The excision of tuberculous glands is often a difficult operation, because of the number and deep situation of the glands to be removed, and of the adhesions to surrounding structures.  The skin incision must be sufficiently extensive to give access to the whole 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 sole of the foot.  The affected glands nearly always break down and suppurate, and after destroying the overlying skin give rise to fungating ulcers.  The treatment consists in excising the glands and the affected skin.  The dissection may be attended with troublesome haemorrhage from the numerous veins that converge towards the femoral trunk.