Submucous inflammation and abscess. Solipeds especially. Specific, or
due to microbian pus infection. Traumatism; from foreign bodies in
tonsillar and mucous follicles, from rough, fibrous food, instruments,
etc.
As a sequel of catarrhal pharyngitis. Symptoms; as in catarrhal form,
with more swelling and tenderness, glandular swelling, dyspnœa, and
difficulty in swallowing; local induration followed by fluctuation and
pointing. Complications; asphyxia, laryngeal œdema, purulent or
inhalation pneumonia, pharyngeal fistula, palsy of vagus, secondary
abscesses, septicæmia. Lesions, local, general. Treatment; General and
local, fomentation—hot or cold and antiseptic. Embrocations. Lancing.
Tracheotomy.
As distinguished from catarrhal pharyngitis this is inflammation of the
submucous tissue and adjacent lymph glands, tending to abscess.
It is especially common in solipeds and rather rare in other classes of
domestic animals. As a specific infectious disease it has its type in
strangles (infectious adenitis), also in cattle in the complicated
infection of purulent tubercle, but apart from such it is often the
result of the penetration of the pus microbes from a catarrhal pharynx
into the lymph plexuses and lymph glands. Traumatism may play an
important part in causation as when vegetable barbs, awns, chaff or
seeds, or strong hairs or bristles enter the open mouths of the mucous
follicles, or the tonsillar cavities. Similarly trouble may arise from
scratches by tough, fibrous fodder, from pricks by pointed or cutting
instruments, by fractures of the hyoid, or by bruises by probangs, or
tooth rasps. An overgrowth of the last molar, and a resulting wound and
ulcer of the soft palate, and the presence of local deposits like those
of glanders and actinomycosis, are other occasions of the entrance of
the pus organisms. It will be recognized that this affection is not
necessarily due to a difference in the infecting organism, but rather of
the tissue involved, the microbes gaining the submucous tissues and
expending their violence on these instead of confining their ravages to
the surface layers of the mucosa. For this reason the deeper or
phlegmonous affection may supervene on a catarrhal inflammation which
may have already persisted for several days.
_Symptoms._ Beside the general phenomena of catarrhal pharyngitis, this
form of the malady is characterized by a greater swelling and tenderness
of the throat, extending from ear to ear, and from the trachea forward
in the intermaxillary space; by nodular and painful swellings of the
pharyngeal lymph glands, by the greater difficulty of deglutition, the
muscular tissue being involved; by wheezing breathing amounting at times
to violent roaring and threatened asphyxia. Perspiration on the throat,
the ear, the side of the head or neck, of the fore arm, or of the dorsal
region is not uncommon, and has been attributed to the compression of
the vagus, or of the superior cervical ganglion of the sympathetic by
the swelling. Fever usually runs higher than in simple catarrhal
pharyngitis, which may be partly accounted for by the implication of the
deeper and important structures but also in no small degree by the
entrance into the circulation of the ptomaines and toxins, which in the
catarrhal affection escape largely from the inflamed surface.
The resulting abscess is usually in or near a gland or group of lymph
glands. The part passes through the usual succession of changes, of soft
pitting swelling; firm, tense, painful condition in which the exuded
lymph has coagulated; and softening and fluctuation which progresses
from the centre toward the circumference. The abscess points variously
according to its seat. If in the intermaxillary space it opens
externally. If sub-parotidean or peripharyngeal it may burst inwardly
into the pharynx or outwardly through the skin. If supra-pharyngeal
(retro-pharyngeal), it may be so thickly encapsulated in unyielding
walls that it may remain long indolent and inactive becoming a cold or
chronic abscess. When an abscess opens into the pharynx, there is a
sudden and copious flow of pus by the nose, and it may be by the mouth
and a simultaneous subsidence of the inflammation.
Among the _complications_ of the affection are asphyxia, œdema
glottidis; abscess of the guttural pouch; rupture of an abscess into the
larynx, and the descent of pus into the lungs; the entrance of saliva
and alimentary matters into the lungs; gangrenous pneumonia; pharyngeal
fistula; pressure on the vagus and paralysis of the pharynx or larynx;
secondary abscesses; septicæmia.
_Lesions._ Besides the general inflammatory lesions some rather
remarkable ones have been observed. Fractured hyoid, dissection of the
mucous from the muscular coat, by aliments, for nearly the whole length
of the œsophagus (Brückmüller), purulent infiltration of the
supra-pharyngeal muscles (Wakefield), ulceration of the pharyngeal or
guttural sac mucosa, or even gangrene, purulent effusion in the tonsils,
around the hypoglossal nerve, the lingual branch of the fifth, or the
vagus, embolic inflammations, suppurations or gangrene of the bronchia,
and implication of the lung tissue and pleura. Catarrhal enteritis and
fatty liver and kidney are common.
_Treatment._ Beside the general measures advised for catarrhal
pharyngitis, this type demands especially measures to moderate the
intensity of the suffering, and when abscess appears inevitable to
hasten its maturation. The first demand is met by hot fomentations
persistently applied to the throat. This may be done by spongio-piline,
or simply by well washed wool or cotton bound upon the throat and wet at
frequent intervals with water rather hotter than the hand can bear. The
addition of a little carbolic acid will secure at once some local
anæsthesia and a measure of antisepsis. In warm weather the substitution
of cold water has been resorted to with apparently good effect. If
adopted it should be frequently removed so as to keep up the constant
action of cold and moisture. These have been especially recommended in
dogs injured by a tight or ill-fitting collar.
When suppuration appears imminent as shown by the dense, hard,
circumscribed phlegmon, stimulating embrocations may be used to hasten
its progress. Camphorated spirit is suitable for carnivora and sheep. It
may be combined with tincture of cantharides for horses. For cattle and
swine, oil of turpentine may be added, the three being used in equal
proportions. A liniment of ammonia and oil may be used more or less
frequently and energetically according to the relative thickness and
insensibility of the skin of the animal affected.
When matter has formed and fluctuates, it should be at once evacuated
and the cavity treated by antiseptic dressings. In this way secondary
abscesses, septic infections, molecular ulcerations and other injurious
sequelæ may be largely obviated.
In case of threatened asphyxia the _dernier resort_ of tracheotomy is
always available, and this often acts very favorably in improving the
æration of the blood, in restoring the flagging vital functions which
depend on hæmatosis, and in removing the friction and irritation
consequent on the passage of air through the narrowed and tender
passages.