A second incision at the edge of the sternornastoid muscle is neces sary only in the rare cases in which a large abscess is about to break through the outer skin.
(c) Acute Swellings of the Lymph-glands of the Neck (Lymphadenitis acuta) (Finkelstein, vol.iii) should in the first place be handled etiologic ally. They belong regionally to affections of the scalp (eczema, impetigo, pedieffii), the ear (otitis media, discharge from the ear), the oral cavity (teeth), or tire pharyngeal or nasal cavities (catarrh, angina).
We first remove thoroughly the respective cause and then treat the glands according to the conservative surgical rules which we have given above and which insure healing without consequent deforming scars; this is especially important in this region of the body, as scars might later cause the patient to be suspected of a healed tuberculosis (scrofulosis). Lymphadenitides in other parts of the body (groins or axiffie) should never be treated radically; the application of heat and punctate incisions will usually suffice, especially when no disquieting general symptoms arise. In deep lymphatic abscesses permanent drainage is used and
they are never packed.
Tuberculous Lymphadenitis (see page 20S).
The pharyngeal mucosa responds to chronic irritations with hyper plasia, especially in lymphatic diathesis. (See Finkelstein, Hyperplasia of tire Faucial and Pharyngeal Tonsils, vol. iii).
If the adenoid growth should narrow the passage it should be removed by operation, adenotomy either with Gottstein's curette or with forceps; the instrument is introduced behind the velum and the hyperplastic tissue is cut off; it is of the greatest importance to remove all loose remnants, because they might cause a serious late hemorrhage. (After having performed hundreds of adenotomies the author considers narcosis superfluous.) The faucial tonsils, when excessively large, are removed with a tonsillotome (Falinenstock's or Matthicu's). This operation can be done in the physician's office, as the bleeding is inconsiderable and will stop soon. Dusty air as well as hard and hot foods should be avoided for a few days.