Tuberculous disease in the mesenteric and bronchial glands is described with the surgery of regions.

#Syphilitic Disease of Glands.#—­Enlargement of lymph glands is a prominent feature of acquired syphilis, especially in the form of the indolent or bullet-bubo which accompanies the primary lesion, and the general enlargement of glands that occurs in secondary syphilis.  Gummatous disease in glands is extremely rare; the affected gland rapidly enlarges to the size of a walnut, and may then persist for a long period without further change; if it breaks down, the overlying skin is destroyed and the caseated tissue of the gumma exposed.

#Lymphadenoma.#—­Hodgkin’s Disease (Pseudo-leukaemia of German authors).—­This is a rare disease, the origin of which is as yet unknown, but analogy would suggest that it is due to infection with a slowly growing micro-organism.  It is chiefly met with in young subjects, and is characterised by a painless enlargement of a particular group of glands, most commonly those in the cervical region (Fig. 80).

[Illustration:  FIG. 80.—­Chronic Hodgkin’s Disease in a boy aet. 11.]

The glands are usually larger than in tuberculosis, and they remain longer discrete and movable; they are firm in consistence, and on section present a granular appearance due to overgrowth of the connective-tissue framework.  In time the glandular masses may form enormous projecting tumours, the swelling being added to by lymphatic oedema of the overlying cellular tissue and skin.

The enlargement spreads along the chain of glands to those above the clavicle, to those in the axilla, and to those of the opposite side (Fig. 81).  Later, the glands in the groin become enlarged, and it is probable that the infection has spread from the neck along the mediastinal, bronchial, retro-peritoneal, and mesenteric glands, and has branched off to the iliac and inguinal groups.

Two clinical types are recognised, one in which the disease progresses slowly and remains confined to the cervical glands for two or more years; the other, in which the disease is more rapidly disseminated and causes death in from twelve to eighteen months.

[Illustration:  FIG. 81.—­Lymphadenoma (Hodgkin’s Disease) affecting left side of neck and left axilla, in a woman aet. 44.  Three years’ duration.]

In the acute form, the health suffers, there is fever, and the glands may vary in size with variations in the temperature; the blood presents the characters met with in secondary anaemia.  The spleen, liver, testes, and mammae may be enlarged; the glandular swellings press on important structures, such as the trachea, oesophagus, or great veins, and symptoms referable to such pressure manifest themselves.