INFECTION of the mediastinum may originate from so many different sources and have such divergent manifestations that the term "mediastinitis" means little unless qualified by a description of its type and kind. The process may range from a simple, nonsuppurative inflammation in association with pericarditis, bronchitis, influenza or pneumonia to a very grave, often lethal, diffuse suppurative phlegmon. A chronic variety is seen in tuberculosis which is sometimes called mediastinopericarditis. Tuberculosis also involves the tracheobronchial lymph nodes with occasional suppuration to form a tuberculous mediastinal abscess. These same nodes are infected in many upper respiratory infections, and should they suppurate, a pyogenic mediastinal abscess results. This -phase of the subject has recently been emphasized by Lerche.35 Pyogenic abscesses also follow invasion of the mediastinum from contiguous lung abscesses, empyema, cervical infection, spondylitis, perforating wounds or retroperitoneal infection. These abscesses usually develop slowly enough to allow time for diagnosis, localization and drainage. They have been cured by spontaneous rupture into the trachea or esophagus, repeated aspirations by needle puncture, dorsal mediastinotomy, sternal trephine or cervical drainage. In contrast, a mediastinal phlegmon spreading through so vital a spot may be quickly lethal unless strenuous efforts are undertaken for its control. This diffuse suppuration of the mediastinum may come from any of the sources causing localized abscess if the speed and magnitude of the contamination is sufficient; but the visceral perforations of 'chest and neck are its commonest cause, and of these the cervical lesions are the most frequent. The consideration of diffuse suppurative mediastinitis might well begin with a study of infections in the neck that gravitate into the mediastinum. This demands a knowledge of the fascial spaces connecting the two, for the infection travels along these and it is in them that the surgeon must intercept or drain it. The spaces lie between layers of the cervical fascia, a structure that is so complex that if followed through all of its ramifications is apt to resemble a maze. The subject may be greatly simplified by considering only that part of the cervical fascia and its spaces which significantly relates to the spread of infection. For this purpose it is sufficient to deal with the viscerovascular compartment which contains the visceral space in the center and around it, the previsceral space, the retrovisceral space and the vascular sheath on either side.The first experiments designed to study the compartments of the neck were undertaken by Bichat.2 But many years elapsed before an intensive 588

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