When suppuration occurs there can be no room for differences of opinion regarding the necessity for surgical interference. To wait till the abscess spontaneously perforates the skin is certain to lead to the infection of the cutaneous tissues and the abscess cavity with pyogcnic organisms intro duced from without.
As the contents of these abscesses are often sterile there is ample scope for successful aseptic surgical measures. Various procedures are followed, and in the main these are such as have already been detailed in the articles on Abscess and Hip-Joint Disease. The common situation of the suppurat ing glands at the angle of the jaw or anterior aspect of the neck introduces the problem of cosmetic effect, and the surgeon's endeavour should be to evacuate the contents and leave as small a scar as possible.
The skin having been sterilised, an incision is made with a tenotomy knife and an endeavour made to remove the abscess cavity intact. This will usually fail, and then a curette is introduced to scrape the walls of the abscess cavity in such a way as to leave no tags of infected tissue. If the surgeon has succeeded in this he may close the wound completely, providing only for escape of blood within the first 24 hours after operation.
The plan of applying a Klapp's suetiun-llell over a small incision as in the treat a lea I of acute septic lyini diatlenit is is sometimes resorted to.
Anv of the methods described under Abscess may be followed. When the skin has already become involved the best procedure is to pack the cavity with lodoform gauze after scraping with the sharp spoon. It may be necessary to clip away the infected overlying skin margins.
Sinuses may be most satisfactorily healed by injecting Beck's Bismuth Paste (warmed) into the openings, but this preparation should not be used fur filling the abscess cavity before sealing up the wound in the skin.
Tuberculous lvmphadenitis is rare in the groin glands, but many years ago before excision was introduced the writer successfully dissected out a mass of chronically inflamed glands in the interior of which was a large calcareous deposit. This had led to the case being regarded for years as one of disease of the femur, since a probe introduced through any of the numerous sinuses struck upon the calcareous mass.
Lymphadenitis involving the mediastinal glands is as a rule only to be dealt with by open-air life and improved hygiene combined with minute doses of Tuberculin. Mesenteric Gland Disease is referred to under its own heading.
The non-suppurative cervical lymphadenitis of Dawson Williams, like that present in German Measles, requires no active interference, as spontaneous resolution always occurs.