PHLEGMONOUS INFLAMMATION OF THE PHARYNX. 473 



find a hard, painful swelling. Even more frequently than in cafcarrhal 

 pharyngitis, the inflammation extends, with severe pain, to the Eusta- 

 chian tube and tympanum. While the local symptoms thus increase 

 for three or four days, the fever grows higher, and symptoms of hyper- 

 femia of the brain occur ; the patient has severe headache, is sleepless, 

 tormented by horrible dreams, or even becomes delirious. When the 

 inflammation ends in resolution, the local and general symptoms usu- 

 ally subside toward the end of the week, and the patient generally re- 

 covers in eight to fourteen days. When suppuration occurs, and ab- 

 scesses form, there is a sudden remission after the symptoms have 

 reached their highest point. The patients often perceive the opening 

 of the abscess only by the sudden relief they experience, as the pus 

 may be swallowed or overlooked ; in other cases the opening may be 

 instantly recognized by the fetid odor and the yellow color of the sub- 

 stance thrown out. It is doubtful how the pus, which has been com- 

 pletely enclosed and protected from the air, acquires this very disagree- 

 able smell. After the opening of the abscess convalescence is gener- 

 ally rapid. 



Acute parenchymatous inflammation of the soft palate gives sub- 

 jective symptoms similar to those of acute tonsillitis, and we can only 

 decide on the presence of one or the other by the objective appear- 

 ances. 



Chronic parenchymatous angina either results from protracted at- 

 tacks of the acute form, or comes on gradually and independently. It 

 generally causes very little trouble; there is little or no pain, the in- 

 creased mucus is due to the accompanying catarrh ; but the slightest 

 irritation causes the chronic to relapse into the acute form again. The 

 speech is often changed by the hypertrophy of the tonsils ; in other 

 cases pressure on the Eustachian tubes causes permanent deafness. 

 The enlarged and elongated uvula may irritate the entrance to the 

 glottis, and so excite habitual spasmodic cough. 



TREATMENT. General and local blood-letting are recommended 

 ni acute parenchymatous angina. The former, which Bouillaud em- 

 ployed as " saigne"es coup sur coup," is never required by the disease 

 itself, and but rarely by its complications. Leeches, applied to the 

 neck, give little ease, and even scarification of the tonsils has not done 

 as much good as was expected of it. 



If called the first or second day of the disease, we may employ the 

 treatment advised by Velpeau / that is, apply powdered alum to the 

 inflamed part two or three times daily, and advise the patient to rinse 

 ms mouth frequently with a solution of alum ( 3 iij 5 ss to vj of 

 barley-water). Instead of alum, solid nitrate of silver has been recom- 

 mended to cut short the disease. 



