Recurrent Renal Calculi
Boston Medical and Surgical Journal
several months. When this patient was last seen, the disability in the shoulder was much improved and the deformity much less evident, although the brace had not then been worn for some weeks. In addition to the brace, we employed massage. Though we do not feel that tuberculous glands should never be dissected, we are convinced that such cases should only be done with the most careful regard for the nerve supply of the muscles of the neck, and that the spinal accessory nerve should always be
... served. Dr. Frank H. Lahey, Boston : There is very little to add. It is obvious that in cases of cancer of the neck one disregards the spinal accessory, and this paper is aimed at "bloc" dissections of tuberculous glands. As Dr. Clute has said, these dissections of the glands are not worth while. Better results can be accomplished with the x-ray and with the treatment, of the locally broken down glands. Incidentally, I believe there is a feeling that incision of softened glands is a safe thing, and that you don't get the spinal accessory nerve in this procedure. In this series there have been cases where the spinal accessory has been cut, not in "bloc" dissection but in cervical abscesses, where the visiting surgeon thought it was perfectly safe to turn the case over to a house officer, but the patient got a shoulder drop just from incision. Therefore, you should have the location of this nerve in mind just the same when abscesses are incised and glands poked into for drainage.