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.
6. Oesophagus. Contents, size (dilatation, stenosis, diverticula), color and character of mucosa (normally smooth, transparent, pale, grayish-white, often hypostatic on posterior surface), inflammation, swelling of mucosa, leukoplakia, œdema, erosions, ulcers, action of corrosive poisons, perforation, foreign bodies, varices (cirrhosis, splenic anæmia), hemorrhage, aneurismal erosion, infective granulomata (tuberculosis, syphilis and actinomycosis are all rare), neoplasms (benign are rare, sarcoma rare; carcinoma most common usually at the lower or middle third), parasites (thrush the most important infection). Postmortem softening of the œsophagus from the regurgitation of stomach-contents must not be mistaken for pathologic conditions. Oesophagomalacia is of the rarest occurrence during life.
7, 8. Larynx and Trachea. Nature of contents, character and position of epiglottis and plicæ aryepiglotticæ (the latter should be thin; greatly thickened in inflammation and œdema), mucosa (normally gray-red and smooth); vocal cords (position and relations as viewed from above; should be thin and tendon-like; mucosa thickened in inflammation and œdema; may be atrophic), œdema, inflammation, diphtheritic membranes, ulcers, syphilis, tuberculosis, leprosy, glanders, actinomycosis, rhinoscleroma, neoplasm, foreign-bodies, etc. An extreme œdema of the glottis may disappear after death, and its occurrence be shown only by the wrinkled appearance of the mucous membrane. Anomalies are rare, the most common being a laryngocele. In typhoid fever erosions and ulcers are not rare in the larynx. In small-pox ulcers, diphtheritic inflammations and hemorrhages may occur. The most common tumor is the fibroma or fibro-epithelioma (papilloma), occurring particularly in children and singers (“children’s nodule,” “singer’s nodule”). Angioma, myoma, lipoma and chondroma are rare. Thyroid adenoma, the so-called “amyloid-tumor” and adenoma of the mucous glands are rare. Sarcoma is also rare. Lymphosarcoma and leukæmic infiltrations are not common. Primary carcinoma is more frequent than sarcoma, but is relatively rare. It occurs most frequently in men, arising on the true vocal cords, and is squamous-celled. In trichinosis the laryngeal muscles usually show an early and abundant invasion. The most important pathologic conditions of the trachea are anomalies (diverticula, fistula, tracheocele), inflammation (catarrhal, membranous, pseudomembranous), tuberculosis, syphilis, secondary erosions, ulcers and perforations (tumors of thyroid, cancer of œsophagus, tuberculosis and suppurating lymphnodes, aneurisms), stenosis, compression from enlarged thyroid, thymus or lymphnodes, dilatation, tracheotomy, intubation, and neoplasms (relatively rare). The cartilages of both trachea and larynx should be examined for inflammation, pigmentation, etc.
9. Thyroid. Weight is 30-60 grms. The dimensions of the lateral lobes are: Length 5-7 cm., breadth 3-4 cm., thickness 1.5-2.5 cm. They should be symmetrical. Note variation in form, character of cut-surface (normally glassy, granular and yellowish-pink). The colloid is transparent, yellow or brown in color, and rises above the cut-surface. Cysts of varying size are very common, likewise encapsulated adenomata. A firm, yellowish, moderately enlarged thyroid is often seen in cases of pulmonary tuberculosis. Increase of the stroma with hyaline change and calcification is common. The most important pathologic conditions of the thyroid are: goitre (struma diffusa, nodosa, maligna, benigna, parenchymatosa, hyperplastica, adenomatosa, colloides, gelatinosa, cystica, vasculosa, fibrosa, hæmorrhagica, calculosa, ossea, amyloides, inflammatoria, etc.), inflammation (thyreoditis simplex, purulenta, abscess), neoplasms (carcinoma the most common form of malignant tumor, sarcoma not rare, adenoma and cystadenoma very common, combinations of sarcoma and carcinoma have been observed; other forms rare), granulomata (tubercles and gummata are rare), parasites (echinococcus). Especial examination should be made of the thyroid in cretinism, myxœdema, all forms of cachexia of unknown etiology, infantilism, lymphatic constitution, unexplained death, rachitis, chondrodystrophia, acromegaly, giantism, idiocy, etc. In marked constitutional disturbances conditions of athyreosis, thyreoplasia and hyperplasia of the thyroid may play an etiologic rôle. Accessory thyroids are not uncommon in the neck, in the supraclavicular fossæ and behind the sternum. They usually show the structure of fœtal adenomata, but may become cystic or undergo carcinomatous change.
