Malignant quinsy, or putrid sore throat,Scurvy of the mouth - canker of the mouth

-SMALL A. E.,
Malignant quinsy, or putrid sore throat
The malignant sore throat often makes a part of that awful scourge, - the malignant scarlet fever. It is usually epidemic, and generally occurs in damp and sultry autumnal seasons.
Symptoms

It begins with shivering, followed by heat and languor; oppression at the chest; nausea, vomiting, and often with purging; eyes inflamed and watery; cheeks of a deep red color; greater or less inflammation of the tonsils, and they secrete a thin, acrid discharge, sometimes excoriating the nose and lips; pulse weak and hardly perceptible, small and irregular; tongue white and moist; swallowing painful and difficult; throat of a bright red color, and much swollen. This state soon passes away, and numerous ulcers, varying in size, then manifest themselves upon the swollen part, which finally become covered with a livid coat. Sometimes these ulcerations are more extensive than at others, spreading to the back part of the mouth, over the entire arch, and down to the opening into the windpipe, and c., and assuming a sloughing appearance as they increase in magnitude. Excessive prostration of strength immediately ensues; the lips, tongue and teeth are covered with blackish incrustations, there is more or less delirium; the breath is fetid, and the patient conscious of a disagreeable odor; the countenance is sunken, and there is severe purging.

There is considerable swelling of the neck, and its color is livid. There are often livid spots upon the body (petechiae,) which indicate in some measure the violence of the disease.
This affection carries off many children and adults, and may be regarded as exceedingly dangerous when there is the appearance of livid spots, or petechiae, and other indications of a putrid character, with weak, fluttering pulse, sometimes intermittent; extreme prostration; bleedings from the nose, mouth, and c.
When there is a gentle sweat, that breaks out about the third or fourth day, and when the sloughs are thrown off in a favorable manner, leaving a clean, healthy looking bottom, and the countenance becomes lively and the respiration normal, and the pulse stronger and more equal, a salutary result may be expected.
The fever accompanying the malignant sore throat is more frequently of a typhoid or typhus character, and calls for those remedies best adapted for these fevers in their uncomplicated form.
Treatment
Remedies, Aconite, Arsenicum, Belladonna, Conium, Lachesis, Mercurius, Nitric Acid, Pulsatilla, Rhus, Secale, and Sulphur.

Aconitum napellus
is only useful in the very first stage of the disease, when the fever appears of an inflammatory character; and after the use of this remedy, Belladonna may be called into requisition as soon as the patient complains of dryness, with difficulty in swallowing, and a sense of choking in the throat.
DOSE. - Of either remedy, one drop, or four globules, every three hours.
Arsenicum album
is useful when there is great prostration of strength, rapid sinking of the patient, nausea, or vomiting; or when the ulcers present a livid hue, and also, when in a more advanced stage, they are covered with dark scabs, surrounded with a livid margin; the lips and teeth encrusted with brownish scabs; the skin dry and parched; the tongue blackish, dry, cracked, and tremulous; constant muttering and delirium; unable to close the mouth; labored breathing; acrid discharges from the nostrils, causing excoriations; the eyes dull and glassy; thirst excessive, though but little is drunk at a time, and swallowing is performed with difficulty; and finally, when in addition to extreme prostration there is a rash of livid color that breaks out in blotches, intermingled with petechiae, or livid spots.
DOSE. - This remedy is of so much importance, when indicated as above, that it should be administered with the greatest promptness, as follows: One drop of the dilution, or four globules, may be given in a spoonful of water, every two hours, until three doses are given, and then, every three hours, until amelioration, or change.
Conium maculatum
will class very well with Arsenicum, for malignant quinsy, because it is equally energetic, and has been employed with great success, when the diseased parts have suddenly assumed an ashy gray color, or a blackish appearance, and the ulcerations secreting a fluid exceedingly offensive and fetid, without sensible pain, the strength and also the natural temperature of the body have suddenly declined, the spirits of the patient have become depressed and anxious, with signs of indifference, the febrile seasons irregular, sometimes commencing with chills, and concluding with heat, at others beginning with heat and chilliness simultaneously, or in rapid alternation, and concluding at night in a copious perspiration; a whitish eruption also appearing in the skin; the face grows pale, features change, and often with swelling; the tongue becomes coated with a thick dark covering, swells and is painful; the speech is difficult, and the stools are thin, watery, or bloody and involuntary. Many of these symptoms may indicate the use of Mercurius corrosivus, and if so, this remedy may precede the use of Conium. The Mercurius corr. should be given three times, in doses of four globules, or one drop, in a spoonful of water.

DOSE. - Of a solution of one drop, or six globules, in four tablespoonfuls of water, give a teaspoonful every two hours at first. If the patient exhibits any signs of convalescence, do not repeat the remedy oftener than once in three or four hours.
Lachesis mutus
This remedy is one of the polycrests in malignant ulceration of the throat, and will frequently be found useful after Arsenicum, should the patient complain of great pain in the throat, aggravated by the slightest external pressure; or should the scabs or sloughs seem indisposed to cast off, and the neck become much swollen and discolored; after this remedy has been used for some time, if the tendency to gangrene continues, and the patient is still affected with great prostration of strength, accompanied with debilitating sweats, China may be called into requisition, as there is no remedy more likely to meet the existing condition of the system; or Arsenicum may come in well after Lachesis, especially if the countenance is sunken, and the eyes appear glassy, and there is the extreme sinking for which this remedy is so remarkably adapted. After the use of Arsenicum, Nux vomica may be given with great benefit, when diarrhoea is present, and only partially checked, and numerous foul, offensive, though small ulcers, are found in the mouth and throat. This remedy, again, may be succeeded by Carbo vegetabilis, should a copious, fetid, thin, sanious fluid be discharged from the ulcers, attended with great prostration, and small, indistinct, or scarcely perceptible pulse.

