144 DISEASES Oi" THE SALIVARY GtLANDS, TONSILS AND MARVNJC. 



indicative of repeated obstruction in the pharyngeal, oesophageal or 

 laryngeal region. At the moment of deglutition, the polypus is thrust 

 towards and obstructs the oesophageal orifice. 



Eeflex stimuli are thus excited, which prevent deglutition ; an attack of 

 coughing occurs, and food mixed with saliva is ejected from the mouth 

 and nostrils. The attack of coughing displaces the polypus either 

 in a forward or lateral direction, and swallowing then again becomes 

 possible, until by changing its position the growth produces fresh signs 

 of obstruction. 



In other cases the polypus may only be of such small size as to 

 impede the food passing through the pharynx on its way into the 

 oesophagus or to cause difficulty in respiration by partially blocking 

 the pharyngeal portion of the nasal cavities. In such cases deglutition 

 is only checked and rendered slower. 



Or again, the pedicle of the polypus may be sufficiently long to allow 

 the growth at certain moments to fall in front of the laryngeal opening. 

 Eespiration is then painful, difficult and noisy. Unless the growth is 

 displaced during the subsequent attack of coughing, asphyxia may appear 

 imminent, or may even occur unless assistance is afforded. 



Guided by these symptoms, the operator will explore the pharynx 

 manually, and thus discover the position and size of the tumour. 

 Tumours of the naso-pharynx produce very similar symptoms. 



The prognosis is based on the information obtained by manually 

 exploring the pharynx. It is relatively favourable if the polypus has a 

 well-marked neck, but is very grave if the tumour is largely sessile and 

 cannot be removed. 



Treatment. Medical treatment appears useless except in cases of 

 polypi due to the presence of actinomyces. The administration of iodine 

 and iodide of potassium, in large doses, may then lead to resorption ; but 

 extirpation is often preferable. 



In other cases extirpation is the only rational treatment. The 

 operation necessitates the performance of provisional tracheotomy in 

 order to avoid risk of asphyxia. The growth may be directly removed 

 through the buccal cavity without incision, provided that it prove pos- 

 sible to pass the chain of an ecraseur around the pedicle ; or through the 

 buccal cavity, with incision, after vertically or obliquely dividing the soft 

 palate; or, lastly, through the larynx, after performing median laryn- 

 gotomy, thus obtaining access to the pharynx. 



Only the first method of intervention is to be recommended ; the last 

 two are more delicate. They necessitate after-treatment, and when the 

 patients are in a condition for slaughter it is frequently preferable to 

 send them to the butcher. The essential point is not to act without a 

 full knowledge of the causes. 



