Quinsy (Acute Tonsillitis) :
- RUDDOCK.E.H,
DEFINITION. - Acute Inflammation of the tonsil or tonsils and subjacent mucous membrane, with general fever.
SYMPTOMS. - It comes on quickly, with rapid swelling of one or both tonsils, severe throbbing pain, hoarseness, and difficult swallowing and expectoration, occasioning a painful and almost constant effort to bring up and detach the viscid mucus which adheres to the inflamed surface; Headache; pain in the back and limb; foul tongue; offensive breath; and general febrile symptoms. The morbid action generally extends to the uvula, which, becoming swollen and elongated rests on the base of the tongue, and gives rise to an unpleasant sense of titillation. If the disease be promptly and skilfully met, the inflammatory symptoms subside in a few days, leaving the tonsils enlarged; otherwise, suppuration ensues, indicated by rigors, and throbbing, darting pains in the throat, extending to the ears. When the abscess is fully mature, it ruptures, to the immediate relief of the patient. Often the Abscess forms on one tonsil, and after its discharge another forms on the other.
CHRONIC ENLARGEMENT OF THE TONSILS. - Repeated attacks of acute Inflammation, or attacks only partially cured, are followed by chronic enlargement and induration, causing difficult swallowing, hoarse voice, noisy and laborious breathing, especially during sleep, affections of the ear, arising from an extension of the disease along the mucous membrane, and extreme liability, from slight causes, to a frequent recurrence of acute Inflammation.
CAUSES. - The predisposing are - Tubercular constitution, abuse of Mercury, and previous attacks of Quinsy. The exciting cause is one of the germs of suppuration, but a sudden atmospheric change, or a chill from getting wet through seems occasionally to be the final factor, lowering the natural resistance and enabling the germ to find a hold. Quinsy is most frequent in plethoric persons, between fourteen and twenty, and for several years is liable to recur unless preventive means are adopted.
DANGERS. - Extension of the Inflammation to the Uvula, soft palate, the salivary glands, pharynx, and particularly to the root of the tongue, with difficult breathing, etc. But early and skilful treatment usually prevent such complications.
TREATMENT. - When suppuration has occurred the abscess should be opened; but prompt treatment sometimes prevents abscess formation.
Aconitum. - Feverishness, headache, dizziness, and restlessness; stinging, pricking, fulness, or even choking, the throat looked as if scorched.
Belladonna. - Bright redness and rawness of the affected parts; flushed face, glistening of the eye, Headache, and pain and difficulty in swallowing. Bell. may follow, or be alternated with Acon.
Mercurius Biniod. - Swollen throat; copious accumulation of saliva; swelling of the gums and of the tongue; shooting pain on swallowing; a disagreeable taste; foetid breath. Ulcers on the side of the mouth; pains from the throat extending to the ear. Profuse perspiration, and nightly exacerbations, also point to Merc.-Biniod.
Baryta Carb. - If given early, before suppuration can supervene, this remedy will often disperse the engorgement. For this purpose it seems to act best in high potencies, 30 and upwards. It is also useful in chronic Tonsillitis.
Hepar Sulph. - When matter has formed. It is especially useful in the Tubercular, in constitutions injured by Mercury, and when a liability to the disease has become established. In our experience it is more rapidly curative than any other remedy.
Lachesis. - When the left tonsil is affected, and the mucous membrane of a livid colour.
Lycopodium. - Beginning on the right side.
Arsenicum. - Severe attacks, with much general prostration.
Calc.-Phos. and Iod and Guaiacum are also useful remedies.
Nux Vomica or Pulsatilla, when gastric derangements cause, or are associated with, Quinsy.
Administration. - In acute cases, a dose every one or two hours; in sub-acute, every three or four hours; during convalescence, every six or twelve hours.
ACCESSORY MEANS. - The constant sucking of ice during the commencement of an acute attack moderates the heat and pain; it also checks the secretion of mucus, which gives rise to disagreeable and painful efforts to detach. In severe cases ice may be employed in this manner till the disease has abated. (See Sec. 25) When ice is not procurable, or when it is not admissible, as when it has not been adopted early in the disease, the next most effectual local application is the steam of hot water, and equally so whether the object be to bring about resolution or to facilitate the suppurative process. Steaming the throat assiduously acts as a fomentation, and removes the mucus from the crypts and follicles of the tonsils. See Section on Inhalation.
In some cases a warm milk-and-water gargle frequently used, will be found useful and soothing. Further, in severe attacks, a hot poultice should be applied across the throat, extending nearly to each ear; in mild attacks the throat compress (see Sec.28) may be used. The patient should remain indoors, and in bad cases in bed. The air of the patient's apartment should be maintained at a temperature of about 65* or 70*, and be kept moist by the evaporation of hot water from shallow dishes near the bed, but proper ventilation should also be preserved.
In chronic enlargement of the tonsils, the advisability of operation should be considered if there is any commencement of deafness or obvious obstruction to nasal respiration. Adenoids are virtually always associated with chronic enlarged tonsils. Much can be done to prevent and cure them by breathing exercises, etc., but if the patient shows signs of deafness they should be removed.
PREVENTIVE TREATMENT. - Freely bathing the neck, jaws, etc. and gargling the mouth and throat every morning with cold water. After exposure to cold, especially if symptoms of Sore throat come on, the compress should be at once applied.
