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Lympi Iadenitis

mouth, abscess, glands, wall, infection and consists

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(LYMPI IADENITIS) The infection travels through the neighboring lymph-vessels into the lymph-glands, which are really filters interposed in the lymph channels, and is deposited there (lymphadenitis purulenta). The glands may be regarded as outposts which guard the parts of the body behind them against the advance of the virus. In the skin flaming red streaks mark the advance of the infection in the lymph-channels. As soon as the poison and the germs which produce it reach the glands they begin to swell and the lymphocytes increase in number, the glandular struc tures arc filled with serous exudate, and the glands are extremely sensi tive to motion and pressure.

If the lymphatic gland should not be able to withstand this attack, then it will itself succumb to the poison and heroine necrotic, the germs are thus themselves checked in their advance and the dying gland still fulfils its mission of protecting the body; the germs are later eliminated, together with the broken-down glandular substance.

The treatment is identical with that of deeper abscesses. In the simple form with painful swelling, rest and heat to produce hyperamia are sufficient ; the gland goes down, the swelling is "scattered." If there is suppuration, the inflammatory focus is walled off against its surroundings: later this wall reaches the surface and heroines adherent; redness and fluctuation determine the time for surgical intervention, which consists in a puncture open ing, aspiration and, in sonic cases, drainage.

Larger incisions are justified only in deep phlegmons when the gravity of the general condition demands this. A "thorough cleaning out" of all in fected glands means tearing down all the protective walls and therefore the grave danger of a general infection and an injury to the child's body which is hard for it to overcome.

The following purulent inflamma tions which start from the mucous membranes and travel into the ad joining lymph-spaces and lymph glands arc typical of childhood: (a) Suppuration of the Floor of the Mouth (Moro, vol. iii) (Fig. 100).

_ This consists in a purulent inflam mation which starts from the mucosa of the floor of the mouth. The infection attacks the lymphatic apparatus of the chin; the swelling makes the subment al region protrude and the tongue is lifted up and frequently swollen as well. Treatment consists in timely incision either through the mouth or from the chin, and warm moist compresses.

(b) Retropharyngeal Almcess (Finkelstein, vol. iii).—This usually starts from the mucous membrane and the lymphatic apparatus of the pharyngeal wall, or sometimes from the tonsillar tissue as a tonsillar or a retrotonsillar abscess.

The abscess may spread along the pharyngeal wall, pushing it forward, and may interfere with respiration and swallowing, either through its own volume or through the collateral mleina. To make breathing easier the mouth is kept. open. These difficulties may increase to such an extent as to cause death from suffocation; in favorable cases the abscess will break and the pus is discharged in streams from the mouth and nose.

This process may be caused either by the well-known pus-bacteria or by a local tuberculous focus or one at a distance from which the pits has descended to this region.

The diagnosis is easy from the pronounced symptoms. Inspection of the neck arid pharynx and palpating with the finger will reveal the baggy swelling of the pharyngeal wall. Whenever a child has difficulty in breathing we should always think of this affection.

Treatment consists in opening the abscess. All except the point of a knife is covered with adhesive plaster and it is then introduced through the mouth upon the guiding finger and the abscess opened, guarding, however, against injuring any other organs (especially in struggling children). As soon as the abscess is opened the child should be quickly inverted so that it cannot swallow the pus or aspirate it into the respira tory tract.

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