THE LYMPHATICS 



H5 



the region of the pharynx, from whence the infection is easily spread 

 to the glands. 



There is great swelling of the glands, which causes much inter- 

 ference with the respirations and with deglutition, owing to pressure 

 upon the pharyngeal wall. Evidences of enlargement of the glands 

 make their appearance just below the ear, where they cause the thin, 

 upper portion of the parotid to bulge outwardly, and also, and more 

 frequently, near the postero-inferior end of the parotid, where the 

 condition has advanced to those glands which extend towards the 

 thyroid body. As infection progresses the chain of lymphatics along 

 the course of the carotid artery becomes affected, and a long diffuse 

 swelling makes its appearance in the jugular furrow. 



The condition is easily distinguished from a swelling of the 

 parotid gland, since the swelling in the case under consideration is 

 much more ill-defined. The parotid gland is pushed outwardly, and 

 careful manipulation will reveal the fact that its outline is better 

 marked. 



As in the case of abscess formation in the parotid the condition 

 here quickly progresses, fluctuation may be readily detected ; and 

 unless a surgical outlet is made for the escape of the purulent 

 contents, the abscess bursts. 



From the relationship of the glands to the pharynx it will be 

 readily understood that there is very little resistance to the pointing 

 and bursting of the abscess towards the pharynx, and to the 

 consequent discharge of its inflammatory contents into that chamber, 

 with the result that pneumonia arises as a serious complication. 



The surgical opening of the abscess is thus indicated at the 

 earliest possible opportunity, and of the methods recommended 

 probably that of Virborg is the one which is attended by least risk. 

 The principle of this method is that, after the cutaneous incision has 

 been made, the use of a sharp instrument is discarded, and the under- 

 lying structures broken down or separated by the operator's finger, 



