The course of an acute suppurative process in the cervical region may cover a wide range of clinical manifestations and give rise to pathologic changes of a bizarre character. The capricious behavior and often bewildering influences of inflammatory disease in this part of the body have given rise to diligent research and clinical experimentation in this field. In this particular study laryngologists have advanced with striking rapidity. They have learned the great importance of early recognition of the many morbid changes produced by inflammation in the neck and the value of well directed surgical efforts in reducing the outcome to something less than an inevitable slow and painful death. To the sum and total of this knowledge have been added a clearer understanding of the mode of spread of infection to the mediastinum and rational methods for the treatment of an acute suppurative process within this part of the thoracic cage.In this connection reference is made to acute mediastinal infection arising from an inflammatory process within the tissues of the mouth, pharynx or cervical region. For an understanding of the etiologic factors which favor the development of such a process, a study of the pathways along which infection may travel through the deep cervical tissues is imperative. To this end an attempt has been made to observe the complex arrangement of the cervical fascia in a study of serial sagittal and transverse sections of the neck and thorax, to which embryologic observations have been added in support of some of the opinions herein expressed. In order to gain a better perspective of these anatomic relations, gross dissections of the cervical region and thorax were made. These comprised a careful reflection of the planes of the body, commencing with skin and subcutaneous tissue and following in orderly sequence from without inward, layer by layer, until the dorsal
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