Treatment. — In pharyngeal syphilis, as in syphilis everywhere, constitutional treatment is of primary importance. If the symptoms are urgent, the hypoder mic method of administering mercury should be employed, as it gives the most speedy results. Local treatment consists in maintaining perfect cleanliness of the diseased parts, and stimulating mucous patches and ulcerations to heal by daily applications of the acid nitrate of mer cury, diluted with five parts of water. The remedy is effective, but painful, and almost equally satisfactory results are sometimes obtained by touching the ul cers with nitrate of silver, GO grains to the ounce of water.
Retropharyngeal Abscess.
An abscess of the posterior pharyngeal wall may be hidden above and behind the soft palate, and require the rhino scope to ascertain its outline; it may lie situated opposite the larynx and only be partly visible with the laryngoscope; or it may be situated in such a manner as to be hidden by one of the posterior pil lars of the pharynx. flowerer, the most common seat of abscesses is the posterior wall of the pharynx opposite the oral cavity.
It may occur as the result of phleg motions inflammation of the cellular tis sue of the pharynx, or from the breaking down of an inflamed lymphatic. Caries and necrosis of the vertebriu or temporal bone are occasional causes of the affec tion.
There is usually but slight systemic disturbance. Local symptoms arc usu ally the first to attract attention, espe cially in infants, among whom the dis ease is the more common. When the abscess is situated high up upon the pharyngeal wall, a sensation suggesting the presence of a foreign body causes almost constant hawking and spitting, while there may be present obstructed nasal respiration with more or less pain and tinnitus. When the abscess is oppo site the larynx, dyspncea is a marked symptom, appearing in "spasms," which may endanger the patient's life, while swallowing of liquids or solids is danger ous, owing to their passage into the lar ynx. An abscess in the pharyngeal wall
opposite the oral cavity presents none of these symptoms unless it is very large.
Treatment. — Left to itself, a retro pharyngeal abscess will discharge either into the throat or at some remote point; but it should be opened as soon as a diagnosis is made, by means of a curved small trocar and cannula. Should the pus recur, an incision should be made into the abscess at its lowest part, and the opening maintained patulous by the daily passage of a probe.
Tumors.
Any of the varieties of tumor found in other parts of the body may occur in the pharynx. They are most frequently located in the lateral walls and may in volve the surrounding structures. In the following order of frequency are found in the pharynx: Gumma, sar coma, carcinoma, lupus, papilloma, cysts, fibroma, osteoma, enchondroma, ade noma, and aneurisms.
When the growth is large, it may be come an obstruction to deglutition or even respiration. In carcinoma and ul cerating lupus, pain is present, usually radiating into the ear.
Carcinoma of the pharynx and larynx usually runs a rapid course, attended with the characteristic lancinating pains, constant and often intolerable. As re gards the fauces, there is, coincident with pain during deglutition, a stiffness of the angle of the jaw; an intense, boring, ever-present pain in the ear is often the chief complaint. The tonsil, the most frequent starting-point, at first presents a dark-red appearance, with a grayish white spot in the centre; the surround ing tissues on the affected side are hyper femic; it subsequently exceeds the con fines of the tonsil and rapidly spreads over the surrounding tissue in a cauli flower-like manner. J. S. Gibb (Medi cine, Jan., '98).
Early extirpation with the knife, gal vanoeautery, or snare should be prac ticed.