File:The practice of surgery (1910) (14593123707).jpg

Identifier: practiceofsurger00mumf (find matches)
Title: The practice of surgery
Year: 1910 (1910s)
Authors: Mumford, James Gregory, 1863-1914
Subjects: Surgery
Publisher: Philadelphia and London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ect first thespinal accessory nerve on the affected side, in the hope that this willrelieve the symptoms. Should this operation fail, the surgeon may pro-ceed to the more radical division and avulsion of the posterior branchesof the three first spinal nerves on the opposite side (Keen); or even totenotomies of all the muscles affected (Kocher). After the operationthe patients head should be supported for at least three weeks in a well-fitting Thomas collar, and the surgeon must attend specially to thepatients general condition, directing careful massage, suitable tonics,an out-of-doors rest-cure, or a long vacation. Persistence in these CERVICAL ADENITIS 589 measures will often relieve completely the sufferer; and the destructionof nerves and muscles, even, may be so far recovered from as to leavethe patient with a useful and sightly neck. CERVICAL ADENITIS Cervical adenitis furnishes frequent occasions for operations u))onthe neck. The lymphatics of the neck drain a region peculiarly
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Fig. 389.—The lymph-nodes of the neck (Campbell). susceptible to infection, and for this reason the nodes of the neck, morethan any other group of nodes in the body, are wont to be found enlarged.Anatomists divide the cervical lymphatic nodes into two sets, the super- 590 THE FACE AND NECK ficial and the deep—those immediately below the platysma, and thoseresting upon the carotid sheath. For the clinician, however, no suchinvariable division is possible; the lymphatic channels communicatefreely with each other, and infections of nodes, both superficial anddeep, frequently coexist. Observe the interesting fact, recently pointedout by Crilc: the lowest cervical nodes in the region of the clavicle .seemto act as a collar or barrier, below which malignant processes extendslowly and late—malignant as compared with inflammatory involve-ments. The latter extend early below the clavicle. For the surgeon,then, dealing with cervical adenitis, the important nodes are thoseimmediately behin

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