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 surface 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.