110 THE PHARYNX AND NASOPHARYNX TREATMENT. Treatment is that of syphilis, and should be undertaken by a venereologist. Local hygiene is necessary and the highly contagious nature of the mucous patches must be explained to the patient. TUBERCULOSIS OF THE PHARYNX Acute miliary tuberculosis is the most common variety found in the pharynx, but is a rare complication of the pulmonary lesion. It is characterized by minute grey or yellow tubercles on the fauces or palate. These rapidly break down into shallow ulcers which spread widely in the mouth and pharynx to cause pain on swallowing, excess salivation, a throaty voice and rapid emaciation. The diagnosis must be made from syphilis, in which pain is absent, and from diphtheria, which is excluded by a throat swab and by a biopsy from the edge of the ulcer. Treatment is by antituberculous therapy with streptomycin, PAS and isoniazid. The prognosis is improving, but the miliary nature of the condition calls for a guarded outlook. LUPUS OF THE PHARYNX Lupus rarely attacks the pharynx, but when it does it produces minute pinkish-yellow nodules which resemble the apple-jelly nodes on the skin, which is also affected. The nodules cause some discomfort, but even when they break down, ulcerate and then heal with radiating scars there is little pain (Plate VI, 3). Treatment is largely that for tuberculosis, but calciferol may be prescribed with due care to guard against renal damage. SCLEROMA AND LEPROSY Scleroma is rarely seen in this country in the pharynx. It is fairly common in Eastern Europe and in Asia. The nose is more often affected than the pharynx. It forms painless hard infiltrations which on section show hyaline bodies and Mikulicz cells. The diplobacillus may be obtained from the lesions. There is no specific treatment. Leprosy is also uncommon in this country. Leprosy of the pharynx is secondary to cutaneous leprosy, and gives rise to painless nodules which contract to leave pale cicatrices involving the palate, uvula and faucial pillars. The condition is diagnosed by recovering the bacilli from the nasal discharge, and by biopsy of the nodules. Treatment is by sulphone which must be continued for years. SUBMUCOSAL FIBROSIS This is an uncommon and recently described disease affecting young Indians. It has been ascribed to the chewing of betel nuts or tobacco, to deficiency in vitamin A or B and to a deficient iron metabolism. Vesicular eruptions occur on the palate and the faucial pillars, and these lead to submucosal fibrosis with trismus. Treatment with the steroids may help in early cases, but not once fibrosis has occurred.