32 



DISEASES OF THE DIGESTIVE APPARATUS. 



gitis it is pale, thickened, plicated, and covered with a thick, 

 thread-like mucus (Bruckmuller). Inflamed glands and follicles 

 predominate in the shape of small pimples of the size of a millet- 

 seed. In intense pharyngitis we find an œdematous inflamma- 

 tion with very marked redness of the mucous membrane; this 

 may even be found to have a pulpy consistence. Sometimes 

 the exudate coating it is purulent or bloody and ichorous, some- 

 times it consists of a greenish, glue-like coating, under which the 

 membrane, stripped of its epithelium, seems gnawed away. The 

 lymphatic follicles and the mucous glands are enlarged, and may 

 become the size of a pea; they are often found ulcerated; we 

 observe numerous small purulent points on the mucous membrane, 

 especially in the neighborhood of the amygdalae, which, according 

 to Bruckmiiller, have sometimes undergone calcareous transforma- 

 tion. 



When the lesion of the mucous membrane is communicated to 

 the subjacent connective tissue, pharyngitis takes a phlegmonous 

 character. We then find the cellular sub-mucous tissue infiltrated 

 with serum and blood ; it is often transformed into a purulent or 

 gelatinous mass, which may form a more or less large abscess, 

 often opening through the mucous membrane, or causing gangrene 

 by excessive pressure. The purulent infiltration of the subcuta- 

 neous connective tissue may be the determining cause of abscess, 

 fistula, or a diffuse mortification of the mucous membrane. The 

 alimentary matters enter into the false tracts thus burrowed by the 

 abscess formation, maintaining suppuration, and at times pro- 

 ducing gangrene. Bruckmiiller has seen these foreign bodies 

 between the mucous and muscular walls of the œsophagus, extend 

 from the pharynx to the stomach. 



The pharyngeal ganglions always, and the sublingual glands 

 frequently, participate in the inflammation. They are found 

 tumefied, with hemorrhagic infiltration, or transformed into a 

 reddish pulpy mass, or broken down into abscess. Post-pharyn- 

 geal abscesses, sometimes simple, sometimes sinuous, are more or 

 less voluminous ; they contain a thick, creamy pus (a decilitre or 

 even more). This pus may undergo a cheesy transformation, an 

 abundant connective-tissue hyperplasia. In serious pharyngitis 

 the ganglions of the throat are tumefied, form abscess, and the 

 pus which they contain finds its way to the surface through one or 

 several fistular tracts. The mucous membrane of the larynx is 