DEFINITION. - Acute Inflammation of the tonsil or tonsils and subjacent mucous membrane, with general fever.
SYMPTOMS. - It comes on quickly, with rapid swelling of one or both tonsils, severe throbbing pain, hoarseness, and difficult swallowing and expectoration, occasioning a painful and almost constant effort to bring up and detach the viscid mucus which adheres to the inflamed surface; Headache; pain in the back and limb; foul tongue; offensive breath; and general febrile symptoms. The morbid action generally extends to the uvula, which, becoming swollen and elongated rests on the base of the tongue, and gives rise to an unpleasant sense of titillation. If the disease be promptly and skilfully met, the inflammatory symptoms subside in a few days, leaving the tonsils enlarged; otherwise, suppuration ensues, indicated by rigors, and throbbing, darting pains in the throat, extending to the ears. When the abscess is fully mature, it ruptures, to the immediate relief of the patient. Often the Abscess forms on one tonsil, and after its discharge another forms on the other.
CHRONIC ENLARGEMENT OF THE TONSILS. - Repeated attacks of acute Inflammation, or attacks only partially cured, are followed by chronic enlargement and induration, causing difficult swallowing, hoarse voice, noisy and laborious breathing, especially during sleep, affections of the ear, arising from an extension of the disease along the mucous membrane, and extreme liability, from slight causes, to a frequent recurrence of acute Inflammation.
CAUSES. - The predisposing are - Tubercular constitution, abuse of Mercury, and previous attacks of Quinsy. The exciting cause is one of the germs of suppuration, but a sudden atmospheric change, or a chill from getting wet through seems occasionally to be the final factor, lowering the natural resistance and enabling the germ to find a hold. Quinsy is most frequent in plethoric persons, between fourteen and twenty, and for several years is liable to recur unless preventive means are adopted.
DANGERS. - Extension of the Inflammation to the Uvula, soft palate, the salivary glands, pharynx, and particularly to the root of the tongue, with difficult breathing, etc. But early and skilful treatment usually prevent such complications.
TREATMENT. - When suppuration has occurred the abscess should be opened; but prompt treatment sometimes prevents abscess formation.
Aconitum. - Feverishness, headache, dizziness, and restlessness; stinging, pricking, fulness, or even choking, the throat looked as if scorched.
Belladonna. - Bright redness and rawness of the affected parts; flushed face, glistening of the eye, Headache, and pain and difficulty in swallowing. Bell. may follow, or be alternated with Acon.
Mercurius Biniod. - Swollen throat; copious accumulation of saliva; swelling of the gums and of the tongue; shooting pain on swallowing; a disagreeable taste; foetid breath. Ulcers on the side of the mouth; pains from the throat extending to the ear. Profuse perspiration, and nightly exacerbations, also point to Merc.-Biniod.
Baryta Carb. - If given early, before suppuration can supervene, this remedy will often disperse the engorgement. For this purpose it seems to act best in high potencies, 30 and upwards. It is also useful in chronic Tonsillitis.
Hepar Sulph. - When matter has formed. It is especially useful in the Tubercular, in constitutions injured by Mercury, and when a liability to the disease has become established. In our experience it is more rapidly curative than any other remedy.
Lachesis. - When the left tonsil is affected, and the mucous membrane of a livid colour.
Lycopodium. - Beginning on the right side.
Arsenicum. - Severe attacks, with much general prostration.
Calc.-Phos. and Iod and Guaiacum are also useful remedies.
Nux Vomica or Pulsatilla, when gastric derangements cause, or are associated with, Quinsy.
Administration. - In acute cases, a dose every one or two hours; in sub-acute, every three or four hours; during convalescence, every six or twelve hours.
ACCESSORY MEANS. - The constant sucking of ice during the commencement of an acute attack moderates the heat and pain; it also checks the secretion of mucus, which gives rise to disagreeable and painful efforts to detach. In severe cases ice may be employed in this manner till the disease has abated. (See Sec. 25) When ice is not procurable, or when it is not admissible, as when it has not been adopted early in the disease, the next most effectual local application is the steam of hot water, and equally so whether the object be to bring about resolution or to facilitate the suppurative process. Steaming the throat assiduously acts as a fomentation, and removes the mucus from the crypts and follicles of the tonsils. See Section on Inhalation.
In some cases a warm milk-and-water gargle frequently used, will be found useful and soothing. Further, in severe attacks, a hot poultice should be applied across the throat, extending nearly to each ear; in mild attacks the throat compress (see Sec.28) may be used. The patient should remain indoors, and in bad cases in bed. The air of the patient's apartment should be maintained at a temperature of about 65* or 70*, and be kept moist by the evaporation of hot water from shallow dishes near the bed, but proper ventilation should also be preserved.
In chronic enlargement of the tonsils, the advisability of operation should be considered if there is any commencement of deafness or obvious obstruction to nasal respiration. Adenoids are virtually always associated with chronic enlarged tonsils. Much can be done to prevent and cure them by breathing exercises, etc., but if the patient shows signs of deafness they should be removed.
PREVENTIVE TREATMENT. - Freely bathing the neck, jaws, etc. and gargling the mouth and throat every morning with cold water. After exposure to cold, especially if symptoms of Sore throat come on, the compress should be at once applied.
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