PHLEGMONOUS INFLAMMATION OP THE PHARYNX. 



471 



CHAPTER IV. 



PHLEGMONOUS INFLAMMATION OF THE PHAEYNX. 



KTIOLOGY. The submucous tissue of the pharynx and the inter- 

 stitial tissue of the tonsils, which are the seat of simple oedema in ca 

 tarrhal and croupous inflammation, may also suffer from inflammatory 

 disturbances of nutrition. These often consist in infiltration of the 

 tissue with fibrinous exudation, and in proliferation of the connective 

 tissue ; in other cases pus is formed, the tissues melt away, and ab- 

 scesses result; diffuse mortification and phagedasna of the affected 

 parts occur in some rare cases. 



The same causes, according to their intensity, or the predisposition 

 of the patient, appear capable of exciting the catarrhal and parenchym- 

 atous forms of pharyngeal inflammation ; hence we refer to the etiol- 

 ogy of the catarrhal form. Parenchymatous pharyngitis also leaves 

 great tendency to relapse ; the more frequently it has affected a per- 

 son, the more liable he is to have it again. Many persons have it 

 yearly, or even oftener. Once having ended in suppuration, it seems 

 disposed to take the same course on subsequent occasions, so that, in 

 such cases, in new attacks, there is little hope of causing the disease to 

 end in resolution. 



ANATOMICAL APPEARANCES. Acute parenchymatous pharyngitis 

 usually attacks the tonsils ; one or both may be inflamed, sometimes 

 the inflammation passes from one to the other. From the exudation, 

 with which they are infiltrated, the tonsils often swell to the size of a 

 walnut ; their surface appears nodulated, dark red, covered with glu- 

 tinous exudation or croupous deposits. As the inflammation passes 

 on to suppuration, some circumscribed spot usually becomes softer and 

 more prominent, and finally the pus perforates the thinned walls of 

 the abscess. More rarely the acute parenchymatous inflammation oc- 

 curs in the submucous tissue of the soft palate ; a hard swelling forms 

 here, and fluctuation gradually occurs ; finally, in this case also, the 

 pus is evacuated into the mouth or pharynx. 



Chronic parenchymatous pharyngitis also almost exclusively affects 

 the tonsils ; more rarely the uvula, or the soft palate, is permanently 

 thickened by inflammatory hypertrophy of the submucous connective 

 tissue. From this cause the tonsils may become very large and hard ; 

 then* surface is often uneven and nodulated, and has depressions where 

 there was formerly a loss of substance fi om suppuration. The mu- 

 cous membrane is but slightly reddened, or is even pale. We often 

 find the above-described cheesy plugs in the gaping openings on the 

 surface of the tonsils. 



