CATARRH. 411 



largish plug, wliicli projects from the mouth of the pouch, but 

 does not, however, escape from it ; this alone contributes in no 

 small degree to the enlargement of the entire tonsil. Add to 

 this the inflammation and suppuration in the follicles. One 

 after another (for they do not all aj^pear to be affected at once) 

 they swell and soften. The contiguous abscesses run together 

 here and there, until at last (supposing the natm-al order of 

 events not to be forestalled by interference with the knife or 

 caustics), the entire tonsil is excavated by a sinuous abscess, 

 which is converted, when the pus escapes, into a sinuous fistula. 

 This usually occurs at several points at once. Thereupon the 

 gland suddenly collapses ; always supposing that the follicular 

 abscesses have previously become confluent. In the contrary 

 event, those follicles which have not yet burst, together with 

 those wdiich have entirely escaped the disease, undergo no 

 further change, and represent what is left of a tonsil. The 

 fistulous sinus, as a rule, is speedily filled up by cicatricial tissue, 

 without the occurrence of any dangerous complication. Should 

 the healing process be delayed, should the base of the ulcer 

 assume a gangrenous and putrid character, the proximity of the 

 internal carotid becomes a source of danger ; intractable haemor- 

 rhage may result, when the vessel is laid bare by suppuration 

 and then perforated. {Hcemorrliagia per dkhrosin.) 



§ 352. The changes which the secretions of the mucous 

 membrane undergo, under the influence of catarrhal inflamma- 

 tion, are so striking, and aftbrd such weighty indications for 

 clinical diagnosis, that catarrhal disorders have been summarily 

 defined by more than one author, as anomalies of secretion. 

 This is an error, inasmuch as the morbid state of the secretions 

 is not the cause, but the consequence of the catarrh. It would 

 be quite as incorrect to see nothing in a catarrh beyond a quan- 

 titative increase of the normal secretion. One secretion ma}" 

 differ from another, and this difterence is very manifest in the 

 present case. Those secretions of the mucous tract which are 

 most important physiologically, the gastric and intestinal juices, 

 are not by any means more abundantly secreted by the catarrhal 

 than by the healthy mucous membrane ; on the contraiy, a 

 diminution in the amount of these secretions may be expected 

 as an invariable functional concomitant of catarrhal inflamma- 

 tion. Tliis statement does not apply in the same degree to the 



