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Show 3344 or cenrxc our run GLANDS or Inn Drum" to cut out. Therefore, when these glands are small and loose, but have become very hard, and have not yet condensed the surrounding cellular membrane, I would have the surgeon to examine well previously; then fix them betwixt his fore and middle finger, pressed upon. the side of the chest; then cut down upon the glands, and before the fingers of the left hand are raised, put the dissecting hook fairly through them, and pull them out. But this is a trifling operation compared with the dissection of the deep indurated and clustered tumour of the axillary glands. In this case, the tumour should be dissected to lit. tle more than the extent of its outward hemisphere ; and then insulated by working with the fingers ; then around the stringy shreds and vessels by which it is held a ligature is to be put, and the glands cut off ; or, taking hold of this root with a pair of strong forceps, and resisting with the forceps, the tumour is to be pulled away: if this be dexterously done, the tumour does not bleed, and the parts heal very quickly. It is recommended to use the needle here ; to pass a needle and double ligature through the fat and cellular substance, immediately beyond the glands. In the first volume of the Anatomy, the consequence of the use of the needle in the hands of common surgeons, is exemplified. They may go too deep, and strike it into the nerves, or even into the artery. But of this there will be no danger, if the gland is well insulated by the fingers from the loose cellular membrane, and if the surgeon does not dive wide and at random. I fancy it is when the arteries have been cut across, and have shrunk into the axilla, that the surgeon does mischief in diving for them with the needle. Though it be unpleasant to use the sponge, yet it is good to EX'IIRPATION OF THE BREAST. 135 If there be much loss of skin, and the lips meet with much difliculty after the extirpation of the mamma, one or two liga. tures may be used with advantage, whilst the arm is bound forward upon the chest, and the head is inclined a little. But in common cases, and where the integuments meet, liga- tures and the needle are out of the question. The adhesive straps, compress, and bandage, are most effectual in retaining the wound together, and in procuring adhesion. Adhesive straps are useful not only as bringing the parts accurately together, but as a general support to the parts. The wound should be put together, and a compress of soft lint held upon it lightly for some time before it is dressed; the patient raised, comforted, and assured that the operation is over : she should be made to take a little wine. If there be any arteries of importance untied, they will probably bleed now; and it with this they do not bleed, the dressing will secure her against hr'emorrhage from such arteries. The surgeon, with the towel in his hand, lays the edges of the integuments neatly together, at the same time pressing them to the side of the chest, so as to prevent all oozing un~ der the skin. The ligatures are to be brought out at the ex~ tremities of the wound. While the surgeon holds the parts properly in contact, his assistant places the adhesive straps (which should be about an inch in breadth) at the distance of a quarter of an inch from each other. The strap should be placed on one side of the wound first, and then the surgeon putting it down over the lips with the point of his finger, the assistant fixes it in all its length. The edges of the skin, in this manner, it ill be prevented from curling in. After this, lay some strips of soft lint along the edges of the Wound, and a large soft compress over the whole. Be attenv know that almost any degree of haemorrhagy, but what pro-v tive in laying the tips of the wound, and keeping the flaps of ceeds from the axillary artery itself, may be suppressed by the skin close, and equally pressed to the pectoral muscle. use of the sponge and compress, as described in the Introduc- broad roller of flannel is put about the chest, and the one end of a split cloth being sewed to it behind, the other extremi» ties are brought over the shoulders and fastened to the roller before by pins. tion. The arteries may he commanded by placing the arm by the side after the compress is put into the arm-pit, and bandaging it down well. A |