470 AFFECTIONS OF THE PHARYNX. 



inconvenience. Sometimes we find them accidentally, when examining 

 the throat of a patient who has other symptoms of syphilis. If they 

 hare changed to ulcers, they cause pain in swallowing. The objective 

 symptoms are given above. 



Gummy tumors do not cause pain or difficulty or swallowing till 

 they have softened and ulcerated. When patients that we suspect of 

 syphilis complain of difficulty in swallowing, we should never neglect 

 to examine the posterior surface of the velum with the finger or the 

 rhinoscope, when inspecting the throat. Occasionally our attention is 

 called to ulcerated nodules at the above locality, by a circumscribed 

 dark-red spot on the anterior surface of the velum. The acts of swal- 

 lowing and speaking are impaired, as before described, by perforation 

 of the velum ; this impairment is the greater the farther forward the 

 perforation has occurred. In eating and drinking, solids and fluids 

 return into the nose ; and as soon as the patient speaks, -we hear the 

 nasal twang to his voice. For the objective symptoms, we may refer 

 to the last paragraph. 



TREATMENT. Syphilitic affections of the throat must be treated 

 according to the rules to be hereafter laid down when speaking of 

 syphilis. In recent cases, the favorable action of mercurials is very 

 striking. When there is danger in delay, I often employ Weinhold^s 

 treatment (which is of late very unpopular), with the modification that, 

 for several evenings in succession, I give ten to twenty grains of calo- 

 mel, until the ulceration is arrested, which is usually by the third or 

 fourth day. 



CHAPTER VI. 



RETROPHARYNGEAL ABSCESS. 



ETIOLOGY. Inflammations terminating in suppuration are oc- 

 casionally seen, especially among children, in the connective tissue 

 between the spinal column and the pharynx. This affection is usually 

 caused by caries of the spine, or a " scrofulous " inflammation and 

 suppuration of the lymphatic glands at the back of the pharynx ; at 

 other times it develops with secondary inflammation of other organs, 

 late in typhus, measles, the septicaemia, and other infectious diseases : 

 lastly, it appears to occur occasionally as an idiopathic inflammation. 



ANATOMICAL APPEARANCES. The posterior wall of the pharyns 

 is often pressed forward by the collection of pus, and the pharynx con- 

 tracted or entirely closed ; the pus may subsequently perforate the 

 wall of the pharynx, or even sink into the breast, and there perforate 

 the oesophagus, trachea, or pleura. 



SYMPTOMS AND COURSE. When disease of the cervical vertebra 



