The rules of aseptic and antiseptic surgery; a practical treatise for the use of students and the general practitioner . ment ofscrofulous cervical glands. The incision should be ample,and, if the tumors be very exten-sive, the formation of a flap is advisable. The capsule of the uppermostgland being split, the glandular body is shelled out of its nest. This ismuch facilitated by an assistants holding aside the detached capsule witha small, sharp retractor while the surgeon suitably changes the position ofthe mass by turning it one way, then another, until all the looser attach-ments are divid
The rules of aseptic and antiseptic surgery; a practical treatise for the use of students and the general practitioner . ment ofscrofulous cervical glands. The incision should be ample,and, if the tumors be very exten-sive, the formation of a flap is advisable. The capsule of the uppermostgland being split, the glandular body is shelled out of its nest. This ismuch facilitated by an assistants holding aside the detached capsule witha small, sharp retractor while the surgeon suitably changes the position ofthe mass by turning it one way, then another, until all the looser attach-ments are divided. Great care must be exercised herein not to lacerate orcrush the brittle substance of the gland. Each gland has its afferent and efferent vessels, and these form a sort ofpedicle, which must be tied off before it is cut. In cases of very extensive involvement of the cervical glands situatedboth in the vascular and intermuscular interspaces (see page 208), it is veryadvisable to cut the sterno-mastoid muscle across and in two. The spinalaccessory nerve will be found near its posterior margin, and should be Fig. 198.—Giaut cell coritaiuiuii one bacillusfrom a scrofulous gland of the neck (700diametersj. (Koch.) TREATMENT OF TUBERCULOSIS. 271 The stumps of the divided sterno-mastoid muscle are raised from theirmesial attacliments, and one is turned up, the other is turned down. Theotherwise difficult and even dangerous dissection of the glands from thevicinity of the large vessels is made much easier by the free exposure affordedby cutting the sterno-mastoid, which should be reunited by a number ofcatgut stitches after the completion of the exsection. The manner of placing the drainage-tubes, the suture, and dressings,do not differ from the usual arrangement. Before closing the wound, athorough mojiping out with a strong solution (1 : 500) of corrosive subli-mate is necessary, to make sure of destroying all spores of tubercle bacillithat may have escaped with cheesy m
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