Sup7'a- Pharyngeal { Retro- P/iatyngeal) Abscess. 59 



tissues may soften and degenerate and the pus may make its way 

 spontaneously to the pharynx, or less frequently through the 

 skin of the parotid, or intermaxillary region, or into the CESopha- 

 gus or Iar3aix. A fistula of the pharynx opening externally and 

 allowing the escape of alimentary matters has been often noticed. 

 These are especially liable to follow puncture of the abscess. 



iVmong the less common sequelae are fistula of the oesophagus ; 

 purulent pneumonia in connection with the purulent dissection of 

 the oesophagean walls and rupture into the chest (Fichet, Schnei- 

 der); ulceration of the blood vessels in the cow fjonge); adenitis 

 and lymphangitis of the neck, and the thoracic glands, followed 

 by pericarditis and pleurisy (Cadeac); multiple embolic abscesses 

 of internal organs (Dieckerhoff) ; compression and degeneration 

 of the vagus nerve, with consequent respiratory and digestive 

 troubles CBaudon) ; and compression and obstruction (^f the jugulars 

 with passive congestion of the brain and vertigo. (Delamotte> 

 Debrade). Even when the abscess opens into the pharynx the 

 orifice is usually small, the pus escapes imperfectly, and food 

 materials enter and the fistula may thus persist for a length of 

 time. The same imperfect discharge is liable to take place with 

 an external orifice and the pent up pus becomes inspissated, 

 caseated and even calcified. 



Diagnosis. Supra-pliaryngeal abscess is to be distinguished 

 from pus in the guttural pouches, by the lack of coincidence of 

 the discliarge with tlie dependence of the head in grazing, eating 

 roots or drinking from a bucket ; by tlie absence of the inter- 

 mission when the head is elevated ; and by tlie fact that the dis- 

 charge is less frequently limited to the one nostril. The hearing 

 too is less likely to be affected. 



Treatment. As soon as the presence of pus can be recognized 

 it should be evacuated. This is often attempted through the roof 

 of the pharynx, but with such an opening there is always danger 

 from tlie entrance and decomposition of alimentary matters. If 

 fluctuation can be felt externally, it is better to be opened through 

 the skin. The integument may be incised with a lancet, and the 

 tissues further penetrated by manipulations with tlie finger nail, 

 a grooved sound or the point of closed scissors. In this way 

 the vessels and nerves are pushed aside and the dangers of 

 hemorrhage, fistula and paralysis avoided. The cavity must be 



