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Clinical Lecture on Diseases of the Pharynx

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Clinical Lecture on Diseases of the Pharynx / Oct. 13, 1906. / THE HOSPITAL. 29 Hospital Clinics. CLINICAL LECTURE ON DISEASES OF THE PHARYNX. Andrew By Wylie, M.D.(Glas.), Assistant Surgeon Central London Throat and Ear Hospital. The following interesting lecture was specially dition is called 'pharyngitis sicca, and is usually reported for The Hospital, and illustrates the associated with nasal disease. practical character of the teaching given to In treating this condition, if gout, anaemia, dys- graduates seeking instruction at this special centre pepsia, hepatic disease are present, these should be of graduate teaching in London. attended to. A course of saline water is usually re- The most common diseases the general practi- commended at some natural spring. In this country tioner has to treat are those belonging to the there are many good mineral springs, as at Buxton, pharynx. Many troubles and affections, including Bath, and Strathpeffer. The wonderful success of colds, bronchitis, pneumonia, rheumatism, scarlet- the fashionable continental springs is not due to fever, diphtheria, typhoid fever, and syphilis begin any great virtue in the waters, but to the thorough with an amount of discomfort to the pharynx way in which the treatment is carried out by On the other hand, severe maladies like tubercu- patients and doctors at these places. Besides the losis, lupus, syphilis, epithelioma, and the simpler mineral springs at Aix-les-Bains or Homburg, a growths?papilloma, fibroma, and polypi?are very thorough system of local treatment is recom- common in the pharyngeal region. mended. Mild astringents like potassium chlorate Pharyngeal disease is frequently a sequence of or sodium bicarbonate, or, in more severe or granu- occupation, and is found among miners, masons, lar cases, painting the pharynx with sulphate of motorists, vocalists, and public speakers. zinc (20 grains to the ounce), perchloride of iron, or Mandl's solution 10 to 1 Local Diseases. (iodine grains glycerine oz.) must be resorted to. If large granular fol- Acute catarrhal is a common lymph 'pharyngitis very licles are present they can be treated the disease. The are soreness on quickly by symptoms swallowing galvano-cautery. Vocalists, and other and the membrane of clergymen, general malaise; lining the public speakers should be taught how to rest the pharynx, the tonsils, and also the nares, becomes red voice and use it properly. and inflamed. in forms. It manifests itself various A fourth condition is acute tonsillitis, usually caused a when (?) Idiopathic, by chill; (b) diathetic, caused by changeable weather. It appears most due to or from gout rheumatism; (c) toxic, drugs, commonly in the hot season of the year, when there as and or infectious a mercury potassium iodide, is sudden change of temperature. In many cases fevers like measles and scarlet-fever; (cl) traumatic, of this disease the Klebs-Loeffler bacillus is present, from or hot fluids irritating vapours. and such cases at first should be treated as diph- Acute inflammation of the or theria until the is In " septic pharynx, contrary diagnosis proved. hospital sore throat," is another manifestation lacunar tonsillitis the mucous membrane of the of local mischief. The symptoms are general tonsil becomes inflamed, with patches of yellowish malaise, rigor, rise of temperature, pain and diffi- exudation from the crypts. Soon the deeper tissues culty in swallowing. The mucous membrane be- are involved and the swelling of the tonsil becomes comes hypersemic, swollen, and oedematous, and very severe. This condition is termed parenchy- these conditions, extending to the submucous matous tonsillitis. When the connective tissue in tissues, give rise to suppuration. Some cases may front and above the tonsil becomes inflamed the spread rapidly until suppurative cellulitis ensues, term peritonsillitis is applied, and when suppura- extending to the larynx and trachea and ending tion takes place a peritonsillar abscess is the result. fatally. The symptoms depend on the degree of inflam- In order to treat this condition effectively the mation. It commences with pain in the throat, patients must be fed as well as possible, iron and aching of the limbs, and a feeling of malaise, a strychnine administered internally, and local anti- slight rigor, rise of temperature, constipation, and septic soothing solutions employed as a mouth-wash. a coated tongue. Often a slight erythematous rash the A third local disease is chronic pharyngitis, appears on the surface of the body, resembling a few which may be the result of (a) simple catarrh; scarlet-fever rash. This is fairly common (?) nasal obstruction; (c) fevers; (d) gouty dia- days after the operation of tonsillotomy, and if not such a condition thesis; (e) exposure to dust or irritating fumes; the surgeon is familiar with (/) excessive use of