The Head and Neck 



109 



from migration of pyogenic or tubercular bacteria. It commonly 

 develops during the course of inflammations of adjacent mucosal 

 areas, notably during pharyngitis. There would also seem to be a 

 specific form, or the disease may at least be enzootic in certain local- 

 ities, for Dessart, a Belgian practitioner, wrote that it was common 

 as a phlegmonous angina in the vicinity of Genappe, Belgium. 



Acute Lymphadenitis. This, the pyogenic form, always runs a 

 very rapid course and terminates in suppuration, the pus tending to 

 be discharged spontaneously. 



Symptoms and Diagnosis. The trouble commences as a hot, pain- 

 ful, unilateral or bilateral tumefaction at the site of either or all the 

 glands, sometimes together with edema of the facial tissues. The 

 head is held stiffly and eating is generally suspended. In severe cases 

 there may be considerable dyspnea and some danger of asphyxia. 

 The inflammation quickly spreads beyond the capsule of the gland 

 to the surrounding connective tissue giving rise to a diffuse peria- 

 dentitis which then obscures the outline of the gland. Suppuration 

 taking place, individual suppurative foci become confluent and form 

 a large abscess, which fluctuates, and if not relieved by lancing, 

 points, bursts spontaneously and discharges a great quantity of pus. 



Treatment. Hot fomentations should be employed externally and 

 as soon as fluctuation is per- 

 ceived, the pus should be evac- 

 uated by free lancing and further 

 accumulation prevented by keep- 

 ing the opening free during the 

 few succeeding days. 



Cihronic or Tuberculous 

 Lymphadenitis. Tuberculous 

 lymphadenitis occurs in the 

 glands of the neck, which be- 

 come infected by auto-inocula- 

 tion in the same manner 

 as in acute lymphadeni- 

 tis. It may develop as a 

 primary lesion through 

 absorption of bacilli ar- 

 rested in the upper pas- 



, , Ho. 3S. (After Cadlot and Breton). Tnbercnloas l/m- 



SageS, but more com- phademtls. Fistulous tract. 



