A text-book on diseases of the ear, nose and throat . of the soft palate have beenreported by Grossard,^ whohas seen two instances of thisrare accident, and who alsorefers to a previous case ofTalamons and to one of Bar-biers.^ In a patient seen byDu Cast el, ^ the hard palatewas perforated by the tuber-cular process. Deformities ofthe faucial pillars may resultfrom deep ulcerations. Symptoms.—In addition tothe general features of tuber-culosis, which will vary inevery case according to theextent and severity of thelesion, the most marked symp-tom is early and constant i^ainin the affected are
A text-book on diseases of the ear, nose and throat . of the soft palate have beenreported by Grossard,^ whohas seen two instances of thisrare accident, and who alsorefers to a previous case ofTalamons and to one of Bar-biers.^ In a patient seen byDu Cast el, ^ the hard palatewas perforated by the tuber-cular process. Deformities ofthe faucial pillars may resultfrom deep ulcerations. Symptoms.—In addition tothe general features of tuber-culosis, which will vary inevery case according to theextent and severity of thelesion, the most marked symp-tom is early and constant i^ainin the affected area. Theuvula becomes swollen andoedematous : the palatal mus-cles become stiffened, so that swallowing is difficult 5 food accumulates in the recesses of the pharynx,and may pass to the nasopharynx ; cough is present, and it is difficultfor the patient to keep the mouth clear of secretion. Unless the tongueor larynx is involved, there is not much change in the voice, though apeculiar hesitancy of speech is often present. Worst of all is the painful. Pharyngeal tuberculosi?. (Chappell.) .4. primary ;£, sec-ondary. 1 Ann. des Mai. de 1Oreille, June, 1899, p. 771. 2 Bull, de la Soc. Hop. de Paris, January 26. 1899. 3 Ibid., October 27, 1898. 600 DISEASES OF THE PHARYNX. Fig. 186. swallowing. Owing to the intense odynphagia, the patient is apt todefer taking food as long as possible, and the emaciation due to the con-stitutional malady is thereby accentuated. If the lesion is confined tothe tonsils, the pain is much less. Later there may be enlargement of the cervical glands. Diagnosis.—The characteristic appear-ance of the parts has already been de-tailed. Eeliance is to be placed on thecoexistence of tubercular lesions in otherl^arts of the body. An element of un-certainty may exist if syphilis is syn-chronous with the tubercle, and a differ-
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