Diagnosis.—­The chief importance lies in differentiating tuberculous disease from lympho-sarcoma and from lymphadenoma, and this is usually possible from the history and from the nature of the enlargement.  Signs of liquefaction and suppuration support the diagnosis of tubercle.  If any doubt remains, one of the glands should be removed and submitted to microscopical examination.  Other forms of sarcoma, and the enlargement of an accessory 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.