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April 30, 1927


Author Affiliations

From the Medical Service of Cook County Hospital.

JAMA. 1927;88(18):1386-1387. doi:10.1001/jama.1927.02680440020007

In differentiating the causes of enlarged cervical glands, the occurrence of fistulas is usually taken as evidence of tuberculosis. The fistulas in lymph gland tuberculosis are the result of caseous areas attaching to and perforating the skin. Caseation is common in tissues invaded by lymphogranuloma (Hodgkin's disease). This form of necrosis occurs oftenest in the densely matted glands of the late stages. Lymphogranuloma characteristically respects anatomic boundaries. In advanced cases, however, it infiltrates the gland capsule and invades adjacent structures. According to Naegeli, 1 the skin over the lymphogranulomatous glands remains absolutely intact. In his experience, infiltration of the skin, adhesion of the affected glands to the skin, or fistulas have never occurred, except as sequelae to injections.

REPORT OF CASE  J. W., a white man, aged 57, a section hand, entered the service of Dr. E. K. Kerr at the Cook County Hospital, May 21, 1926, with the diagnosis