of the affected
area, and to avoid disfigurement should, whenever possible, be made in
the line of the natural creases of the skin. In exposing the glands the
common facial and other venous trunks may require to be clamped and
tied. Care must be taken not to injure the important nerves,
particularly the accessory, the vagus, and the phrenic. The
inframaxillary branches of the facial, the hypoglossal and its
descending branches, and the motor branches of the deep cervical plexus,
are also liable to be injured. The dissection is rendered easier and is
attended with less risk of injury to the nerves, if the patient is
placed in the sitting posture so as to empty the veins, and, instead of
a knife, the conical scissors of Mayo are employed. When the glands are
extensively affected on both sides of the neck, it is advisable to allow
an interval to elapse rather than to operate on both sides at one
sitting. (_Op. Surg._, p. 189.)

If the tonsils are enlarged they should not be removed at the same time,
as, by so doing, there is a risk of pyogenic infection from the throat
being carried to the wound in the neck, but they should be removed,
after an interval, to prevent relapse of disease in the glands.

_When the skin is broken_ and caseous tuberculous tissue is exposed,
healing is promoted by cutting away diseased skin, removing the
granulation tissue with the spoon, scraping sinuses, and packing the
cavity with iodoform worsted and treating it by the open method and
secondary suture if necessary. Exposure to the sunshine on the seashore
and to the X-rays is often beneficial in these cases.

#Tuberculous disease in the axillary glands# may be a result of
extension from those in the neck, from the mamma, ribs, or sternum, or
more rarely from the upper extremity. We have seen it from an infected
wound of a finger. In some cases no source of infection is discoverable.
The individual glands attain a considerable size, and they fuse together
to form a large tumour which fills up the axillary space. The disease
progresses more rapidly than it does in the cervical glands, and almost
always goes on to suppuration with the formation of sinuses.
Conservative measures need not be considered, as the only satisfactory
treatment is excision, and that without delay.

#Tuberculous disease in the glands of the groin# is comparatively rare.
We have chiefly observed it in the femoral glands as a result of
inoculation tubercle on the toes or