Cases of branchial fistulae in the external ears / by Sir James Paget.

  • Paget, James, Sir, 1814-1899.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Cases of branchial fistulae in the external ears / by Sir James Paget. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    5/12 (page 3)
    this secretion was always augmented during any accidental bronchial or nasal catarrh. Very rarely portions of cartilage, such as may be thought arrested rudiments of cervical ribs, have been felt under the skin near the openings of the fistulas.1 The cervical branchial fistula? appear, as a rule, to undergo no material change from birth to the end of life. They may become so troublesome by their secretion as to need surgical treatment; and I believe that the best treatment is with the galvanic cautery applied through their whole length. Such are, generally, the cervical branchial fistula?, and it may suffice if I merely refer to the probability that some rare instances of diverticula from the pharynx may be re- garded as dilatations of portions of branchial fistula? closed externally but remaining open within; and to the further probability that some congenital and infantile cysts, and even some ranula?, may be derived from branchial canals closed at both ends and distended with fluid, as hydrocele in the in- guinal canal may be formed by the filling of part of a canalis vaginalis.2 Of the branchial fistula? in the external ears no account, I believe, has yet appeared in this country, and in foreign literature I have found descriptions of only six or seven cases, and some of those are very incomplete.3 The instances of which I have to tell are in the family of a member of our profession, an active well-formed man. He showed me a well-marked branchial fistula on the left side of his neck opening near the middle of the anterior border of the sterno-mastoid muscle, and often yielding a thin, clear, mucous fluid. His father, he told me, had an exactly similar fistula, and so had one of his sisters. Moreover, of his eight 1 Heusinger, u. supra, and in B. xxxiii, p. 177. 2 These matters may be studied in Heusinger. ' Virchow's Archiv,' B. xxxiii, p. 177; Roser, ' Elemens de Pathologie Chirurgicale,' traduit par Culmann, 1870, p. 177; Schede, as quoted by Sehmitz, u. infra; and K. F. v. Heusinger, in the ' Deutsche Zeitschrift,' u. supra. 3 They are collected by Sehmitz ; ' Ueber Fistula Auris congenita : Inaug. Diss.,' Halle, 1873. The first and best case is by Heusinger, Virchow's ' Archiv,' B. xxix.