10. Parathyroids. These organs are usually four in number, sometimes more, sometimes only one or two. They are usually paired, and are found near the inner posterior borders of the lobes of the thyroid, near the two terminal branches of the inferior thyroid artery. They vary in size from 3-15 mm. in length, 3-4 mm. broad, by 1-2 mm. in thickness. They are normally brown in color, and soft in consistence. It is often difficult to distinguish them from the hæmolymph nodes that are common in this region. The parathyroids should be examined in all cases of tetany, paralysis agitans, acromegaly, epilepsy, infantile atrophy, myotonia and obscure cachexias. Conditions of supposed hypoparathyreosis have been reported. Hypertrophy of the parathyroids has been observed in acromegaly. Adenoma has been described by several writers. Cysts, fatty degeneration, fatty infiltration, colloid degeneration, cloudy swelling and tuberculosis have been reported as occurring.
11. Cervical Lymphnodes. Note number, size, color, consistence, character of cut-surface, etc. The most important pathologic conditions are: tuberculosis, secondary carcinoma, Hodgkin’s disease, lymphosarcoma (leukæmic and aleukæmic), various forms of inflammation, dermoid and epidermoid cysts, cystic lymphangioma (congenital cystic tumor of the neck), branchiogenic carcinoma, and hyperplasia in syphilis, rachitis and status lymphaticus. In acute inflammation the lymphnodes are red and soft; in chronic inflammation they are usually grayish-white and firm.
12. Salivary Glands. The parotid, submaxillary and other salivary glands are examined as to size, color, consistence and character of cut-surface. The most important conditions are: parotitis (epidemic and secondary), chronic inflammation, calculi, cystic dilatation of ducts [ranula], Ludwig’s angina, salivary fistula, granulomata (tuberculosis, syphilis and actinomycosis), neoplasms (most common forms are the mixed tumors containing cartilage, fibrous connective-tissue and myxomatous tissue and cords or rows of cells regarded by some observers as endothelial, by others as epithelial; other less common tumors are adenoma, fibroma, carcinoma and sarcoma). Symmetrical enlargement of the salivary and lachrymal glands occurs as the result of aleukæmic or leukæmic lymphocytoma (“Mikulicz’s disease”).
13. Cervical Vessels and Nerves. Examine the arteries and veins, noting contents, thickness and character of walls, size of lumen, changes in the intima, sclerosis, atheroma, calcification, thrombosis, embolism, etc. In death from strangulation or hanging the intima of the carotids may be torn. The aorta is usually examined after the section of the neck-organs. Note size of lumen. In the adult it usually admits the index-finger or thumb. The circumference of the thoracic aorta is 4.5-6 cm.; that of the abdominal aorta is 3.5-4.5 cm. Note its elasticity, contents, thickness of wall, changes in intima, etc. Fatty degeneration of the intima, sclerosis, atheromatous plaques and ulcers, calcification and thrombosis are the most common conditions. Syphilis is a very common cause of mesaortitis, shown by linear or radiating depressions of the intima. The carotid gland (paraganglion intercaroticum) at or near the division of the carotids should be noted. It is about the size of a rice-grain, oval, vascular and of firm consistence, resembling very much the superior cervical ganglion. Alveolar tumors apparently primary in this gland have been observed by a number of writers. Its epithelial nature is denied by some observers who class it with the sympathetic system. The nerves and ganglia should be examined and any change from the normal noted, such as atrophy, effects of pressure, involvement in scar-tissue, hæmorrhage, inflammatory processes, neoplasms, etc.