Epidemiology and control

the mouth or pharynx, the cellulitis may extend into the mediastinum and so cause a septic pneumonia. The effect on the patient is that of a virulent septic infection, plus the interference with the function of the parts involved,-speech, deglutition, respiration-plus, also, the infection of larynx and lungs. Death may come in a few hours from overwhelming sepsis, or later from interference with nutrition and more particularly respiration (edema glottidis), or later yet from septic pneumonia, and it may even occur when the patient is seemingly convalescent, and then is apparently by heart failure. In Thomas's careful paper (An. Surg., I908, p. I69), he reports io6 cases, observed or collected; in ninety-two the swelling began external to the mouth and pharynx, and in sixty-one of them it was first noticed in the sub-maxillary region. Incision in this region, parallel to the border of the mandible, is of prime importance, though a mesial incision from the jaw to the hyoid quite through into the mouth has been advised and practised. The incision must go through the deep fascia or to pus. If it is made early only serum may be found, and gangrenous cellular tissue. After the supervention of edema of the larynx, tracheotomy will be of very doubtful value, as the trachea would be opened directly into an infected area. There has been much discussion regarding the keeping of the name "Ludwig's Angina." In I895 Felix Simon, St. Thomas, London, claimed that acute edema of the larynx-edematous laryngitiserysipelas of pharynx and larynx-phlegmon of pharynx and larynx and angina ludovici, were all the same thing. This seems to me to be too sweeping a statement, for laryngeal and pharyngeal infection may occur without the cellulitis, or cellulitis may not lead to the infection of the larynx and pharynx. Thomas advises the keeping of the name, as indicating a fairly well defined lesion, which is said to be not so rare as my experience would make it.