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Retro-Piiaryngeal Abscess

sometimes, pharynx, symptoms, occasionally, neck, appears and little

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RETRO-PIIARYNGEAL ABSCESS' of matter occasionally form in the loose cellular tissue at the back of the pharynx. The disease is of importance, as the abscess, by its situation, interferes seriously with the functions of respiration and deg lutition, and gives rise to symptoms which, unless referred to their true -origin, may be a source of considerable perplexity.

abscess is more common in childhood than in after years, and during the first twelve months than at a later period of life. In eighty-nine cases collected by Gautier, nearly one-third of the patients were infants under a year old.

Scrofulous tendencies appear to have a powerful influence in favouring the occurrence of the disease. In the subjects of this diathesis, the abscess is sometimes found to occur as a sequel of one of the acute specific diseases of scarlatina, measles, diphtheria, or erysipelas. Caries of the cervical vertebr, to which such children are prone, may induce it ; and it may follow tonsillitis, ulcerations about the mouth, or eczema of the scalp or back of the neck. In many cases, however, the cause of the malady is obscure. It has been attributed to exposure to cold, to the action of irri tants, such as too hot liquids, and to injury from fish-bones, pins, and pointed spicuke of bone inadvertently swallowed. Indeed, such substances have been occasionally discovered in the contents of the abscess.

Morbid Anatomy.—The collections of matter situated behind the pos terior wall of the pharynx vary considerably in size. Sometimes they are as large as a hen's egg, and may even extend for a considerable distance upwards and downwards. They are not always seated in the middle line ; indeed, more commonly, perhaps, they are placed at an appreciable distance to one side. They are almost invariably single, and their contents consist of purulent and cheesy matter. Sometimes the abscess may open spon taneously. In other cases it may set up ulceration in a large vessel, such as the carotid, and give rise to fatal hcemorrhage. Occasionally it has been known to force its way along the cellular tissue of the neck, and open into the mediastinum or the pleural cavity. In a case which was under the care of my colleague, Mr. Parker, in the East London Children's Hospi tal—a little boy fifteen months old—the abscess formed a fluctuating swel ling,, the size of a hen's egg, below and behind the angle of the lower jaw on the right side. There was also a soft, cushiony tumour at the back of

the pharynx. After the abscess had been opened externally, pressure on the pharyngeal swelling caused pus to well up through the wound.

In young infants, the primary seat of the suppuration appears to be the lymphatic glands which lie along the posterior wall of the pharynx. Kor mann states that with his finger he has been able to detect enlargement of these glands in certain cases of thrush, ulcerative stomatitis, ozcena, etc., but that only in one instance has he known the inflammation to pro ceed to suppuration. Fleming, too, in 1850, attributed the post-pharyn geal suppurations to inflammation of these glands.

Symptoms.—Unless the retro-pharyngeal abscess be due to caries of the cervical vertebrm, the case seldom comes under observation until some im pediment to breathing has attracted the attention of the mother. The earlier symptoms are usually so indefinite that they excite very little notice. If, however, the purulent collection occurs as a consequence of suppura tion of bone, the formation of the abscess is preceded by symptoms indica cative of caries of the vertebrae of the neck. These symptoms have been described elsewhere (see page 178).

Pain or difficulty in swallowing, is perhaps the first symptom observed. The presence of the pharyngeal swelling so interferes with the passage of food that the patient may have the greatest difficulty in taking nourish ment. Liquids can often be swallowed, but solid matters pass only with oTeat effort, or not at all. Sometimes the obstacle appears to be complete. 'in these cases, the child, if an infant, sucks eagerly for a few seconds, and then suddenly throwing back his head, discharges the fluid he has taken through the mouth and nose. As a consequence of the impediment, serious interference with nutrition invariably follows, and the child loses flesh rap idly. It must be said, however, that cases are sometimes met with in which no difficulty of deglutition is present, and nutrition appears to be little affected by the presence of the abscess.

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