section of the gland, are sometimes seen to be connected by prolongations of softening with the softened centre. Evacuation of the liquefied matter may eventually take place, a communication being formed with some neighbouring organ.

The tubercule sometimes becomes cretaceous, as it does in other organs.

In bronchial phthisis the glands lying at the bifurcation of the trachea are usually the most enlarged. Those accom-. panying the bronchial tubes into the interior of the lung are less increased in size, although they may be seen larger than natural as far as the third or fourth division of the bronchial tubes. A mass formed of these enlarged glands may occupy the anterior mediastinum, extending from the base of the heart to the top of the sternum.

In mesenteric phthisis the glands often unite to form an irregular nodular mass as large as the fist, or even larger. The mass is situated in front of the vertebral column. If the mesentery is involved, the tumour is fixed; if the mesentery is free, the mass can be moved a little to one side or the other.

Treatment.-On account of the readiness with which the lymphatic glands, both internal and external, become enlarged in tuberculous and scrofulous children, it is of great importance to remove as quickly as possible any local irritations, the continuance of which would lead to the glandular disease. All purulent discharges, skin eruptions, and ulcerations of the skin and mucous membranes, must therefore receive prompt attention. "Little colds " must not be neglected, as disease of the bronchial glands is produced by pulmonary irritation; and the danger of tubercular enlargement of the glands of the mesentery is an additional reason for keeping a careful watch over the condition of the stomach and bowels.

In bronchial and mesenteric phthisis the general measures to be employed are the same as those already

recommended for the treatment of tuberculosis. Cod's liver oil is said to be of especial value in these cases, and should be given with the precautions previously enjoined.

In the case of bronchial phthisis, counter-irritation should always be adopted, either in the form of pustulation with croton oil, or, for children of six or seven years old, by the application of a blister of the size of a two-shilling piece, which must be kept open for some time. The counterirritant should be applied to the upper part of the sternum in front, and between the scapulae behind, alternately. The internal use of iodide of iron is also strongly advocated. The syrup of the iodide may be made use of, or a mixture containing half a grain of iodide of potassium, and five grains of potassio-tartrate of iron, in half an ounce of distilled water, three times in the day. The quantity of the iodide of potassium may be gradually increased.

For mesenteric phthisis, the ointment of iodide of lead may be rubbed into the belly twice a day, and iodide of iron should be given internally as recommended above. Should peritonitis occur, hot linseed-meal poultices applied to the belly, and opium given cautiously by the mouth, form the best remedies. The diarrhoea which is so frequent an accompaniment of the glandular disease should be arrested as rapidly as possible. For the treatment of this complication the reader is referred to the chapter on tuberculosis, and that on chronic diarrhoea. Small enemata of warm starch containing five or ten drops of tinct. opii are very useful in these cases. Unfortunately the diarrhoea is, in many instances, the result of accompanying tubercular ulceration of the bowels; if so, all our efforts will little avail in retarding the fatal termination.

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INDEX.