tobacco or alcohol; (g) dyspepsia, considerable anxiety often ensues. I have known the constipation, portal congestion; (li) anaemia; (?) neu- several cases of children with a slight rash after rotic temperament in females. removal of tonsils being diagnosed as having con- In this condition the complains of weak- tracted scarlet-fever, and I remember one such case patient When ness and discomfort and a dragging sensation in the which was removed to an isolation hospital. " there is con- fauces, with the continual up of the inflammation of the tonsil extends hawking" in mucus. The voice gets tired and an irritable cough siderable pain in the ears and great difficulty become in- ensues. The mucous membrane is in some cases swallowing. The sub-maxillary glands and and the follicles fected, and the saliva is profusely secreted congested lymph hypertrophied; inflamma- in other cases it is and and there is allowed to flow from the mouth. This dry pale-looking forms a latter con- to the tissue, a diminution of lymph follicles. This tion, extending peritonsillar 30 THE HOSPITAL. Oct. 13, 1906. large smooth swelling in front of the tonsil. If adult, wliere the haemorrhage is often troublesome fluctuation is elicited, pus is present, and should after using a tonsillotome, I use a wire ecraseur foe removed at once. The usual way is to anaesthe- or take the tonsil out piecemeal by means of punch- tise the swelling with a 10-per-cent. solution of forceps. Severe haemoiTliage after tonsillotomy is cocaine. Use a guarded knife?that is, a knife rare, but slight haemorrhage is common. It with no long blade which might injure the tongue usually comes on several hours after the operation, ?or lips if the patient moved, but one with a point and is due to: (a) An abnormality of the blood- only. The point of incision is well above the tonsil, vessels, (b) haemophilia, (c) a small piece half cut and should be made in the lateral direction, nearly through and left, (d) excessive retching and vomit- at the level of the base of the uvula. One free in- ing. If severe, the bleeding point must be caught cision should be made, and the wound subsequently by artery-forceps or touched with the galvano- opened up with a pair of sinus forceps, this ensuring cautery; but as a general rule ice to suck and com- free exit of the pus and subsequent drainage. plete rest curtails it. Various knives and instruments may be employed Hccmorrhages occur from the pharynx from a is for this operation; very ingenious appliance several causes, upon which the treatment depends. ?composed of a spring which, when pressed, reveals The causes are (a) general debility from albumi- a concealed knife for the incision and dilatation nuria, diabetes, and fevers; (b) acute inflamma- of the wound. The drawback is it cannot readily tions; (c) ulcerations, as tubercular, malignant, foe taken to pieces for sterilising purposes. and specific; (d) after excessive mercurial treat- acute tonsillitis is not The treatment of very ment ; (e) enlarged varicose veins or hepatic is in complicated. Sodium salicylate given fairly disease; (/) traumatic, from a needle, pin, gun- three with to iv. large doses every hours, gr. ij. gr. shot wound, or, as in a case I saw lately, where a be with The fauces should painted guaiacum and man fell on the point of his umbrella and it entered gargled with potassium chlorate or with a carbolic his pharynx. acid solution. Small pieces of ice are given to suck, Retro-pharyngeal abscess is another local disease and the strength maintained by beef-tea, milk, and of the pharynx, although it is usually associated soon as the brandy. As acute symptoms begin to with a general strumous condition, chiefly seen in of iron in doses is re- disappear perchloride large young children. It may simply be a swelling and commended. suppuration of the cellular tissue on the posterior I do not advise removal of or inflamed tonsils, for pharyngeal wall, it may be due to caries, generally the general health being lowered and the tonsil tubercular, of the upper cervical vertebrae. The is probably suppurating, it inadvisable to form any symptoms are difficulty in respiration, causing a extensive raw surface. croupy sound and slight dyspnoea. The head be- Chronic enlargement of the tonsil is often the comes fixed, there is swelling of the glands at the result of acute repeated attacks, occurring in angle of the jaw, and pain when pressing on the strumous children or amongst people inhabiting head. On examination a bulging is seen on the -damp houses or moist districts. posterior surface, and often fluctuation will be felt in the The patient trouble is subject to acute or with the finger. The treatment is to evacuate the ?sub-acute attacks of tonsillitis. Enlargement of pus. An incision is made into the most prominent the tonsils causes in difficulty breathing. Adenoid part with a guarded knife. Immediately the knife " growths are usually present in the naso-pharynx.
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