ae BOTANIC PHYSICIAN. 
_ yet it answers the purpose better, to lay the glands first bare by an 
Mee sicn, in t maga I have advised, and then to dissect them 
cautiously out with the scalpel. In the course of the dissection, & ‘ 
good deal of assistance may be obtained from passing a strong liga 
re through the largest gland; by which the whole cluster with — 
which it is: connected, may be elevated from the parts below, so as _ 
to admit of their being more easily cut out with the sealpel ; and it 
often happens, that these indurated glands run so near to the arm- 
pit artery, as to render it highly proper to use every probable means 
' for rendering the dissection safe and easy. § 
In like manner, when a cluster of diseased glands is found to ex- 
tend towards the collar bone, or in any other direction, after the 
teguments have been freely divided, the glands themselves should be 
__ totally removed ; and both here and in similar affections in the arte 
pit, the divided teguments should be brought together and retained 
aed ation, either by means of compression, or, when this i 
not sufficient, by the introduction of one or more sutures. - 
The point that I more especially wish to inculcate, respecting this 
operation, is, the propriety of saving as much skin as possible, The 
necessity of this had rarely, if ever, occured to our forefathers ; and 
accordingly, the common practice has been, to remove all the skin 
corresponding to the morbid parts underneath ; by which much un 
necessary pain is produced ; a very extensive and ugly sore is left, 
and the cure is always tedious. Instead of which, although it may 
not m every instance, be practicable by the means I have advised, to 
cover the sore entirely with skin ; yet, in all cases, a considerable 
part of it may for certain receive this important advantage ; by which 
the extent of the sore will be mach diminished; a cure will be prose = 
portionably sooner effected ; and by the cicatrix being less extensive, 
the risk of the patient in future will probably be less also. — 
OPENING THE WINDPIPE. 
_When respiration becomes much obstructed, and endangers thé — 
life of the patient, and when this appears to proceed from a local af 
fection, or obstruction of the upper part of the windpipe, an opera- 
tion may become necessary for relief . oe 
This operation has in general been supposed to be of amore dan- 
gerous nature than it really is; and this has, no doubt, often pre 
vented it, when it might have saved life. eS 
The causes that may render an opening of the windpipe necessary, 
BrYOgre +. wee 
1. Spasmodic affections of the funnel of the windpipe, when they 
threaten suffocation : this may happen from catarrh, or acid mucuss 
or from hard substances passing into the windpipe, which, even 
_ thoughtheir size would not choke the passage, may, by their irrita 
tion, Cause a spasmodic contraction. . 
2. Apiece of bone, flesh, or any other firm substance, being lodg- 
ed in the funnel, or upper part of the food canal, and too large tO 
pass down to the stomach, may, by its bulk, compress the back. and 
_ membranous part of the windpipe in such a manner as to produce | 
total obstruction of the passage of air into the lungs. Instances a 
ave occurred, of suffocation being produced by a piece of fies 
