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LUDWIG'S ANGINA

LUDWIG'S ANGINA Abstract Medical men have always been, and I suppose will always be, divided into two groups: first, the Hippocratic group, composed of those who, like Hippocrates, object to the unnecessary multiplication of diseases and who prefer to assign so-called new diseases to their proper places under already recognized pathologic processes; and, second, the Cnidians, for whom every new symptom and every complication constitutes a new disease. But though my own inclinations lean toward the former school, it is impossible to deny that new clinical entities are from time to time recognized by acute observers, and that in this way both the science and the art of medicine are advanced. Consider, for instance, appendicitis: Is it, or is it not, a distinct disease? The Hippocratic group will argue that it is not a new disease but merely an ordinary disease which is known as inflammation; and so far they will be correct. References 1. Parker ( Lancet 2:570, 1879)Crossref 2. Muckleston ( Tr. Am. Laryngol. Rhin. & Otol. Soc. 33:42, 1927) 3. Vachey and Dechaume ( Lyon chir. 24:642, 1927) 4. Ludwig: Med. Cor.-Bl. d. Württemb. ärztl. Vereins, Stuttgart 6:21, 1836. 5. Roser ( Deutsche med. Wchnschr. 9:153, 1883) 6. Nélaton ( Bull. et mém. Soc. de chir. de Paris 18:489, 1892 7. Gaz. d. hôp. 65:757, 1892) 8. Ludwig: Gaz. méd. de Paris 4:577, 1836 9. Schmidt's Jahrbücher, Leipzig, 1837, vol. 15, p. 25. 10. International Encyclopedia of Surgery (Ashhurst) ed. 2, New York, 1888, vol. 1, p. 41. 11. Ashhurst, J., Jr.: Textbook , 1872 12. Encyclopedia, 1881. 13. König: Entzündlichen Processe am Hals, in Billroth and Lücke: Deutsche Chirurgie, 1882, no. 36, p. 20. 14. Semon: Tr. Roy. Med.-Chir. Soc., London 78:181, 1895. 15. Boehler: Thèse de Paris, 1885, no. 299. 16. Delorme: Bull. et mém. Soc. de chir. de Paris 18:505, 1892. 17. The word angina, from the Latin, angere (to strangle, to suffocate), is sufficiently descriptive of the malady to be retained in connection with the name of Ludwig, who first brought the condition into notice. 18. Davis, G. G.: Ann. Surg. 44:175, 1906. 19. Thomas, T. T.: Ann. Surg. 47:161, 1908. 20. Price: Am. Surg. 48:649, 1908. 21. Thaden, in Boehler (footnote 9). 22. Tillaux: Traité d'anatomie topographique, Paris, 1877, p. 438. 23. Poulsen: Deutsche Ztschr. f. Chir. 37:55, 1893. 24. It is interesting to note that in the first and second series of the Index Catalogue of the Surgeon General's Office, U. S. Army, the heading Ludwig's angina refers the reader merely to Neck, Abscess of; while in the third series, publication of which commenced with the year 1918, the reference is to Throat, Inflammation of, Septic. This indicates a correct tendency to separate cases of Ludwig's angina from the general group of abscesses of the neck and to recognize the disease rather as a phlegmonous process (cellulitis). Thomas later (in Keen's Surgery, Philadelphia, 1913, vol. 6, p. 418) spoke of Ludwig's angina as a cellulitis but stated that the infection passed from the mouth "to the submaxillary lymph nodes, where it takes on virulent activity, leading to a rapidly spreading periadenitis. After the development of an extensive cellulitis here, or occurring simultaneously with it, the process extends to the floor of the mouth." In this explanation Muckleston follows Thomas, who himself follows Tillaux (footnote 14), who thought cellulitis always secondary to lymphadenitis, the latter itself being due to dental infection. 25. Hamann: Cleveland M. J. 4:387, 1899. 26. Roser: Deutsche med. Wchnschr. 9:153, 1883. 27. Sappey: Déscription et iconographie des vaisseaux lymphatiques, Paris, 1886, p. 6. 28. In a somewhat similar sense, acute septic osteomyelitis is a cellulitis of the bone marrow. 29. Panton and Adams ( Lancet 2:1065, 1909) 30. Such, perhaps, was the condition in case 17, recorded here. 31. Sébileau: Presse méd. 29:213, 1921. 32. Ivy, R. H., in Nelson's Loose-Leaf Living Surgery , New York, Thomas Nelson and Sons, 1928, vol. 2, p. 643. 33. Moty: Bull. et mém. Soc. de chir. de Paris 18:536, 1892. 34. The facial vein on the contrary, does not traverse the submaxillary space, but runs in the layers of that portion of the fascia colli which separates this space from the platysma (see fig. 4). 35. Van Wagenen and Costello ( Ann. Surg. 87:684, 1928) 36. This case probably corresponds to those which Van Wagenen and Costello class as "secondary Ludwig's angina." Perhaps the original submental swelling was a lymphadenitis, secondary to the "pimple" on the chin. Before admission, however, the floor of the mouth was attacked by cellulitis, and subsequently both submaxillary regions were invaded by cellulitis, probably spreading downward from the sublingual tissues by the route around the posterior border of the mylohyoid. 37. Abstr., Med. Cor.-Bl. d. Württemberg. ärztl. Vereins, Stuttgart 36:134, 1866. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1929 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1929.01140140001001
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Abstract

