DISEASES OF THE MOUTH AND PHARYNX - diseases of the mouth and pharynx do not present many questions of interest in a diagnostic point of view. The parts are readily examined, and simple inspection is generally sufficient to determine the seat of the affection, and the nature of the dis ease. It is not our object to give a history of pathological states; but merely to point out the distinctive signs and symptoms by which these states may be recognized.
The complaint of the patient is of soreness in the mouth or throat, and of difficulty in taking food. Conjoined with this there may or may not be symptoms referable to the entrance of the windpipe, hoarseness or aphonia, harsh sound or difficulty in breathing. The continuity of surface, as already mentioned in speaking of diseases of the respiratory organs, often leads to an extension of inflammatory action from the one set of organs to the other; and to this fact very often the affections of the pharynx owe their importance and significance.
In complex cases it is very desirable to make out, if possible, whether the difficulty in swallowing were preceded or even accom panied from the very first by cough or difficulty in breathing; as the disease is always of graver import, which, commencing in the larynx, produces a difficulty in swallowing, merely as a subsidiary affection, than one which has its original seat in the pharynx. In simpler cases little is learnt from the history beyond its duration and the occurrence of a febrile attack in its com mencement; points which may serve to correct a faulty diagnosis, but are rarely essential to its, accuracy.
The difficulty in swallowing may be referred to a point below the inlet of the pharynx, and may be due to disease situated lower down, such as stricture of the cesophagns or pressure : but inspection of the faeces should never be omitted, as it may reveal deep-seated ulceration of the pharynx as the cause of this sensation. Thickness of speech will always result from obstruction about the fences ; but it is very different from the hoarseness or aphonia of laryngitis : the mistake is only important inasmuch as it gives rise to false alarm, and to treatment unnecessarily active and severe. It is unnecessary here to revert to the means of distinguishing laryngitis from pressure on the trachea. (See Chap. XX., 1 and 10.)
The appearances divide themselves into redness, swelling, ulcer ation. aphtha3, and false membrane ; each of which may be recog nized singly or in groups over different portions of the mouth and fauces.
§ 1. As affecting the Mouth.—Redness and swelling of the tongue constitute what is called glossitis; at all times a rare disease, and now almost unknown, since the absurdities of mercurial ptyalism have been abandoned. When such symptoms are present, this must not fail to be inquired into ; but it is to be remembered that the quantity of mercury taken is no criterion of its effect, for, in peculiar constitutions and in certain conditions of the system, it is produced with great facility ; and cases of spontaneous pty alism are also on record. We find a pretty safe indication in the fetor of the breath accompanying mercurial salivation. Yet even such a point as this requires both experience and accuracy of observation. I have known the odor of sloughing ulceration mistaken for mercurial fetor.
The tongue is also often affected with simple ulceration, or covered with aphthte. Both of these ought to be regarded as constitutional states: even when ulceration seems to be directly caused by the edge of a broken tooth, its real history is probably a condition of depraved nutrition ; and this is confirmed by the occasional appearance of ulceration along the edge, when no such exciting cause is present. Aphtha3 of the tongue are much more numerous than points of ulceration ; they have an appearance of elevation rather than depression, look whiter and more solid, while ulcers are hollow, and filled with fluid secretion : spots of ulcera tion are apt to follow on aphtha3 when the white crust is detached, but the general aphthous state is still sufficiently marked. Both occur much more commonly in childhood that in adult life : ulceration is evidently allied to that condition which gives rise to cutaneous disorders, especially impetigo ; aphthte, on the other hand,point more directly to disorders of the mucous membrane. In infants the disease is known as "thrush," and is always asso ciated with intestinal disorder; in adults it is most freqtently met with in the last stages of ulceration of the bowels, preceded by a red and glazed tongue, or when diarrhoea occurs as one of the signs of general exhaustion.