The medico-Iegal aspects of wounds of the great arteries of the superior mediastinum are outlined briefly, and the literature reviewed. A case is descriptionbed of a t inch incised wound of the pulmonary trunk with survival for 1 1/4 hours.
Tonsillectomy, the most frequent operation performed, can be associated with mild to extensive trauma in the nose, nasopharynx, oro-pharynx and tonsillar region. Endotracheal anaesthesia is also associated with an equally formidable list of physical traumata, with psychical trauma in addition. Selection of the best modern instruments available, gentleness, co-operation with the anaesthetist and elimination of haste will help considerably in minimizing trauma. A traumatic anaesthesia and tonsil dissection will give rapid, painless convalescence, with no sequelae. An earnest endeavour should be made by all tonsillectomists to respect the fragility of the mucosa of the pharynx, nose and throat, and to realize that trauma in these regions, of even the slightest degree, is suffered in exaggerated form by the patient.
The experience of emergency hospitalization, more particularly with children in the highly formative pre-school years, has potentially serious psychological effects. Although many children return from hospital more amenable to discipline and with less 'adult-provoking' symptoms, usually both feelings of dependence and of guilt are intensified. This tends to retard the development of satisfactory extra-familial social relationships, and to increase the severity and inflexibility of the super-ego.The central figure in dealing with this and allied probblems, would appear to be a practioner with specialist training as a family doctor.