GANGLION These small tumours appear oftenest on the back of the wrist, and, when seen early, are in most cases easily dealt with by flexing the wrist so as to make them tense and prominent, when with the firm pressure of the surgeon's thumbs the cyst wall is ruptured and the jelly-like contents squeezed into the surrounding tissues. A smart blow with a smooth hard object effects the same result. When the ganglion resists such pressure a penny-piece wrapped up in two or three layers of lint may be tightly bandaged over it for several hours, the local circulation being carefully watched in the meantime, or milder pressure may be applied over strong Iodine applications. Failing this. a tenotomy knife may be inserted under the scrupulously sterilised skin, making a valvular incision and dividing the wall of the cyst on its lateral aspect. Mere puncture of the ganglion with the point of the knife, as usually recommended, is often useless, as the fluid speedily gathers again. After the incision c.c. of the following should be injected : Absolute Alcohol .. .. It) parts.
Camphor .. 45 parts.
Ac. Carbolici .. 45 parts.
This causes a localised inflammation of the lining membrane of the cyst, and prevents further secretion of the distending fluid.
Another plan is to pass a strand of carbolised thread or horsehair through it under aseptic precautions, and permit it to remain for 5 or 6 days, after which the punctures are to be sealed up by a dry antiseptic dressing.
When, notwithstanding these measures, the fluid reappears, the only treatment is to excise completely the ganglion. This is the recognised routine method of dealing with the large compound ganglia, which are always of tuberculous nature. In the dissection the whole of the diseased sheath must be taken away, and its prolongations followed up even in some instances to the opening up of the smaller joints. All melon-seed bodies with every portion of the walls of the sac must be removed. The space should then be freely smeared with Bipp (Morrison), and the wound closed with sutures under an antiseptic gauze dressing. The joints involved should be exercised passively and actively within a period of at most to days to prevent ankylosis and gluing of the tendons in their new sheaths. The plan of injecting Iodine or other irritant into compound ganglia is not to be recommended.