THROAT (AS. Protu, 011(i. drozza, Ger. Drosscl, throat; connected with AIIIG. strozze, throat, Ger. strotzen, to swell, Eng. strut), AF FECTIONS OF TIIE. The throat includes those structures lying behind and below the anterior pillars of the lances. In the common accepta tion of the term it also means the anterior por tion of the neck, containing the windpipe, gullet, and a number of large blood-vessels and nerves. The throat may be divided anatomically into the pharynx and the larynx, the latter being the upper part of the windpipe and the principal organ of the voice. Into the pharynx open the nasal passages and the Eustachian tubes. The en trance to the pharynx is nearly surrounded by a ring of lymphoid tissue, comprising the faucial, lingual, and pharyngeal tonsils. The first of these are usually known as'the tonsils, are al ways present, and often enlarged, and are situ ated at the sides of the fauces between the an terior and posterior pillars. The lingual tonsil, when it exists, lies between the base of the tongue and the epiglottis. The pharyngeal ton sils, more often referred to as adenoid growths, spring from the roof and sides of the pharyngeal vault. They are often present in children and when in any amount constitute a pathological condition, giving rise to obstructed nasal breath ing, nasal catarrh, and general poor health. Any or all of these structures may he involved in diseases of the throat, and expert examination of them is often necessary. Inspection is usually conducted by light reflected into the throat from a head mirror, a circular, concave reflector pierced with a hole for vision. The light is projected through the open mouth upon the back of the throat. From this point the rays of light may be reflected by means of a small mirror introduced into the pharynx either downward to examine the larynx (laryngoscopy) or upward to inspect the posterior mires and the vault of the pharynx (rhinoscopy), the tongue being mean while held out or depressed. In direct examina tion the tonsils, soft palate, uvula, posterior wall of the pharynx, and often the top of the epiglottis may be seen. Laryngoscopy shows the whole of the epiglottis, the root of the tongue, lingual tonsil, the true and false vocal cords, the opening of the glottis, and even the bifurcation of the trachea. The throat is lined with mucous membrane, plentifully supplied with blood-vessels, glands, and nerves, and is often the seat of acute or chronic catarrhal inflammation. Acute inflam mation of either the pharylix or larynx is due to exposure, sudden change of temperature, the inhalation of dust, steam, or irritating vapors, indigestion and constipation, and certain diseases such as rheumatism, gout, and tuberculosis. Chronic catarrh arises also from the causes named when long continued, and may be due to excessive use or straining of the voice. Spe cific inflammations of the throat accompanying scarlatina and diphtheria are described under these titles. Catarrhal inflammation of the throat is marked by a sense of dryness, or of a foreign body in the pharynx, a slight but annoy ing cough, and the expectoration of viscid, tena cious mucus, sometimes tinged with blood. The
voice is hoarse, easily fatigued, or entirely ab sent. In the treatment of eatarr•hal conditions in this region, alkaline and antiseptic douches are given to remove the mucous accumulations, and stimulating and astringent applications, such as tannin, iron, and nitrate of silver, used to reduce congestion and restore the membrane to its normal action. Naso-pharyngeal catarrh is frequently caused by intrmnasal abnormalities and may as often he remedied by restoring natural respiration through the nose. General tonic treatment is always necessary. Internally iron, quinine, and strychnine are the best reme dies.
Abscesses sometimes occur in the throat either in the region of the tonsils (see QuiNsv) or at the base of the tongue. An acute and alarming inflammation of the loose tissues about the larynx is found in connection with abscess, acute laryngitis, the injecting of scalding fluids or irritant poisons, and as a complication of certain diseases such as smallpox, scarlatina, or Bright's disease. ill this condition, known as (edema of the glottis, the swollen and dropsical tissues fill up or overlap the opening of the glottis, preventing the ingress of air and threat ening immediate suffocation. if not speedily relieved,. cedema of the glottis causes death by asphyxiation. This affection is treated by punc ture or scarification of the dropsical sae, the application of leeches over the sides of the larynx, and the administration of pilocarpine. Sometimes intubation, laryngotomy. or trache otomy may he necessary. lntubation consists in the introduction of a metal o• hard-rubber tube between the vocal cords, with a flange resting above them to prevent slipping into the trachea. Laryngotomy or tracheotomy is employed when intubation is not feasible. Tne former consists in opening the larynx from the outside through the ericothyroid membrane, and introducing a tube through which the patient breathes. In tracheotomy the opening is made lower down, in the trachea.
Tuberculous laryngitis occurs in many pbthis ical patients. There is swelling, ulceration, and destruction of the vocal cords and adjacent struc tures, with hoarseness, loss of voice, great pain, and inability to swallow solid food.
Syphilis, particularly in its tertiary stage, often attacks the throat, producing fibrous tissue which gradually contracts, and narrows, distorts, and partially destroys the larynx.
Foreign bodies not seldom find their way into the larynx, and if small are apt to pass into the trachea or bronchial tubes, and if not removed may produce death by suffocation or set up a fatal pneumonia. In children it is often possible by inverting and shaking the patient to dislodge a foreign body: in other eases these have to be removed by specially devised instru ments or a cutting operation.
Cancer and other tumors of a polypoid or fibrous character may develop in the larynx or its neighborhood. Cancer is nearly always fatal. See CATARRH; DIPHTHERIA; QUINSY; TONSIL.