At any stage the disease may be arrested and the glands remain for long periods without further change. It is possible that the tuberculous tissue may undergo cicatrisation. More commonly suppuration ensues, and a cold abscess forms, but if there is a mixed infection, the pyogenic factor being usually derived from the throat, it may take on active features. [Illustration: FIG. 78.--Mass of Tuberculous Glands removed from Axilla (cf. Fig. 79).] The transition from the solid to the liquefied stage is attended with pain and tenderness in the gland, which at the same time becomes fixed and globular, and finally fluctuation can be elicited. If left to itself, the softened tubercle erupts through the capsule of the gland and infects the cellular tissue. The cervical fascia is perforated and a cold abscess, often much larger than the gland from which it took origin, forms between the fascia and the overlying skin. The further stages--reddening, undermining of skin and external rupture, with the formation of ulcers and sinuses--have been described with tuberculous abscess. The ulcers and sinuses persist indefinitely, or they heal and then break out again; sometimes the skin becomes infected, and a condition like lupus spreads over a considerable area. Spontaneous healing finally takes place after the caseous tubercle has been extruded; the resulting scars are extremely unsightly, being puckered or bridled, or hypertrophied like keloid. While the disease is most common in childhood and youth, it may be met with even in advanced life; and although often associated with impaired health and unhealthy surroundings, it may affect those who are apparently robust and are in affluent circumstances. _Diagnosis._--The chief importance lies in differentiating tuberculous disease from lympho-sarcoma and from lymphadenoma, and this is usually possible from the history and from the nature of the enlargement. Signs of liquefaction and suppuration support the diagnosis of tubercle. If any doubt remains, one of the glands should be removed and submitted to microscopical examination. Other forms of sarcoma, and the enlargement of an accessory thyreoid, are less likely to be confused with tuberculous glands. Calcified tuberculous glands give definite shadows with the X-rays. Enlargement of the cervical glands from secondary cancer may simulate tuberculosis, but is differentiated by its association with cancer in the mouth or throat, and by the characteristic, stone-like induration of epithelioma. The cold abscess which results from tuberculous glands is to be distinguished from that due to disease in the cervical spine, retro-pharyngeal abscess, as well as from congenital and other cystic swellings in the neck.