f the neck. The condition--which
goes by the name of _angina Ludovici_--is usually met with in adults,
and appears to originate in some infective focus in the mouth.

_Clinical Features._--In all forms the process spreads rapidly, and
the neck becomes swollen, brawny, and of a dusky red colour. The head
is flexed towards the affected side, and there is pain on movement and
on palpating the swelling. Pus forms early, but, as it is under great
tension, fluctuation can seldom be detected. Respiration may be
interfered with by pressure on the air-passages, or by the onset of
oedema of the glottis, and tracheotomy may be urgently called for.
Swallowing may also be affected by pressure on the pharynx and
oesophagus. Pressure on the important nerves traversing the neck may
give rise to irritative or paralytic symptoms. The main vessels may
become thrombosed or eroded--particularly when the cellulitis is
associated with scarlet fever--and in the latter case copious
haemorrhage may follow incision of the abscess.

There is always marked constitutional disturbance, as evidenced by
rigors, high temperature, a small, rapid pulse, and delirium; and
death may result within a few days from toxaemia.

_Treatment._--In the earliest stages hot fomentations or ichthyol and
glycerine should be applied, but if the process does not begin to
abate within twenty-four hours, and if the swelling becomes brawny in
character, one or more incisions should be made through the deep
fascia where the signs of inflammation are most intense, and the
deeper planes of the neck opened up by dissection. Drainage is secured
by tubes or strips of rubber tissue. If profuse haemorrhage occurs it
may be necessary to ligate the main artery lower in the neck.

#Actinomycosis# manifests itself in the neck as a diffuse, painless
swelling, which slowly infiltrates the superficial structures,
becoming brawny at some places, and at others breaking down and
forming sinuses from which the ray fungus escapes in the discharge.

#Boils and carbuncles# frequently occur on the back of the neck, where
the skin is thick and coarse and is rubbed by the collar.

The affections of the _cervical lymph glands_ have already been
described (Volume I., p. 330).

TUMOURS

#Cystic Tumours.#--A great variety of cystic tumours is met with in
the neck.

#Branchial cysts# are formed by the distension of an isolated and
unobliterated portion of one of the branchial clefts. They us