Abstract Medical men have always been, and I suppose will always be, divided into two groups: first, the Hippocratic group, composed of those who, like Hippocrates, object to the unnecessary multiplication of diseases and who prefer to assign so-called new diseases to their proper places under already recognized pathologic processes; and, second, the Cnidians, for whom every new symptom and every complication constitutes a new disease. But though my own inclinations lean toward the former school, it is impossible to deny that new clinical entities are from time to time recognized by acute observers, and that in this way both the science and the art of medicine are advanced. Consider, for instance, appendicitis: Is it, or is it not, a distinct disease? The Hippocratic group will argue that it is not a new disease but merely an ordinary disease which is known as inflammation; and so far they will be correct. References 1. Parker ( Lancet 2:570, 1879)Crossref 2. Muckleston ( Tr. Am. Laryngol. Rhin. & Otol. Soc. 33:42, 1927) 3. Vachey and Dechaume ( Lyon chir. 24:642, 1927) 4. Ludwig: Med. Cor.-Bl. d. Württemb. ärztl. Vereins, Stuttgart 6:21, 1836. 5. Roser ( Deutsche med. Wchnschr. 9:153, 1883) 6. Nélaton ( Bull. et mém. Soc. de chir. de Paris 18:489, 1892 7. Gaz. d. hôp. 65:757, 1892) 8. Ludwig: Gaz. méd. de Paris 4:577, 1836 9. Schmidt's Jahrbücher, Leipzig, 1837, vol. 15, p. 25. 10. International Encyclopedia of Surgery (Ashhurst) ed. 2, New York, 1888, vol. 1, p. 41. 11. Ashhurst, J., Jr.: Textbook , 1872 12. Encyclopedia, 1881. 13. König: Entzündlichen Processe am Hals, in Billroth and Lücke: Deutsche Chirurgie, 1882, no. 36, p. 20. 14. Semon: Tr. Roy. Med.-Chir. Soc., London 78:181, 1895. 15. Boehler: Thèse de Paris, 1885, no. 299. 16. Delorme: Bull. et mém. Soc. de chir. de Paris 18:505, 1892. 17. The word angina, from the Latin, angere (to strangle, to suffocate), is sufficiently descriptive of the malady to be retained in connection with the name of Ludwig, who first brought the condition into notice. 18. Davis, G. G.: Ann. Surg. 44:175, 1906. 19. Thomas, T. T.: Ann. Surg. 47:161, 1908. 20. Price: Am. Surg. 48:649, 1908. 21. Thaden, in Boehler (footnote 9). 22. Tillaux: Traité d'anatomie topographique, Paris, 1877, p. 438. 23. Poulsen: Deutsche Ztschr. f. Chir. 37:55, 1893. 24. It is interesting to note that in the first and second series of the Index Catalogue of the Surgeon General's Office, U. S. Army, the heading Ludwig's angina refers the reader merely to Neck, Abscess of; while in the third series, publication of which commenced with the year 1918, the reference is to Throat, Inflammation of, Septic. This indicates a correct tendency to separate cases of Ludwig's angina from the general group of abscesses of the neck and to recognize the disease rather as a phlegmonous process (cellulitis). Thomas later (in Keen's Surgery, Philadelphia, 1913, vol. 6, p. 418) spoke of Ludwig's angina as a cellulitis but stated that the infection passed from the mouth "to the submaxillary lymph nodes, where it takes on virulent activity, leading to a rapidly spreading periadenitis. After the development of an extensive cellulitis here, or occurring simultaneously with it, the process extends to the floor of the mouth." In this explanation Muckleston follows Thomas, who himself follows Tillaux (footnote 14), who thought cellulitis always secondary to lymphadenitis, the latter itself being due to dental infection. 25. Hamann: Cleveland M. J. 4:387, 1899. 26. Roser: Deutsche med. Wchnschr. 9:153, 1883. 27. Sappey: Déscription et iconographie des vaisseaux lymphatiques, Paris, 1886, p. 6. 28. In a somewhat similar sense, acute septic osteomyelitis is a cellulitis of the bone marrow. 29. Panton and Adams ( Lancet 2:1065, 1909) 30. Such, perhaps, was the condition in case 17, recorded here. 31. Sébileau: Presse méd. 29:213, 1921. 32. Ivy, R. H., in Nelson's Loose-Leaf Living Surgery , New York, Thomas Nelson and Sons, 1928, vol. 2, p. 643. 33. Moty: Bull. et mém. Soc. de chir. de Paris 18:536, 1892. 34. The facial vein on the contrary, does not traverse the submaxillary space, but runs in the layers of that portion of the fascia colli which separates this space from the platysma (see fig. 4). 35. Van Wagenen and Costello ( Ann. Surg. 87:684, 1928) 36. This case probably corresponds to those which Van Wagenen and Costello class as "secondary Ludwig's angina." Perhaps the original submental swelling was a lymphadenitis, secondary to the "pimple" on the chin. Before admission, however, the floor of the mouth was attacked by cellulitis, and subsequently both submaxillary regions were invaded by cellulitis, probably spreading downward from the sublingual tissues by the route around the posterior border of the mylohyoid. 37. Abstr., Med. Cor.-Bl. d. Württemberg. ärztl. Vereins, Stuttgart 36:134, 1866.

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1929

References