108 



DISEASES OF THE DIGESTIVE APPARATUS. 



cuts, injuries or specific eruptions (aplitha, tuberculous ulcerations, the 

 ulcerations of gangrenous coryza, etc.) on the gums indications of 

 gingivitis, periostitis, mercurial poisoning, actinomycosis of the maxilla, 

 and ulcerations of all kinds ; on the tongue, of wounds, of simple or 

 specific inflammatory eruptions (aphtha, the ulcerations of actinomycosis, 

 tuberculosis, gangrenous coryza, etc.), as well as the swellings due to 

 superficial or deep-seated glossitis. By the same method of examination, 

 though with somewhat more difficulty, one can detect abnormal mobility, 

 irregularity of development, caries, etc., of the teeth, the condition of 

 the excretory ducts of the salivary glands, the state of the hard and 



soft palate, and the existence of 

 fissures, vegetations, polypi and 

 tumours. 



Salivary glands. The salivary 

 glands, particularly the parotid and 

 submaxillary, should be examined 

 by direct inspection and palpation. 

 Direct inspection reveals the 

 existence of swellings, deformity 

 of parts, increase in salivation, or 

 ptyalism, which sometimes occur 

 in conjunction with foot-and- 

 mouth disease, actinomycosis, 

 acute stomatitis and mercurial 

 poisoning, as well as increase in 

 size of the salivary ducts. 



Palpation reveals the degree 

 of sensibility of the parts, the 

 existence of oedema, induration, 

 cysts, and, more frequently, distension of the salivary ducts as well as 

 the presence of calculi, tumours, the direction of fistulse, etc. 



Difficulties may occur, particularly when the submaxillary and parotid 

 glands are afl'ected ; but methodical and complete examination will usually 

 enable one to difl'erentiate the conditions. 



Pharynx. The pharnyx may be examined externally by inspection 

 and palpation, and internally by direct digital palpation. Inspection 

 res'eals possible deformities of the region of the gullet, palpation the 

 condition of the tissues as well as abnormal sensibility and infiltration. 

 Internally, digital examination must be cautiously conducted, and after 

 a strong gag has been securely inserted in the mouth. Under such con- 

 ditions it is without danger. The hand being inserted exactly in the 

 median line will detect obstructions which may already have been partly 

 identified by external palpation, as well as the existence of inflammation 



Fig. 58. — Examination of the mouth. 



