Tuberculosis of the Lymphatic Glands.
Prior to the discovery of the bacillus of tuberculosis this condition was known as scrofula. It is a form of tuberculous infection which is mild in character and amenable to treatment and does not necessarily dispose the patient to general infection. It is very common among children and among young adults up to middle life it is quite frequent. Perhaps the benignity of this form of the infection may be explained by the fact that the lymph nodes antagonize the entrance of infection of a micro-organic character into the system, and may thus inhibit the virulence of the tubercular bacilli. The condition may be local, as when it affects the cervical, bronchial or mesenteric glands, or it may affect the lymph glands throughout the entire body. This general form is usually secondary to local infection of the cervical glands.
Symptomatology:—In the cervical form there may be no evidences of disease until it is apparent that there is progressive enlargement of the cervical glands. Under the finger these are small, hard, distinctly circumscribed nodules, which slowly increase in size until the single glands become as large as an egg. The enlargement is movable and continues hard and firm, until suppuration occurs. With the development of pus there are the usual symptoms of fever, of an irregular type. Usually the loss of strength and appetite is not excessive, but there is general indisposition, emaciation and anemia. This condition may involve all of the cervical glands as well as the axillary glands also. The tumors may coalesce and form large unsightly masses, and the suppuration may open channels or sinuses between the glands. The condition may occur primarily in the bronchial glands and may result in ultimate pulmonary infection. It may be associated with catarrhal bronchitis when there is present cough and fever with considerable bronchial irritation. The sputum is purulent in character and contains blood and caseous matter, in which the bacilli are found.
The condition invades the mesenteric glands, usually when there has been a primary intestinal tuberculosis. The evidences point to a peritonitis, which ultimately may become general, and is accompanied with effusion. Fever is present, irregular in character and irregularly intermittent. The skin is dry and harsh and assumes a characteristic pallor and there is emaciation and anemia.
When the infection becomes general within the lymph glands the usual symptoms of debility, progressive emaciation, a cachetic appearance, with mild fever, are present. The fever is persistent, but seldom high. There is loss of appetite, constipation and ultimately a general inactivity of the glandular organs throughout the system. Malnutrition is one of the common accompaniments of the disease.
It assumes a chronic character in nearly all cases. The danger lies in its inducing an active infection outside of the lymph glands of a more serious type.
The pathological elements of this disease are very similar to those of pseudo leukemia.
Treatment of glandular tuberculosis:—Taken early, this form of tuberculosis is usually quite amenable to treatment. The patient should be put into the best possible condition as to environment. The country air or the sea coast is essential. He should have a thorough sponge bath, followed by a salt rub twice a week. Any disturbance of the digestion or faults in the appropriation of food must be promptly and positively met with the appropriate remedies, and the nervous system must be built up and thoroughly sustained by appropriate tonics, and finally, but most important of all, the blood must receive studious attention. But it will be useless to attempt to correct the condition of the blood and continue the patient in a close, filthy, poorly ventilated city apartment house, with poor food and improper care.
The specific remedy is phytolacca. This operates directly upon the glandular conditions, assisting in the elimination of the morbific material. This must be enforced by echinacea to destroy the virulence of the infection, and these two remedies must be continued for a long time. With these the iodid of iron is important also, although they should be given in alternation, rather than in conjunction. Berberis given with hydrastis and collinsonia and the carbonate of iron will be found of much service when a change in the treatment is desired for a time. I have also obtained excellent results from a combination which, while not so scientific, is of pronounced benefit. This is made of yellow dock, alnus rubra, phytolacca and podophyllum, the latter in doses just short of producing irritation of the bowels.
Cod liver oil, with or without the glycerophosphates or the hypophosphites is an important adjunct to the treatment in the poorly nourished cases.
When disintegration takes place and pus forms the fever and constitutional indications must be promptly met. Aconite in small doses and bryonia must then be given, but the important procedure if the glands are greatly enlarged is excision. Thorough evacuation of all purulent material is essential, but the excision of all the tuberculous structures, if not too general, is of much importance. Excision is advised only when the glands are greatly enlarged and when, from constitutional conditions, which do not yield to medical treatment, the enlargement is persistent. Begun early, especially with children, the medical treatment is most essential, and conducted with confidence and positiveness, is curative in a large proportion of the cases.
