4C6 AFFECTIONS OF THE PHARYNX. 



the patient suffers still more. As soon as a morsel of food, or, still 

 more, any liquid, has passed the anterior half arches, the patient is 

 greatly terrified, as he cannot pass it either forward or backward. As 

 the substance in the pharynx would pass into the larynx on any at- 

 tempt to breathe, the patients hold then* breath and attempt, in every 

 conceivable manner, to evacuate the contents of the pharynx through 

 the mouth ; they bend far forward and let the head hang over the side 

 of the bed. Nevertheless, some of the contents of the pharynx often 

 enter the larynx, and are again expelled by spasmodic coughing. The 

 patients at last become timid, and, with terror, wave back the drink or 

 medicine offered to them, they pass day and night in the most uncom- 

 fortable postures, so that the saliva may flow out of the mouth, and 

 they may not be obliged to swallow it. A " nasal " tone of the voice 

 is a pathognostic symptom of all affections of the pharynx, where the 

 functions of the muscles of the half arches of the palate a.re affected, 

 and consequently for all the intense forms of catarrhal angina. As is 

 well known, it is only in saying -2V and JWthat we allow the air to pass 

 through the nose ; while pronouncing other letters, the nasal cavities 

 are closed. When patients are unable to shut off the nose in this way, 

 from inability to contract their posterior half arches, the resonance of 

 the nose gives to all sounds a peculiar tone, which is called " nasal," 

 and the person is said to " speak through the nose." Besides this dif- 

 ference of tone, there is a certain difficulty of speech. The patients 

 speak slower and more carefully, because it pains them, especially 

 when saying -ZVJ in doing which the root of the tongue is for a moment 

 pressed against the roof of the mouth. A last characteristic is, that 

 the pronunciation of guttural J?, in which the uvula is made to vi- 

 brate, becomes difficult or even impossible, if the uvula is much swollen 

 and elongated. 



As we said in the first chapter of the previous section, the milder 

 as well as the more severe forms of catarrhal angina are almost always 

 accompanied by catarrhal stomatitis. The patients have a coated 

 tongue, bad taste, foul breath, and the mouth is always full of saliva. 

 Not unfrequently acute pharyngeal catarrh extends to the Eustachian 

 tubes and the tympanum; the patients become deaf, have piercing 

 pains in the ears, which may be excessive, until perforation of the 

 drum permits the escape of pus from the middle ear, when a remission 

 suddenly occurs. 



Catarrhal angina almost always terminates in recovery after a few 

 days. While the pain and difficulty in swallowing subside, quantities 

 of mucus are removed from the pharynx by hawking and spitting ; at 

 the same time the symptoms of oral catarrh pass away. 



In chronic catarrh of the fauces, the pain and difficulty of swallow 



