Atrophic Pharyngitis.
Atrophy of the mucous and submu cous tissues of the pharynx frequently exists when atrophic rhinitis is present, being probably the result of an extension of the atrophic process to the pharyn geal mucous membrane; or contact with the respired air not properly warmed and moistened by the atrophic nasal mu cous membrane, and dry condition of the faucial mucous membrane, amounting almost to pharyngitis sicca, is found in all mouth-breathers, but disappears spon taneously as soon as the nose has been rendered sufficiently pat ulous.
The patient complains that his throat feels dry and stiff. Upon inspection, the pharyngeal mucous membrane appears light colored, thin, and as if varnished. The mucous membrane and submucous tissues are so thin sometimes that the outline of each cervical vertebra can be distinguished. Masses of inspissated mu cus, perhaps dark colored from the dust inhaled and swept into ridges by the mo tions of the soft palate, are seen adher ing to the surface of the atrophied tis sues.
Treatment.—Attention should be mainly directed to the condition of the interior of the nose, because, when a cure of the nasal affection has been brought about, the concomitant throat disease will improve almost without treatment. The general health should receive attention; and, if necessary, tonics should be prescribed, while con stipation should be met by the use of saline laxatives. Iodide and bromide of potash may also be ordered to increase the pharyngeal secretions and diminish reflex symptoms, and a weak solution of nitrate of silver (5 to 15 grains to the fluidounce) should be applied to the atrophied mucous membrane, both above and below the soft palate, to stimulate the atrophied glands to increased secretion, and bring about renewed growth of the atrophied structures. The patient should use Dobell's solution or some other bland alkaline wash as a spray through the nose night and morning in order to re move adherent secretions.
Syphilitic Pharyngitis.
Symptoms.—Syphilitic pharyngitis is an inflammation of the pharynx due to the presence of the syphilitic virus, and may be witnessed during both the pri mary and secondary stages of the disease.
Mucous patches are by no means rare, while gummata or their characteristic cicatrices arc very often met with, espe cially in dispensary practice.
In primary syphilis examination shows a whitish sore, soon followed by swelling, of the glands about the angle of the jaw.. Secondary lesions may present either the form of mucous patches or erythema, characterized by a diffuse redness of the entire fauces; or, in the milder attacks, by a broad red line extending upward upon each of the anterior pillars and ending abruptly and symmetrically at the root of the uvula. The red lines are almost pathognomonic of syphilis, and persist for a long time after other sec ondary lesions have disappeared. In sec ondary syphilis the larynx almost always becomes involved; the voice is hoarse, and there is a short cough of a peculiar metallic character, which, once heard and recognized, is rarely forgotten. Mu cous patches and erythematous areas in the throat are almost always symmetrical, —that is, both sides of the throat are attacked in corresponding localities by similar lesions,—while tertiary lesions do not so constantly present this sym metry. Gummata more frequently in volve the tonsils or soft palate than other parts of the throat. A gumma may be absorbed under treatment, or, breaking down, result in an ulceration. When an ulcerating gumma is situated upon the posterior wall of the pharynx, the cer vical vertebra?, or even the cervical cord itself may finally become involved, and a fatal issue result. In such cases also when the ulceration has involved the posterior surface of the palate, care is required to prevent union of the soft palate and uvula to the pharyngeal wall. Where union has actually taken place, it is difficult at a subsequent period to per manently restore satisfactory communi cation between the oro-pharynx and naso-pharynx by any operation, because of cieatricial contraction after the opera tion.