently affected
and this is especially the case with children. Negroes are more
frequently affected than whites. It is seen especially among those
living in an unsanitary environment. Measles, whooping cough and an
hereditary tendency are predisposing factors. The submaxillary glands
are usually the first affected. At first they are swollen to various
degrees and are tender; later they suppurate and rupture if one is not
able to cure them. There may be fever. The skin over the glands is
usually freely movable; it may, however, be adherent.
The glands above the clavicle, those in the posterior cervical
triangle, and the axillary glands may all be affected. In such cases it
is likely that the bronchial glands are also involved and may infect
the living tissue.
Lesions of the upper and middle cervicals and deep muscles are always
found and undoubtedly are the underlying causes. Lesions of the lower
cervical, upper dorsal, ribs and clavicle, are of frequent occurrence.
Infection may gain entrance by way of the pharynx and tonsils.
The affection often runs a slow course.
The =bronchial= glands may be affected primarily, but usually
secondarily to infection of the lungs. The primary form is seen most
commonly in children and is apt to be associated with suppuration.
Lesions of the upper and middle dorsals and of the cervicals will be
found. Catarrh of the bronchial tubes is a predisposing cause. The
X-ray is of great value in the diagnosis.
The most noticeable symptoms are those due to pressure or irritation.
Systemic infection may follow rupture into a vessel. Local infection of
the lung may occur and the pericardium become infected.
=Mesenteric= cases occur among children and may be primary or
secondary. The primary form is rare. Swallowed sputum is a frequent
cause. The trunk and limbs are puny. The child is anemic, and often
the abdomen is tympanitic. Diarrhea is marked and there is pain and
indigestion. Fever is almost constantly present and of an intermittent
type. The disease is most frequently met with among poor children
in unhygienic, poorly ventilated houses. There may be an associated
tuberculosis of the peritoneum.