MORBID ANATOMY OP THE PHARYNX AND MOUTH.
Congenital malformations.—The pharynx in a very few instances only, presents any mal formation ; when such exists the pharynx ter minates in a cul-de-sac. Sir A. Cooper has recorded a case of this kind, in which also the cesophagus was altogether wanting and the stomach without a cardiac orifice : the child lived eight days. In acephalous monsters a total deficiency of the pharynx has been no ticed, but this is of very rare occurrence. The hard and soft palates are occasionally liable to congenital fissure : owing to an arrest of de velopement they fail to unite in the median line, and the result is what has been termed the cleft palate: this defect may be confined to the velum palati, or it may include the bony palate, and will sometimes extend through the front of the jaw : where the bony palate is involved the defect may vary from a mere fis sure to an entire absence of the palatine arch, so that the nose and mouth are converted into a common cavity. The upper lip is not un frequently fissured either on one or both sides of the median line, constituting the single or double hare-lip. This deformity may exist with or without the fissured palate, but cannot be considered as dependent simply on an arrest of development; for at no period of fcetal life is the lip known to present this peculiar condition: the fissure may only partially divide the lip, or it naay extend into the nose in an oblique or vertical direction. It is very rare to find the lower lip fissured.
Foreign bodies in the pharynx inay produce immediate suffocation, either by mechanically obstructing the opening of the larynx or by inducing spasm of the glottis; when any dif ficulty occurs in the extraction of these bodies, it is more generally dependent on their form than size. Angular portions of bone, needles, &c. are likely to become fixed by the con traction of the pharyngeal walls upon their pointed edges.
Structural changes.—The mucous mem brane of the pharynx and posterior part of the fauces is very frequently the seat of inflam mation, either simple or of a specific cha racter; thus, it rarely escapes in scarlatina and syphilis without exhibiting the effects of these poisons : the latter often producing, by ulce ration and sloughing, total destruction of the soft or even of the hard palate and causing fearful mischief. The tonsils generally parti cipate in these inflammatory affections, or they may become inflamed primarily. In quinsy, the swelling of the tonsil is excessively rapid, and the disease is prone to terminate in sup puration. One effect of frequent inflammatory attacks is an indolent enlargement of the tonsil, a condition which is often with difficulty re medied, and occasionally requires excision of that organ.
Abscess sometimes occurs in the reticular tissue between the pharynx and cerviail ver tebrx, and protrudes the posterior wall of the former forwanls, so as to interfere with de glutition.
Ulceration of the pharynx occasionally hap pens; it may be the result of a simple or specific inflammation, and will sometimes pro ceed to the destruction of its walls : fistulous openings between it and the larynx or other neighbouring parts may be thus produced. Cancer of the pharynx is fortunately not com mon, but cases have been noticed in which it has occurred.
Polypi have sometimes been found to take their growth from the mucous membrane of the pharynx, and most commonly spring from that portion of it which covers the posterior aspect of the larynx. Dr. Monro mentions a case of this kind in which the polypus was of considerable length, hanging down in the cesophagus ; another seat of origin in the pharynx is from the membrane as it invests the under surface of the basilar process of the occipital bone : they have been seen to grow also from the soft palate.
A pouch is occasionally formed either be hind or on either side of the pharynx by an extrusion through the muscular coat of its mucous membrane. A preparation in the Mu seum at St. Thomas's Hospital exhibits such an arrangement: a blind pouch about three inches in length, and of course communicating with the interior of the pharynx, descends by the side of it : the muscular parietes do not appear to have been at all prolonged upon its surface.
The cheeks, gums, and lips in children are sometimes involved in a destructive ulceration, to which the term cancrum oris has been ap plied ; it may extend to almost any length, destroying the cheek, the lips, the gums, and teeth : it is seldom seen in adults. The gums, besides the softened and spongy change in duced by scurvy and the well known effect caused by the introduction of mercury into thc system, are also affected with the disease called epulis. In this case the gum is enlarged, reddened, and ulcerates, and demands ex cision of the entire diseased structure : it is generally considered of a malig-nant nature. The lower lip is sometimes the seat of can cerous ulceration; it has been questioned whe ther this disease is really true cancer. Sir A. Cooper, however, says, in his lectures, " That the disease is of a scirrhous nature, even at the beginning, any surgeon must be satisfied ; it is hard, has a bleeding surface, everted edges, and, as it proceeds in its destructiac course, communicates disease to the glands : there is likewise felt in it, at particular periods, the most dreadful pain. An operation for the complete removal of the disease is the patient's only real hope of succour." It is very rare for the same disease to originate in the upper lip.
( William Trew.)