472 AFFECTIONS OF THE I'ttARFNX. 



SYMPTOMS AND COURSE. Acute parenchymatous pharyngitis gen- 

 erally begins with a high fever, which may be preceded by a severe 

 chill. The general condition of the patient is much affected, the pulse 

 full and frequent, the temperature 104, or over. In this case we have 

 not, as in pharyngeal catarrh, a catarrhal, but we have an inflamma- 

 tory fever, such as accompanies pneumonia and other inflammations of 

 important organs. It is only in rare cases, where the disease is not 

 severe and runs a very sluggish course, that the fever is moderate. 

 With the commencement of the fever, or, perhaps, not till next day, 

 ihe patients complain of a feeling of tension and soreness in the throat, 

 and often of piercing pain, extending to rard the ear ; it feels to them 

 as if there were a foreign body in the f ftarynx, hence they make con- 

 stant attempts to swallow, although the motion increases their pain. 

 Sometimes all the painful and terrifying symptoms occur, which we 

 described in the first chapter of this section as accompanying the se- 

 verer forms of catarrhal pharyngitis. Not only does swallowing be- 

 come very painful, so that, when the patient attempts to swallow a 

 little saliva, he distorts the face ; but, from the imbibition and paraly- 

 sis of the muscles of the palate and pharynx, when he attempts to 

 swallow, both solids and fluids come back through the mouth and nose, 

 or else we have the painful and dangerous condition that we have be- 

 fore described (p. 466) as caused by the impossibility of getting the 

 morsel out of the pharynx. The secretion of saliva is often enormous- 

 ly increased ; if the patient opens the mouth, without spitting, the 

 saliva runs from the corners of the mouth. The tongue is thickly 

 coated, the odor from the mouth very unpleasant ; there is also the 

 characteristic modification of the voice ; its resonance is changed, the 

 speech has the peculiar nasal twang, from which alone we may often 

 suspect the disease as soon as the patient speaks. Other characteris- 

 tics of parenchymatous angina are the difficulty and pain caused by 

 opening the mouth ; frequently the patient cannot separate the teeth 

 more than a few lines; this difficulty is apparently caused by the ex- 

 cessive tension of the bucco-pharyngeal fascia. Respiration is affected 

 far less frequently than speech and the opening of the mouth. Any 

 considerable want of breath, added to the symptoms of parenchyma- 

 tous angina, is always a serious symptom, and must arouse the suspicion 

 that there is oedema glottidis. On examining the mouth and pharynx, 

 which is done with difficulty, we often find the tonsils so swollen as to 

 touch each other or to squeeze the cedematous uvula between them, 

 [f only one tonsil be inflamed, we often see the uvula pressed entirely 

 to the opposite side. We find the soft palate pressed forward into 

 the middle of Ihe mouth. At the part of the neck corresponding to 

 the tonsil, that is, behind and below the angle of the lower jaw, we 



