478 AFFECTIONS OF THE PHARYNX. 



gangrene and sloughing, but in other cases ends in formation of abscess 

 or not unfrequently in resolution. This disease (which is often improp- 

 erly called " gangrenous " inflammation of the neck* and which we 

 name Angina Ludovici, after the deceased Ladwig^ of Stuttgard, who 

 first fully described it) is said by reliable observers to occur as a pri- 

 mary and idiopathic disease, and sometimes to be epidemic. In the 

 few cases that I have observed, the inflammation of the connective 

 tissue undoubtedly proceeded from periostitis of the lower jaw. Last- 

 ly, there is a form of the disease which comes with symptomatic or 

 metastatic parotitis occurring in typhus and other infectious diseases ; 

 this probably starts from the submaxillary glands. 



The disease begins with a more or less painful, very hard swelling 

 in the vicinity of one or other submaxillary gland. We may feel this 

 swelling from the mouth, as well as from the outside ; the skin cover- 

 ing it is of normal color. The swelling soon extends over the entire 

 submaxillary region, and upward toward the parotid ; sometimes also 

 downward, toward the larynx and trachea. The floor of the mouth is 

 pressed far upward. Chewing and speaking become very difficult ; the 

 movements of the tongue are almost arrested, and the patient cannot 

 open the mouth, because the muscles by which this is done are partly 

 embedded in the infiltrated cellular tissue, and partly participate in the 

 inflammation. The affection is usually accompanied by moderate fever 

 and slight general disturbance ; at other tunes the fever is high, and 

 there is great constitutional sympathy. 



Even in favorable cases, when resolution has occurred, the hardness 

 disappears very slowly. When an abscess forms, the skin becomes red 

 at some points, and fluctuation occurs ; finally the pus breaks through 

 the thinned covering. Quite as often the abscess opens into the mouth. 

 When it terminates in gangrene, and there is perforation, instead of 

 healthy pus, we have a fetid, discolored fluid, containing shreds of 

 tissue. Death may result, at the height of the disease, from oedema 

 glottidis and suffocation ; at the termination, in gangrene from septi- 

 caemia ; in the metastatic forms death usually results from the original 

 disease. 



At the commencement of the affection we attempt to secure reso- 

 lution by the application of a large number of leeches near the tumor. 

 Later we should continuously apply warm cataplasms. As soon as 

 there is fluctuation we evacuate the matter%hrough a large incision. 

 Where there is danger of suffocation, we should scarify freely, and, 'if 

 this does not answer, we should proceed to tracheotomy. If a hard, 

 indolent swelling of the maxillary region remain for a long while, I 

 find that repeated blisters do more good than rubbing in iodine 01 

 mercurial salves, or painting on tincture of iodine or JjugoCs solution. 



