140 DISEASES OF THE SALIVARY GLANDS, TONSILS AND PHARYNX. 



swallowiii<:;", interference with respiration or noisy respiration, and intense 

 fever. 



Diagnosis. The diagnosis presents no difficult^', the s_ymptoms men- 

 tioned l)eing easy to identify, whether the condition be simply inflam- 

 mation of the pharynx or be of a more extensive character. Never- 

 theless, cases occur where the symptoms are alarming, but in which 

 one might hesitate between the diagnosis of ordinary acute sore tliroat 

 and the sore throat wdiich ushers in gangrenous coryza. A definite 

 expression of 'opinion must then be deferred to a later date ; for one 

 cannot be absolutely certain whether or not the other signs of gan- 

 grenous coryza will appear. 



When there is only difficulty in swallowing one might a priori sus- 

 pect traumatic injury of the mucous membrane, with or without the 

 presence of a foreign body. It is also necessary to bear in mind the 

 possibility of difficulty in swallowing being occasioned by reflex irritation 

 without local lesions, originating in enlargement of the retropharyngeal 

 lymphatic glands as a consequence of tuberculosis or other disease. 



The prognosis is favourable ; even without treatment acute pharyn- 

 gitis usually tends to recovery in eight to twelve days, and rarely becomes 

 complicated. Nevertheless, some reserve ought to be exhibited in cases of 

 pharyngitis due to the action of rough forage, the removal of the cause being 

 here indispensable to any improvement. Similarly in cases of pharyngitis 

 due to foreign bodies having penetrated the mucous membrane, which 

 are chiefly characterised by inability to swallow, the disease may continue 

 for a very much longer time than above indicated, unless the foreign 

 body is discovered and removed. Inflammation is limited to a zone sur- 

 rounding the point of implantation. It extends more deeply with move- 

 ments of the foreign body, and may end in the formation of an abscess. 

 Of this variety is Hopsomer's remarkable case, in which a darning- 

 needle finally obtained exit through the submaxillary space, in which it 

 had caused the formation of an abscess. 



Treatment. The treatment is the same whether we are dealing with 

 a simple acute pharyngitis or with a more widely distributed inflannna- 

 tion. It consists in smartly stimulating the region of the throat with 

 mustard, cantharides oil, or ointment, or with an ointment containing 

 2 per cent, of tartar emetic and of bichromate of potash, and then cover- 

 ing the parts with a flannel hood. This mode of treatment seems 

 preferable to that recommended by German authors — viz., the applica- 

 tion of cold compresses to the throat, the administration of cold gargles, 

 etc. Moderate bleeding, to the extent of two or three quarts, has the 

 great advantage, as in all similar cases, of lowering the temperature. 



This treatment may, if necessary, be completed by the internal 

 administration of 3 to 5 drams of Kerme's mineral (oxysulphuret of 



