Cyclopaedia of the diseases of children, medical and surgical / The articles written especially for the work by American, British, and Canadian authors. Ed. by John M. Keating.

  • John Marie Keating
Date:
[1889-99]
Catalogue details

Licence: Public Domain Mark

Credit: Cyclopaedia of the diseases of children, medical and surgical / The articles written especially for the work by American, British, and Canadian authors. Ed. by John M. Keating. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    been given exit, as the formation of a large abscess is to be deprecated. Therefore, as soon as pus forms, a free opening should be made in such a position as will secure good drainage, and free suppuration should be en- couraged by the use of warm dressings. It should not be forgotten, how- ever, that while in adults a cure is to be hoped for chiefly by suppuration, iu children there is a stronger tendency to resolution. While thus pursuing general and local measures looking towards a cure, it is most important to see to it that the original cause of the trouble is not maintained. Therefore the patient should be carefully examined, to ascer- tain whether there is any peripheral disturbance which can be regarded as the original irritation. Especially in cases of cervical disease should the nares, pharynx, and tonsils be examined, and, if necessary, the proper treatment to effect a cure instituted. Ordinarily the results of such local treatment as has been referred to are slow to manifest themselves, and they are too often not perceptible at all. We are, therefore, led to consider the adoption of more energetic and positive treatment. The measures which have grown markedly iu favor of late years are excision, enucleation, and puncture with heated needles. All of them are undertaken with the idea of hastening the progress of the case and facilitating it by destruction of the diseased glands. All of them are justifiable measures in cases properly selected and discriminated. Excision is especially indicated when but one or two glands are in- volved, when the relation to vital parts is not too intimate, and when the tumor is comparatively superficial and movable. The last requisite is most important. Such tumors as are suited for excision generally belong to the more slowly advancing cases, where there is little tendency to suppuration. As a general thing, there is little difficulty in the operation, the glands readily separating from their capsules when they are incised. But very often more glands may be involved than was at first expected, and no sooner is one gland removed than another presents itself from a greater depth. Owing, however, to the ease with which the gland and its cajisule separate, it is often safe to shell out glands from greater depths than would be desirable if a close dissection were required. The risks of the oj)eration are that when the skin and fascia are divided the gland may prove to have closer attachments than was anticipated. So intimate may these connections be by agglutination that the gland cannot be removed without the exercise of much force, which may risk the rupture of the gland and injury to neighboring structures. It is important to avoid the former mishap, lest the cheesy contents of the gland be disseminated through the tissues, M'hile by the latter we may find ourselves confronted with injury to a large vessel or to the j^leura or with the free opening of deep fascial ])lanes. Indeed, the difficulty and danger of a deep dissection are so great that it is generally quite as well, if not better, to withdraw from the procedure when the condi- tions are found to be such as have just been descrilaed. Mr. Holmes once cut the axillary artery iu removing a deep glandular mass in that region,