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Pes Equinus

pharyngitis, chronic, pharynx, acute, causes, frequent, mucous and throat

PES EQUINUS HORSE-FOOT).—.\ common deformity of the foot, in which its anterior portion is depressed to a lesser or greater degree, so that the heel does not touch the ground in walking. In severe cases the foot may be turned down to such an extent that the back of the foot lies in the same direc tion as the lower leg (see Fig. 334). The deformity is caused by paralysis of the muscles of the leg, and is frequently an accompaniment of clubfoot. It is of im portance to know that the condition often appears in patients suffering from conta gious febrile diseases, as typhoid, scarlet fever, etc. Cases of developed pcs equines are treated with splints, plaster-of-Paris bandages, or by tenotomy, an operation consisting in cutting the tendon.

PESSARY.—An instrument placed in the vagina to support the uterus. Pessa ries are made from hard rubber, celluloid, hone, or metal, and are of various shapes. It is important to remember that they arc not hygienic instruments unless the vagina is kept scrupulously clean. This may be accomplished, in part at least, by frequent douching under the directions cf a physician. Figs 335-337 show some of the more common forms of pessaries.

PHARYNGITIS.—Catarrhal inflammation of the pharynx (see pp. 1.4r, 147). This disease, which is one of the most frequent affections of man, may be either acute or chronic. The acute form is usually associated with running from the nose, and often involves the larynx and the bronchi, causing hoarseness and cough. In acute pharyngitis all the mucous membranes of the mouth and of the pharynx are congested and inflamed. The symptoms include a sensation of dryness, irritation in the throat, pain on swallowing, and stitches in the ears ; the voice readily tires. The disturbances are increased by eating spicy foods, by drinking alcoholic beverages, by inhaling smoke or dust, by staying in crowded or over-heated rooms, and by prolonged singing or talking. Iced drinks, such as lemonade, act beneficially.

Acute pharyngitis is usually caused by a cold in the head (see CORYZA), or by local irritation due to the inhalation of dust, smoke, chemical vapours, etc. Exaggerated singing or shouting may also be a factor. By observing a proper diet, and by avoiding the harmful influences already enumerated, the acute catarrh usually passes off spontaneously in from two to eight days.

Frequent recurrences of acute attacks may gradually lead to a chronic catarrh of the pharynx. The latter condition, however, may result also from other causes. The primary cause of chronic pharyngitis should usually be looked for in the nose. Obstruction of the nasal passages causes the

patient to breathe through the mouth, especially at night. This causes the mucous membrane of the pharynx to become dry and irritated, so that it gradually becomes the site of permanent inflammatory changes. Constant flow of mucus from the posterior nares, which communicate with the pharynx, likewise irritates the mucous membrane of that organ, leading to congestion, proliferations, and inflammation. Among persons who are especially exposed to chronic pharyngitis may be mentioned hatmakers, employees in cement factories and chemical works, spinners, and persons who drink or smoke to excess. Singers, teachers, and preachers are also in constant danger of being attacked by this affection.

Chronic pharyngitis is characterised by dryness of the throat, alternating with mucous obstruction, by irritation which causes hawking and coughing, by huskiness of the voice, and by temporary sensations as of a fish-bone or other foreign body being lodged in the throat. Long-continued vocal exertions cause the voice to become tired and strained, and may even render talking painful. The clearness of the voice is impaired by frequent accumula tions of mucus, especially on the first attempt to speak or to sing. The mucous obstruction is greatest in the morning, and efforts to clear the throat are often accompanied by retching, or even by vomiting. It is sometimes impossible for such patients to brush the teeth or to rinse the mouth without getting an inclination to vomit.

Since the cause and continuance of chronic pharyngitis are incident to the patient's mode of living or to his occupation, a permanent cure cannot he expected without a change in these conditions. Pharyngitis does not con stitute a menace to health, quack literature to the contrary notwithstanding. It does not lead to tuberculosis. Chronic pharyngitis may extend to the Eustachian tubes, leading to disturbances of hearing. It sometimes causes thickening of the vocal cords, thereby giving rise to permanent hoarseness. The irritation of the pharynx often causes the patient to make swallowing movements. In this way a considerable quantity of air may be swallowed, giving rise to a distension of the stomach, which may simulate an affection of that organ or of the heart. The frequent swallowing of saliva may cause vomiting and loss of appetite. The cure of chronic pharyngitis depends upon avoidance of all harmful influences, upon local treatment by a physician, and upon the use of waters from warm saline springs or from cold sulphur springs.