CATARRHAL INFLAMMATIC N ANGINA CATARRHALIS. 4(J7 



jig are usually slight, and only become worse occasionally when the 

 chronic catarrh is exacerbated by slight injuries. This is particularly 

 true of the chronic catarrh of the soft palate, which is very frequent in 

 patients who have suffered from syphilis, or who have used mercurials 

 for a long while. The slight difficulties that these patients experience 

 in swallowing, and the temporary exacerbations which occur, are a 

 source of unceasing care. They usually soon attain great skill in 

 looking at their own throats in the mirror ; the smallest phlyctenula 

 coming on the soft palate does not escape their notice ; they constantly 

 run after the doctor, who must again look in then* mouth, and again 

 assure them that they are not syphilitic. The cheesy plugs which 

 form in the tonsils are occasionally ejected by hawking. This symptom 

 also troubles the patient a great deal ; the yellow, round bodies, which 

 smell horribly when squeezed, are to them a sure sign that they have 

 tubercles ; and it is as difficult to convince the latter patients that they 

 are not consumptive as to satisfy the former that they are not syphi- 

 litic. Chalky concretions from the tonsils, which are hawked up, are 

 usually represented as lung-stones. The milder cases of chronic pha- 

 ryngeal catarrh, from which most habitual drinkers suffer, usually 

 trouble the patients only in the morning, when the mucous membrane 

 secretes most abundantly a tough mucus, or when it is covered with 

 the mucus secreted during the night. The patients attempt to remove 

 this secretion by continued hawking and spitting, and this straining, 

 which not unfrequently causes nausea and vomiting, is one of the causes 

 of the notorious morning vomiting of drunkards. The severe forms 

 of chronic pharyngeal catarrh, especially of the follicular or granular 

 varieties, are far more troublesome. They do not render swallowing 

 actually difficult, but the patients complain of an irritation, a disagree- 

 able sensation of prickling, also of dryness in the throat, which leads 

 them unwillingly to make the motion of swallowing, or, more fre- 

 quently, to hawk and hack for a long while. It is thought, too, that 

 this repeated hawking is a bad habit. The voice often becomes husky 

 also, as the laryngeal mucous membrane usually participates in the 

 affection. When the follicular pharyngeal and laryngeal catarrh is 

 exacerbated, the hacking increases to a troublesome spasmodic cough, 

 and the husky voice becomes actually hoarse. If the affection extends 

 to the nasal mucous membrane, the nose becomes stopped at night ; 

 hence the patients sleep with the mouth open, and by morning the 

 pharynx and back of the tongue have become so dry that moving them 

 causes cracks in the dry coating, or even in the membrane itself, and 

 then there are slight haemorrhages. Many patients are greatly worried 

 by this spitting of blood, whose origin can hardly be discovered, unless 

 we see the patient just after he has awakened; and thus folliculai 



