44 Anatomy Applied to Medicine and Surge* y. 



that of Hilton, which is carried out as follows : A short 

 incision is made through the integument and superficial 

 tissue in the situation mentioned and a grooved director 

 is thrust, with a boring movement, through the deep fascia 

 into the axilla until pus finds its way along the groove. 

 In making the above incision an artery lying in the super- 

 ficial fascia might be wounded, viz. the superficial ex- 

 ternal mammary running across from the axillary artery 

 to the thorax. Having established the presence and 

 situation of the purulent collection a pair of artery forceps 

 follows up the director, the blades are opened and with- 

 drawn, thus enlarging the channel. This method is per- 

 fectly safe and may be employed in the case of all deep 

 seated abscesses. If the knife were thrust into the axilla 

 there would be danger of wounding some of the blood 

 vessels with resultant hemorrhage, possibly of a serious 

 character, before the surgeon could enlarge the wound 

 and ligate the vessel. Thus, if the knife were entered at 

 the anterior aspect of the axilla, the long thoracic which 

 runs along the lower border of the pectoralis minor, and 

 therefore near the lower border of the pectoralis major, 

 might be wounded. If entered toward the posterior 

 boundary, the subscapular, which lies about one inch 

 above the lower border of the latiss. dorsi, or some of its 

 larger branches might be injured; if too near the thorax, 

 the external respiratory nerve might be severed with 

 subsequent paralysis of the serratus magnus. If exter- 

 nally, the axillary vessels, and especially the vein, might 

 be wounded. The incision above referred to should be 

 employed in the removal of lymphatic glands from the 

 axilla, and in this operation it is inadvisable to tear 

 out a gland with the finger used as a hook through a 

 small incision, since these glands, and especially those on 

 the outer aspect, are intimately connected with the veins, 



