The Symptoms of Pharyngitis

ACUTE: "Cold in the throat;" "sore throat;" mucous membrane dry, red, and swollen, or covered with a tenacious secretion; pain in swallowing; nasal tone of voice; tickling in the throat, exciting cough; coated tongue; foul breath; salivation.

CHRONIC: Slight pain in swallowing; granular appearance of the throat; elongation of the palate; tough, tenacious mucus, occasioning hawking and spitting; "hacking " or "hemming" cough; husky voice; expectoration of small, cheesy or calcareous masses; slight hemorrhages from the throat in the morning.

Acute and chronic catarrh of the pharynx are among the most common of all forms of catarrhal disease. In some localities, one form or another of this disease seems to be almost universal. The causes are not always easy to determine, but the most common origin of the affection is a cold. Sometimes the disease assumes the form of an epidemic, the people of a whole neighborhood or a much larger section of country being almost universally affected at some time with the symptoms characteristic of acute catarrh of the pharynx. This is especially true of the form of the disease known as follicular pharyngitis, in which the throat presents a granular appearance. There are good reasons for believing that in these cases the disease may be allied to, if not identical with, the affection known as diphtheria. We have observed cases in which the most severe form of diphtheria was evidently communicated by a person suffering with what was apparently simple follicular pharyngitis. It is doubtless possible to discriminate between the simple and the contagious form of the disease, but the examination of patients is not generally made with sufficient care to make the points of difference clear. The disease, in both its acute and chronic form, has some tendency to extend into the larynx and thence into the bronchial tubes, inducing acute or chronic bronchitis, although this tendency is not so strong as is generally supposed.

The chronic form of the disease is most commonly the result of repeated attacks of acute pharyngeal catarrh, though it not infrequently arises insidiously, giving no history of acute symptoms. The persons most subject to the habit are those addicted to the use of liquor, tobacco-users, persons of sedentary or dissipated habits, those exposed to an atmosphere charged with dust or irritating gases. A humid atmosphere and changeable climate favor the production of this disease. Males are more frequently affected than females. It is found in its worst form in persons of vicious habits. What is known as clergyman's sore throat is a form of this disease, and it is undoubtedly the result of the sedentary habits of this class of persons. Diseases of the stomach and liver are frequently causes of pharyngeal catarrh. Bad dietetic habits are an important factor in the production of this disease. The use of mustard, pepper, vinegar, pepper-sauce, ginger, and various other condiments, and the excessive use of salt, sugar, fats, and animal food, must be set down among the principal predisposing causes of this form of the disease. In this way the terms "stomach cough" and "liver cough" have arisen, the stomach being really the remote cause of the cough, the direct source of which is the irritation in the throat. The most annoying symptom of chronic pharyngitis is the hacking or "hemming" cough, which is sometimes very harassing. The cough arises in some cases from the irritation from the tenacious mucus of the soft palate, and in others from the elongation of the palate. When the palate becomes so long that the end rests on the back part of the tongue, it is very likely to cause a most annoying cough, and efforts at expectoration.

Chronic pharyngitis is often found connected with partial or complete deafness accompanied with the usual symptoms of chronic catarrh of the ear which has been induced by an extension of the disease from the throat through the Eustachian tubes to the middle ear. This is, indeed, the most common origin of deafness, and the connection between these two conditions has given rise to the term "ear cough." Another common accompaniment of chronic pharyngeal catarrh is enlargement of the tonsils. This affection will be described under the head of "Tonsillitis." The small, cheesy particles frequently expectorated in this disease are masses of hardened secretion coming from the enlarged follicles of the throat, which may be easily seen as whitish bodies, varying in size from that of a millet seed to the size of a pea, imbedded in the tonsils. They gradually ulcerate out, and are discharged. The fetid odor is due to the decomposition which has taken place. Occasionally calcareous decomposition takes place, when the fetid masses are found to be hardened in character, and chalky. These particles are usually mistaken for tubercles, being supposed to come from the lungs, and are taken as a sure sign of tuberculous disease, or consumption. We have often found it very difficult to convince patients to the contrary. Every one should be convinced of the truth by the fact that tubercles are microscopic in size instead of being as large as these particles are found to be.