A retrospect of surgery, January 1886-January 1890 / prepared by Francis J. Shepherd.

  • Shepherd, Francis J. (Francis John), 1851-1929.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: A retrospect of surgery, January 1886-January 1890 / prepared by Francis J. Shepherd. Source: Wellcome Collection.

    45/278 (page 35)
    85 much more common and enlarged glands have been removed with impunity. I have myself removed as many as 30 to 40 enlarged glands in the neck at one operation, with the best re- sults. The patients, as a rule, recover rapidly. The removal, after the first incision along the posterior border of the sterno- mastoid, should be effected by the fingers, aided, occasionally, with a few cuts of the knife. In many cases, although the glands from external manipulation may seem only enlarged and not softened, in turning out the deeper ones they are often found quite caseous. Care should be taken not to operate on a patient affected with lymphadenoma, and to avoid this mistake the glands in other situations (than cervical) should be examined, and also the spleen. Where there is a persistent elevation of temperature, without suppuration sufficient to cause it, it is better to delay operating. The advantages of removing scrofulous glands are : 1, Free- ing the patient from a tedious and exhausting local disease, which disfigures. 2, Removal of foci of infection, and so, perhaps, preventing general tuberculosis. 3, Improving the general health of patient by early removal. In the Lancet of June 19th and 26th is a paper by Mr. Kenda) Franks of Dublin On the nature of Scrofulous Glands in the Neck and their Surgical Treatment. After speaking of the connection between tuberculosis and scrofulosis, and stat- ing his belief in their identity, he says that tuberculosis of the cervical glands was shown to be the result of the entrance of the tubercle bacillus at some contiguous abraded part, and most cases could be traced to some local affection, as eczema of the head, ulcers in the mouth, sore throat, etc., all of which afforded a nidus for the bacillus. The constitutional peculiarity, the vulnerability of tissue, was a most important factor in deter- mining a proper soil for the development of organisms, and much depended on the dose of the poison received as to the future progress of the case. Three courses were open to the gland to pursue: 1, Death of the bacillus and consequent resolution ; this was unusual. 2, Suppuration and expulsion of the tuber- culous virus ; this might occur in one gland after another, and