. Physical diagnosis . ). 2. Abscesses andscars. 3. Thyroid tumors. 4. Pulsations (see below, page 86).5. Torticollis and other lesions simulating it. (6) Tuberculosis of thecervical vertebrae. Rarer lesions will be mentioned below. /. Chains of Enlarged Glands radiate in all directions from the angle of the jaw—upward, in frontof the ear and behind it, forward along the ramus of the jaw, anddownward to the clavicle. The areas drained by the different groupsoverlap so much that it is not necessary to distinguish commonest causes of enlargement are: 30 PHYSICAL DIAGNOSIS (a) Tonsilliti
. Physical diagnosis . ). 2. Abscesses andscars. 3. Thyroid tumors. 4. Pulsations (see below, page 86).5. Torticollis and other lesions simulating it. (6) Tuberculosis of thecervical vertebrae. Rarer lesions will be mentioned below. /. Chains of Enlarged Glands radiate in all directions from the angle of the jaw—upward, in frontof the ear and behind it, forward along the ramus of the jaw, anddownward to the clavicle. The areas drained by the different groupsoverlap so much that it is not necessary to distinguish commonest causes of enlargement are: 30 PHYSICAL DIAGNOSIS (a) Tonsillitis and other inflammations within or around the mouth(diphtheria, the exanthemata, cankers, carious teeth, etc.). Glandu-lar swellings due to these causes are usually acute and more or lesstender; most of them disappear in a fortnight or less, but some persist(without pain) indefinitely. (b) Tuberculosis; long-standing cervical adenitis in children andyoung adults, with a tendency to involve the skin and to suppurate,. Fig. 26.—Tubercular Glands. is usually due to this cause. Certain diagnosis depends on microscopicexamination, animal inoculation, and the tuberculin test. (c) Syphilis; small, non-suppurating glands, occurring in the neckand about the occiput in adults, often accompany syphilis, but thediagnosis depends on the presence of unmistakable syphilitic lesionselsewhere. (d) Hodgkins disease; chronic, large, rarely suppurating glands inthe neck, axillae, and groins, with slight splenic enlargement and nor-mal blood, suggest Hodgkins disease, but microscopic examination is THE NECK 31 necessary to exclude tuberculosis. A superficial gland can be excisedunder cocaine, with very little pain. (e) Lymphatic Leukcemia. No distinguishing characteristics canbe found in the glands, but any nodular enlargement in the neckshould lead us to examine a film specimen of blood, and the leukaemicblood changes are easily and quickly recognized. (/) Malignant disease (near by or at a d
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