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Thus, of the 204 cases, 196 occurred during this period. Another fact which points to the lymphatic glands as * Schmidt's " Jahrb.," 107 B., S. 161. f "Jahrbuch f. Kindcrh.," n. F., 1872-'73, vi, S. 283. 118 ROE: RETRO-PEARY NGEAL ABSCESS. [N. T. Mrd. Joce., the seat of idiopathic retro-pharyngeal abscess is the slow development of the abscess and buy endep its circumscribed condition. Phlegmonous inflammation of the connective tissue, and especially of the loose tissue found in the retro-pharyngeal space, runs a rapid course and ends in a few days in sup- puration, whereas acute lymphadenitis runs its course slowly, and, as Schmitz* observes, spreads rapidly only after the enveloping membrane of the gland has become perforated. Etiology. — All constitutional diseases that predispose to inflannnation of the lymphatic glands in general play an important part in the production of retro-pharyngeal abscess. Of these, scrofula and hereditary syphilis stand at the head. Scrofula is by far the most frequent cause of glandular enlargements, although many cases of syphilis in adults, as well as in children, are overlooked, their results being classed under the general and quite satisfying term scrofula. Bokai f reports two cases in children directly caused by syphilis. Cases are reported in adults the direct result of acquired svphilis. Thus, Edward Martin \ reports a case in a man, forty-four years old, the result of syphilis contracted eight- een years before. Tertiary symptoms appeared, with swell- ing of the lymphatic glands of the neck on the right side, endep 25 associated with suppuration of the middle ear and mastoid cells. The abscess occurred on the right side of the pharynx. After it was opened, pus could be squeezed out by pressure on the mastoid region. The patient recovered. The most frequent exciting cause is exposure to sudden buy endep online changes of temperature and the taking of colds, giving rise endep 10 mg to attacks of rhinitis and inflammations about the fauces. In this connection, the period of the year in which retro- pharyngeal abscess most frequently occurs is quite signifi- cant. From Bokai's tables it is seen that it is most prevalent during the mouths of November, December, January, Feb- ruary, March, April, and May — purchase endep online months during which colds are also most prevalent. There can be little doubt of the connection between chronic rhinitis in children and retro-pharyngeal abscess, for it is a well-known fact that enlargement of the lymphatic glands of the neck is almost always found in children suf- fering from snuflies, and the formation of abscess in lym- phatic endep tablets glands from the absorption of septic material into the lymphatic vessels is endep 50 a very common occurrence. Fraenkel * says : " It is not very uncommon for swelling of the glands to outlast the catarrh which caused it, and then it may remain as an independent affection, endep tablets 10mg subject to further changes." It is now believed that retro-pharyngeal abscess follow- ing scarlet fever, measles, erysipelas, and other affections attended with inflammations about order endep the naso-pharyngeal cav- ity in children, is of the same nature as the idiopathic form, and is the result of disease endep 10 tablets set up in the glands from lym- phatic absorption rather than from the formation of pus in the connective tissue as the direct result of the phlegmon. * Loc. cit. f Loc. cit. j; "Revue mfidicale generic endep de la Suisse Rom.," i, 1881, p. 622. * Von Ziemsseu's " C)'clop;edia," vol. iv, p. 1 21. In support of this view, Lewandowsky * says: " The pre- sumption that these abscesses have really nothing to do with scarlatina, but are only accidental complications, may be rejected, leaving aside all other reasons, for the reason that the views endep 25 mg entertained as to the pathogenesis of these abscesses also give a ready explanation endep 10 of just why they should occur in scarlatina." Of two cases of retro-pharyngeal abscess reported by Lewandowsky occurring after scarlet fever, in endep 10mg children aged seven and twelve months, he says : " While both cases in their general character were of a favorable purchase endep nature, there existed a violent injiammatory condition of the nose, upon endep 25mg which I lay special stress as a cause of the retro-pharyngeal abscess. . . . To explain the retro-pharyngeal lymphadenitis by the an- gina does not appear to me admissible, because in both cases it was exceedingly mild." Bokai also remarks that the cases reported by him as oc- curring in scarlet fever did not differ from order endep online the idiopathic form. Surely violent phlegmons of the pharynx must rarely be the cause of retro-pharyngeal abscess, for, among the many cases seen by Bokai, not one was endep 50mg caused by diphtheria. Suppuration in the tympanic cavity in children is point- ed out by Wiel f as a not infrequent cause of retro-pharyn- geal abscess. He reports a case in a child, nine months old, that died from secondary oedema of the larynx. On post-mortem, the suppuration in the ear was shown to have been the buy cheap endep cause of the abscess.

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