ANGINA LUDOVICL 477 



accompanies retropharyngeal abscess, the affection is preceded for a 

 time by peculiar stiffness of the neck and other symptoms of the verte- 

 bral disease ; in this case we cannot easily make a mistake, for, as soon 

 as there is difficulty of swallowing, the inside of the throat will be 

 carefully examined. It is otherwise, especially in small children, wheo 

 the affection begins without these preliminary symptoms. The rest- 

 lessness of the child, its refusal to take the breast, its anxiety when 

 compelled to drink, and the attacks of coughing and choking which 

 interrupt the drinking, are occasionally referred to some primary affec- 

 tion of the larynx, as croup, laryngismus, etc. This is particularly 

 liable to be the case when, besides the above symptoms, there is con- 

 tinued dyspnoea, the child is hoarse or voiceless, and the cough has 

 a croupy sound. With the above symptoms it would be unpardon- 

 able not to examine the pharynx carefully ; this examination quickly 

 certifies the diagnosis : the finger usually encounters, close behind the 

 soft palate, a tense, elastic tumor, which usually fluctuates distinctly 

 and cannot be readily mistaken. Sometimes the abscess breaks spon- 

 taneously into the pharynx, its contents being swallowed or vomited 

 up, and there is immediate relief of the symptoms. More frequently, 

 if aid be not given at the proper time, the patient dies. There may 

 be complete closure of the glottis by the swelling or the occurrence of 

 oedema glottidis, or the opening of the abscess during sleep, and the 

 entrance of its contents into the larynx, may choke the patient. In 

 other cases the abscess sinks into the breast and causes pleuritis, pneu- 

 monia, pericarditis, etc. 



TREATMENT. The abscess is to be opened as early as possible. 

 My old preceptor, Peter Kruckeriberg, of Halle, said, in his hu- 

 morous way, which always had a substratum of earnest, that every 

 physician should allow one of his finger-nails to grow long, and sharpen 

 it like a lancet, so that it would be always ready to open immediately 

 any retropharyngeal abscess that he might run against. Probably 

 none of his pupils ever followed this advice of " old Peter," but doubt- 

 less some of them have to thank him for the symptoms of retropharyn- 

 geal abscess always remaining fresh in their minds, and that no cases 

 of it have escaped them. 



CHAPTER VII. 



ANGINA LUDOVICI. 



THE floor of the mouth and the intermuscular and subcutaneous 

 connective tissue of the submaxillary region are occasionally the seat 

 of a phlegmonous inflammation, which may readily lead to diffuse 



