CATARRHAL INFLAMMATION ANGINA CATARRHALIS. 465 



that of the larynx or nares. The changes consist in an irregular hy- 

 peraemia, so that sometimes we see only a few varicose vessels in the 

 otherwise pale membrane ; in a thickening, or hypertrophy, which is 

 either diffuse, or limited to undefined spots ; and, in a perverted secre- 

 tion of the mucous membrane. From the partial thickening of the 

 mucous membrane, in which the sub-mucous tissue also participates, the 

 posterior wall of the pharynx acquires a peculiar nodulated appear- 

 ance ; there are numerous round, or oval, sometimes confluent promi- 

 nences, whence the disease is called pharyngitis granulosa. . Some 

 authors designate it pharyngitis follicularis, because they consider that 

 the partial hypertrophy of the mucous membrane is chiefly limited to 

 the vicinity of diseased mucous glands. This view is probably correct, 

 but has not yet been anatomically proved. In some cases the secre- 

 tion of the mucous glands is very abundant, and then it sometimes 

 shows an inclination to dry into disgusting yellow or green crusts ; in 

 other cases it is scanty, and then also shows the inclination to dry, and 

 the posterior wall of the pharynx looks as if covered with a thin coat 

 of varnish. For this form of the affection, Lewin has proposed the 

 very suitable name of pharyngitis sicca. 



SYMPTOMS AND COURSE. Acute catarrhal angina is usually ac- 

 companied by a fever, which has the symptoms of catarrhal fever, as 

 previously described ; this occasionally precedes the local difficulties, 

 but it is sometimes, though rarely, entirely absent. At first the secre- 

 tion from the mucous membrane is diminished; hence the patients 

 complain of dryness in the throat. From the tension of the mucous 

 membrane, especially at the half arches of the palate, where it is 

 closely attached to the subjacent muscles by a scanty connective tissue, 

 there is great pain, which is so increased at every attempt to swallow 

 that the patients make wry faces whenever they attempt it. When, 

 as frequently happens, the elongated uvula touches the tongue, there 

 is a sensation of a foreign body in the throat and a constant inclina- 

 tion to swallow. In very severe forms of catarrhal angina, which arc 

 often called erysipelatous or erythematous angina, the muscles of the 

 palate are often infiltrated with serum and their functions lim- 

 ited. Under normal circumstances, as is well known, the contrac- 

 tion of the muscles of the anterior half arches of the palate prevents 

 the return of food into the mouth ; contraction of the muscles of the 

 posterior half arches closes the passage to the nose, as the uvula fills 

 up the opening that is left. If the function of these muscles be im- 

 paired, fluids would be driven through the nose or back into the mouth 

 by the contractions of the pharynx in the attempt to swallow. If the 

 mucous membrane of the pharynx be the seat of an intense catarrh, 

 and, as a consequence, the muscles be paralyzed by serous infiltration, 

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