Excision may be performed if the mass be large or disfiguring.
1. Whenever fluid—that is, pus—can be detected in connection with a dis eased lymphatic gland, the operation should be done before the skin becomes red and thin. 2. When the diseased gland is subcutaneous—that is, not be neath the deep fascia or muscle, and has been completely removed—the least scar will result if neither stitches nor drainage-tube be used, especially if it be possible to leave the wound uncovered by dressing and exposed to the air, so that the edges may be drawn and glued together by drying lymph. 3. If the diseased gland be beneath the muscle or muscular fascia, then a drainage-tube must be used and the edges of the wound must be united by suture. The best drainage-tube is the gilt spiral wire, especially as it may have to remain from two to eight or ten weeks, accord ing to the depth of the wound or the completeness of the removal of the gland. 4. Where many glands have to be re moved, it is better to remove them through a series of small incisions and thereby avoid very extensive ones. All sinuses and suppurating cavities should be thoroughly cleansed by means of scraper and lint, so as to leave a fresh surface free from granulation or decayed or decaying tissue, and that a drainage exit should be maintained until all the deep parts are healed. Teale (Brit. Med. Jour., No. 1717, '93).
Important to avoid tearing or wound ing the gland in removing it, to keep close to its surface in order to prevent haemorrhage, and to use transverse in cisions. W, K. Treves (Brit. Med. Jour., No. 1717, '93).
Electricity, preferably the constant current, is highly recommended by some authors. Daily sittings of ten minutes each, using 5 to 15 milliamperes, are required.
The great majority of the cases of cervical adenitis are to be treated medi cally, since they only come under ob servation after suppuration has oc curred. In the cases of tubercular adenitis which are not yet suppurating. extirpation through a small incision is indicated at once, with medical after treatment to prevent recurrence. When one hard, caseous nodule exists, it should at once be extirpated, unless the resulting scar will cause marked de formity. When these are multiple, im
mediate extirpation is the treatment to be followed. Should the adenitis be come purUlent, extirpation is only in dicated after all other methods of treat ment have failed. Local injections are advised, with a long sojourn at the sea shore, especially should fistula; occur. Clean dressings must be applied to the fistulre to prevent secondary infection. When extirpation is done, it should be complete. A. Broca (Jour. des Prati ciens, Oct. 26, 1901).
Codliver-oil, the iodides, and iron are indicated in all cases when the digestive organs do not rebel against their use. Arsenic and strychnine are the agents next in order, and sometimes prove very effective. Out-of-door life and plentiful nourishment are of primary importance.
Chronic Adenitis.
Symptoms. — The symptoms vary ac cording to the period of development in which the diseased gland is found at the time of examination.
Three periods of development are commonly recognized in tuberculous adenitis: the period of induration, or indolence; the period of inflammation; and the period of suppuration.
1. Period of Induration, or Indolence. period may last for years, and resolution may even take place, though the gland always remains somewhat en larged and indurated. The glands are felt as hard, elastic, enlarged bodies, rolling under the finger, with more or less distinctness as they are situated superficially or deep. No heat, pain, or redness of the skin is perceived.
2. Period of Inflammation. — In this period we have pain, redness of the skin, and tenderness on pressure. The gland, if solitary, may adhere to the skin. Fluctuation may be present.
3. Period of Suppuration. — In this period we notice much more softening of the contents of the gland than a real suppuration. The skin may ulcerate through almost without inflammatory symptoms, and the contents—consisting of caseous matter half-dissolved in a whitish watery fluid—may be evacuated. When periadenitis occurs, true pus may be present.