Surgical Operations in the Mouth, Fauces, &c

Robert Liston
1844 Boston Medical and Surgical Journal  
I now proceed to speak of affections situated at the posterior part of the mouth-of the fauces. In the first place, you have to treat inflammatory affections of the soft palate and tonsils. These affections are common enough, and many of them do not require more treatment than the patient himself or his friends can conduct. They arise from the exposure of the external surface, or of the mucous membrane, to the influence of cold and moisture. The pain and the swelling will disappear on adopting
more » ... ome means to restore the functions of the skin-warm water, and the exhibition of a diaphoretic. But now and then these inflammations run so high, as to demand the attention of the surgeon : the swelling becomes greater and greater, deglutition is performed with great effort, and the breathing, perhaps, becomes affected. The latter cannot be seriously interfered with, unless the passage to the nostrils is obstructed as well as that by the mouth. Patients have been suffocated by the inflammatory swelling, whether attended by the formation of matter or not. This has occurred where the tonsils have been affected before, and have swollen to a great extent. By the inflammatory action you frequently find the tonsils enlarged ; the whole of the parts are called into such violent action, that there is no passage down the throat, and it has been followed by sudden suffocation. The patient has died in a moment, in the same way as from affection of the rima glottidis-by the entanglement of mucus in the narrowed fissure of the fauces, betwixt the two tonsils. The swelling is sometimes occasioned by the formation of matter between the folds of the velum, and these abscesses sometimes require active surgical interference. If an abscess is allowed to form to a great extent, and the breathing becomes embarrassed, there is even some risk, by its sudden and spontaneous opening, of the matter getting into the windpipe, and causing suffocation. You will be called upon to remove this collection of matter ; and it is, in general, very easily effected. There is no necessity for providing yourselves with this instrument-a pharyngotome, a sort of lancet, in a spring case, with a screw in the handle to regulate the extent of the incision and the length to which the blade can be protruded. An abscess in the 21
doi:10.1056/nejm184412250312101 fatcat:xddcpffzzzf45d5jw6dvhywfza