Chronic inflammation of the follicles of the pharynx is an obstinate com plaint which is often seen in children. The disorder is an important one, as it may induce deafness, and frequently gives rise to a persistent cough, which is a cause of much anxiety to the patient's relatives.
Causation.—Follicular pharyngitis is especially likely to attack strumous subjects, and those who belong to families in which there is a gouty or rheumatic tendency. The disorder is not often seen in very young chil dren, although Dr. Morell Mackenzie has met with it as early as the third year. It is most commonly found in children of eleven or twelve years of age and upwards. It sometimes appears to follow certain specific fevers, such as measles, scarlatina, and small-pox. In other cases it is apparently excited by exposure to cold acting upon a weakly frame. The subjects of the disorder are often ill-nourished and feeble-looking ; and this fact, coupled with the cough which is so common a consequence of the disease, may give rise to fears of consumption.
Morbid Anatomy.—The follicles are enlarged and their walls thickened. They are filled with a cheesy secretion consisting of degenerated epithelial cells, molecules, and oil-globules ; and sometimes contain concretions,of carbonate of lime.
Symptonis.—The case is seldom seen until the derangement is advanced. It is then, usually, as has been said, the cough which excites the alarm of the parents. The cough is frequent and hard, and the child often clears his voice, and when questioned complains that he has a " tickling" in his throat. The symptoms vary in severity from time to time. When the dis ease is severe, the cough is accompanied by pain shooting up into the head or ears. It often comes on in paroxysms, and these are apt to occur in the night. There is also an uneasy sensation in swallowing, and the child may complain that " coughing makes his throat sore." In advanced cases the disease extends to the larynx, producing hoarseness, and into the Eus tachian tubes, causing dulness of hearing. If the posterior nares are at tacked, the sense of smell may be impaired ; if the soft palate, the sense of taste may be affected. Loss of these senses is not common in the child, or
is difficult to ascertain ; but a certain impairment of hearing is frequently complained of. Indeed, I am informed by Mr. Reeves that of the children who are brought on account of deafness to the Ear Department of the London Hospital, a full third owe their infirmity to this affection of the throat. In such cases, a peculiar flattening of the nostrils is often pro duced, owing to the swelling of the posterior nares. The appearance is similar to that which has been so often remarked upon as resulting from a chronic enlargement of the tonsils, and is indeed' produced, like it, by the disuse of the nasal passages in respiration. Disease of the middle ear, with discharge from the meatus, may be also a consequence of the pharyn geal affection. A catarrh is very apt to spread along the Eustachian tube into the tympanum ; and the secretion being unable to escape through the occluded tubes, accumulates, and leads to ulceration of the tympanic mem brane, and otorrhcea.
In mild cases of follicular pharyngitis there is little interference with deglutition ; but when the disease is more pronounced, swallowing may be difficult as well as painful, and the attempt to swallow is said sometimes to give rise to spasm of the pharynx.
On inspection of the fauces, we find small eminences scattered over the mucous membrane at the back of the pharynx. These are rounded or elongated in shape, and may be so numerous as to present a granular ap pearance. Their colour, and that of the whole mucous membrane, is deeper than natural, and enlarged superficial veins may be seen running in the depressions between the prominent follicles. If the disease is extensive, similar granules are found on the pillars of the fauces and on the tonsils. Sometimes mucus, more or less stringy and turbid, may be seen clinging to the tonsils, or hanging down from behind the soft palate, and this may be mixed up with yellow-looking exudation from the diseased follicles.