2. =Tongue.= Mucosa normally is moist and grayish-red. Note
discolorations, coatings, crusts, scabs, exudates, various
forms of stomatitis, “geographical tongue,” glossitis, abscess,
fissures, ulcers (syphilis, carcinoma, decubital), chancre, wounds,
action of corrosives, scars (epilepsy, syphilis), tuberculosis,
neoplasms (carcinoma, lymphangioma, hæmangioma, papilloma, leukæmic
lymphocytoma, adenoma, thyroid adenoma [struma baseos linguæ], and
rarely sarcoma, congenital fibroma, lipoma, myxoma, chondroma,
osteoma and dermoid cysts), thrush, actinomycosis, leprosy, trichinæ,
cysts (lymphangiectatic), hyperkeratosis, leukoplakia, “black hairy
tongue,” macroglossia, partial or total hypertrophy. All forms of
syphilitic lesions may be found upon the tongue (chancre, condyloma,
plaques, papules, fissures, rhagades, ulcers, gumma, etc.) “Smooth
atrophy” of the base of the tongue is regarded by various authors as
pathognomonic of tertiary or congenital syphilis. Cysticercus and
echinococcus are very rare.
3. =Pharynx.= Normal mucosa is smooth and gray-red. Note contents,
color and character of mucosa, atrophy, congestion, œdema, exudations
(mucous, purulent, croupous, diphtheritic, thrush), ulcers, scars,
hyperplasia of lymph-follicles, adenoids, various forms of acute and
chronic pharyngitis, retropharyngeal abscess, syphilis, tuberculosis,
neoplasms (nasal polypi, lymphosarcoma, leukæmic lymphocytoma,
aleukæmic lymphocytoma, carcinoma, retropharyngeal dermoids, lipoma,
cysts, fibroma, chondroma, etc.), glanders, leprosy, actinomycosis,
rhinoscleroma, cysticercus and echinococcus.
4. =Tonsils.= Size (how far do they project?), smooth or showing
depressions, color (normally uniformly gray-red), atrophy,
hypertrophy, hyperkeratosis, various forms of inflammation (acute and
chronic tonsillitis, diphtheria, angina superficialis, lacunaris,
follicularis, pseudomembranosa, purulenta and phlegmonosa, tonsillar
ulcers, cysts and abscess), syphilis, tuberculosis, actinomycosis,
thrush, concretions, neoplasms (carcinoma, primary is rare, secondary
from primary in tongue or larynx more common; lymphosarcoma or
lymphocytoma, either aleukæmic or leukæmic, is the most common
neoplasm of the tonsil, other forms of sarcoma and connective-tissue
tumors are rare), cysticercus and echinococcus are rare.
5. =Nose.= If the brain is not removed and the nasal tract not
examined by the method of Harke, as much of the nose as possible
should be inspected, and the various conditions noted, as described
in Chapter VI.
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