The diseases of infants and children / by Edmund Cautley.

  • Cautley, Edmund, 1864-1944.
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: The diseases of infants and children / by Edmund Cautley. Source: Wellcome Collection.

    267/1070 (page 245)
    A gag must not be used, as it may cause rupture of the abscess. The swelling is lateral, larger, and usually lower than that of post-adenoid abscess. Treatment.—The preventive treatment is that of tonsillar and naso¬ pharyngeal affections. The abscess must be opened through the mouth, and the child turned on its face as soon as the incision is made. Use a straight scalpel, J in. long, and no anaesthetic ; open the mouth with the finger or tongue depressor, but not very wude. If the erect position is chosen, bend the child forward immediately after the incision is made. Sudden respiratory failure may arise from manipulation of the pharynx or the use of a tongue depressor. Other accidents at operation are sudden syncope, spasm of the glottis, haemorrhage from a branch of the carotid, and entrance of pus into the air passages. Secondary infection is rare. The abscess may require re-opening and expression. An extra-pharyngeal abscess and that due to cervical caries are opened by incisions through the neck, generally along the posterior border of the sterno-mastoid. Retro-(Esophageal Abscess is due to spinal caries, diphtheritic pharyn¬ gitis, a caseous mediastinal gland, or extension of suppuration from other parts. The correct diagnosis may be impossible. Dyspnoea is present to a certain extent in all cases, and in many is a prominent and urgent symptom, with recession. The voice is little or not at all affected. Cough is present, perhaps for some months, and may be croup-like or metallic, suggesting laryngeal mischief, stenosis or pressure lower down. Unless the abscess is partly retro-pharyngeal dysphagia is absent, for the oesophagus is easily pushed to one side. It may occur temporarily from rupture into the oesophagus. There may be swelling in the neck on both sides, tenderness, pain on movement and fever. Some of these abscesses burst into the oesophagus or burrow into the tissues of the neck. Rupture into the oesophagus may be followed by secondary stenosis or a diverticulum. The abscess must be opened at the posterior edge of the sterno-mastoid, and the child fed nasally, if unable to swallow. The CEsophagus.— Congenital Malformations—Inflammation— Ulcer— Foreign Bodies.—The oesophagus appears in the foetus at the end of the fifth week as a cylindrical tube. In birds, fishes and reptiles it persists as an impervious cord for a long time. Complete absence has been recorded in 5 cases up to 1902. More commonly it is obliterated or partially stenosed. Other malformations are, a double tube with reunion at the lower end—very rare ; diverticula or pouches, situated in the middle line and not causing symptoms till late in life, but possibly of primary congenital origin ; fistulous communication with the trachea or bronchus, generally associated with atresia ; fistula of the neck, due to imperfect closure of the second and third branchial arches involving the oesophagus ; the lower end opening into the trachea just above the bifurcation, while the upper one ends in a dilated cul-de-sac.