An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall.

Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of diseases of the eye, ear, nose and throat / edited by G.E. De Schweinitz and B. Alex. Randall. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    of ;i pin'* head to that of a cherry, though the majority of them are not larger than a pea. They are more frequently found on the anterior than on the posterior surface. They are attached frequently to the i'rrc edge of the soft palate and faucial pillars. They are of the same structure as true papil- loma, or fibroma papillare, elsewhere. The normal epithelium lining the oro- pharynx, made up of pavement-cells, is exposed to attrition by the passage of food and the rubbing of opposing mucous surfaces. Probably it is to this, rather than to the change in the type of epithelium which takes place behind and above the soft palate, that we are to ascribe the frequency of these growths. Jurazs1 speaks of having seen 14 cases iii his clinic.-, of which 10 were between twenty and thirty, and all between nineteen and forty-four years of age. Eleven of them were men. Symptoms.—They usually give rise to no symptoms, but are frequently seen in examining the pharynx, either as sessile warts on the mucous mem- brane or as pedunculated growths hanging from the tip of the uvula or the edge of the palate. Sometimes they cause tickling and coughing; but this seems to depend quite as much on the idiosyncrasy of the patient and the hyperesthesia of the mucous membrane as upon the size and shape of the growth. The diagnosis is easily made from the gross appearances, and because it is by far the most common of all growths in this locality ; but occasionally the best of observers is deceived. A notable instance of this was in a case reported by Dr. Lefferts,2 in 1889, as a typical papilloma in a girl of sixteen. He made no microscopical examination.3 The growth recurred titter removal, and was again removed by Dr. Simpson ' and reported by him, after micro- scopical examination, as an instance in which a benign neoplasm had degener- ated into a sarcoma. It seems very evident that the growth was malignant from the first. Lennox Browne relates5 a similar mistake as occurring in the practice of Morell Mackenzie; so that, however great the probability, the microscope must complete the evidence. Prognosis.—They are benign growths and, as a rule, of no significance. Treatment.—When large enough to cause symptoms or give the patient any alarm, they may be cut off with a pair of uvula-scissors. Fibroma.—Bosworth refers to 7 cases in the tonsils and 7 in the oro- pharynx. Lefferts6 has reported a case. They are benign growths and easily removed. Angioma.—Phillips has reported a case,7 Bosworth refers to 2 others, and Flatau to another.8 I/ipomata have been reported by Farlow!'and Schmidt. Adenoma.—Natier reports a case.10 He refers to 2 cases by Hutch- inson. Cysts of the Mucous Membrane.—I have observed one case in a middle-aged woman who complained that something had been growing in her throat for the hist eighteen months. A small round tumor, a little larger than a pea, was seen growing at the base of the right posterior faucial pillar. It was smooth and sessile. It gave no evidence of its presence until the 1 Die Krankheiten der Oberen Luftwege, 1891. 2 Trans. Amer. Laryng. Assn., 1889. 3 This case is quoted by Bosworth, and accepted :is a papilloma, in his book published just after Dr. Leflerts's report and before I>r. Simpson's. * Trans. Amer. Laryng. Assn.. 1S;»3. 5 Burnett's System of the Diseases of the Fur, Nose, and. Throat, vol. ii. p. 724. 6 Loc. ell. i y. Y Medical Record, March 12, 1887, p. 293. 8 Nasen, Rachen wnd Kehlkopf Krankheiten, p. 331. '■' Trims. Amer. Laryng. Assn., 1895. ' Rev. Mensuelle de Laryngologie, No. 11, 1887, p. 618. Lancet, May 22, 1886, p. 973.