When one for the first time encounters a severe, perhaps fatal, hemorrhage in connection with an abscess in the throat the first reaction is that of surprise or shock, as the occurrence is unforeseen and wholly unexpected. To one who has successfully treated a large number of patients with retropharyngeal and peritonsillar abscesses over a period of years without untoward results, it is a matter of deep concern to be faced with an alarming hemorrhage or a fatality. As a result one turns to the literature for information on the subject, as textbooks in the main make very little reference to this grave complication, and one is rather surprised to discover that the apparently rare complication is really not so infrequent and that the topic has been freely written about, discussed and investigated many times. No doubt every member of this society has at some time or other encountered such cases, and were it possible to collect and analyze all of these experiences in detail they would undoubtedly afford most valuable data for future guidance.Chronologically, the most significant articles on this subject have been contributed by the following investigators: and Brauer (1933). In addition, there have been numerous case reports with appropriate comment. Yet, despite the fact that these essays have contributed most valuable information, we have felt, in view of our personal experiences, that a more comprehensive review of the subject which would cover all phases might lead to a clearer understanding of it and help point the way to more definite conclusions. We believe that it is not only important to know where the infection is located and how it got there, but even more so to know approximately where the hemorrhage originated and how dangerous it may be. We are persuaded that the question goes beyond peritonsillar or retropharyngeal abscesses Read before the American Laryngological, Rhinological and Otological Society, Chicago, June 9, 1933.
Since the nose is the most exposed feature of the face, it is natural that it bears the brunt of injuries, which accounts for the comparative frequency of nasal deformities as they are commonly seen. I am convinced that a large percentage of these deformities are results of traumas received in childhood at a time when the nasal structure is still incompletely developed. It is furthermore my opinion that a great many of these childhood injuries are unrecognized and untreated for reasons which will be elaborated a little later. A review of the case histories of 1,135 consecutive patients seen in private practice seeking nasal plastic procedures reveals the interesting fact that 323, or 28 per cent, gave a definite history of having sustained an injury to the nose in childhood. The actual percentage is undoubtedly much higher, since it is easily conceivable that in many cases the trauma was received so early in life that the memory of it was subsequently erased. In many cases even the parents had forgotten the incident or were ignorant of it.In addition to consideration of trauma received at the time of birth, it must be remembered that the child when he begins to learn to walk sustains innumerable falls, and although frequently the instinctive extension of the arms at the time protects him from facial injury there are many instances in which this protective reflex fails to act promptly to prevent a direct fall on the face. Also it should be remembered that during the school years, when the child indulges in competitive games in which falls and bumps are common, the nose receives its share of blows, which in many cases cause permanent deformity. Many children are reticent about reporting these injuries through fear of reprimand, and they are therefore unrecognized. I should like to point out that injuries to the nose react differently in children than in adults, because of the difference in structure. The nasal bones, the vomer and the perpendicular plate of the ethmoid are not completely ossified until puberty.1 Since the nasal framework of the child is largely cartilaginous Read at the Forty-Seventh Annual Meeting of the American Laryngological,
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