DOSE. - Of a solution of one drop, or eight globules, in four tablespoonfuls of water, give a teaspoonful every two hours until it becomes necessary to follow with one of the other remedies, then it is necessary that whatever remedy is selected to succeed Lachesis, should be dissolved in the same manner and given at the same intervals.
Mercurius solubilis
is more serviceable in the early part of the disease, before the ulceration has progressed so far as to present the more fetid and putrid odor; but when from the increasing size and painfulness of the ulcers, this remedy does not promise to arrest their progress or cause them to assume a healthy aspect, it will be well to call nitric acid into requisition.
DOSE. - Of a solution of one drop of the dilution, or eight globules, in four tablespoonfuls of water, give a teaspoonful every hour or two hours, until it becomes evident that a change is necessary.
Nitricum acidum
This remedy is particularly required after Mercurius has failed of arresting the increase of the swelling of the throat, and when the ulceration has progressed so far as to present numerous little yellow or white pustules upon the tonsils.

DOSE. - Of a solution of one drop, or eight globules, in four tablespoonfuls of water; give a teaspoonful every four hours, say every hour at first, until two or three doses are given, and then every two hours, and afterwards every three hours.
Pulsatilla pratensis
is useful when the symptoms are of a mild character, or which have been in a measure subdued by the use of Belladonna, and an increased action of the mucus membrane supplies the place of a previous dryness, while the patient is at the same time afflicted with nausea and bilious vomiting; bloated appearance of the face; constipation of the bowels; or on the other hand, the opposite condition or diarrhoea at night, occasionally pains in the bowels, with shivering.
DOSE. - One drop, or four globules, may be given every three hours, or four globules may be given dry upon the tongue with the same frequency.
Rhus toxicodendron
is particularly useful in extreme cases, where there is great muscular weakness with trembling of the extremities, especially on movement; sopor and other symptoms described under this remedy in the chapter where typhus fever is treated of.
DOSE. - Of a solution of one drop, or eight globules, in six spoonfuls of water; give a teaspoonful every three hours.
Secale cornutum
is exceedingly useful when the stupor is long continued, or there is lethargic sleep, or involuntary diarrhoea, and when the ulceration of the throat is of a fetid or putrid character, and there is nausea and disposition to vomit.
DOSE. - One drop, or four globules, may be given every three hours.
Sulphur
is a remedy that may be called into use in the treatment of malignant sore throat, when it becomes apparent that skin difficulties have become suppressed, and when there is swelling and suppuration of the glands; or, when there is deep and fetid ulceration of the tonsils, this remedy may be given with advantage at the very commencement of the disease, and particularly if there is rough throat and loss of voice.

DOSE. - One drop, or four globules, of sulphur, may be given three times a day.
Diet and regimen
It is not often that subjects of malignant sore throat can take much food of any description, and only such as is entirely divested of every rough property, such as rice, arrowroot, corn starch, or thin flour gruel; when the mouth becomes dry, and the sloughs become dry and hard, it is well to moisten them with a little warm milk and water, and to wash the mouth very gently with the same. The room where the patient is, must be kept free from stagnated air, and if it be over a wet, damp cellar, he must be removed. It is far better to secure a good and wholesome atmosphere at first, than to rely upon remedial measures in a bad atmosphere. And when the patient begins to recover, and his appetite becomes established, be careful about overloading the stomach, as this may prove the cause of exciting the most painful sequellae. It is well to begin moderately with toast, black tea, cocoa, milk toast, bread and butter, and as strength is acquired to use some of the digestible meats in great moderation.

Scurvy of the mouth - canker of the mouth
(cancrum oris.)
The peculiar characteristics of this disease are sensitive gums, hot, red and spongy; sometimes they swell, and sometimes they shrink from the teeth, leave them loose and they fall out; at other times small ulcers make their appearance on the gums, the inside of the lips, the cheeks, on the palate, and even on the tongue; not unfrequently there is great offensiveness of the breath, and sometimes discharge of sanious tough phlegm and saliva from the gums; mastication becomes impaired because the teeth are so loose, and the power of swallowing becomes diminished because the throat is so sore, that the act becomes painful in the extreme; sometimes the glands of the throat swell and become painful, there appears to be great prostration, and oftentimes a torpid feverish condition of the system.

Treatment
The remedies employed are Arsenicum, Carbo veg., Dulcamara, Hepar sulph., Mercurius, Natrum muriaticum and Sepia.
Arsenicum album
is particularly useful when the ulceration is very extreme, with violent burning pains; and in alternation with China, if gangrene is threatened, the gums becoming black and the patient very much reduced.
DOSE. - Of a solution of one drop, or six globules, in four tablespoonfuls of water; give a teaspoonful every four hours.
Carbo vegetabilis
is in the highest degree useful when the scurvy has arisen from the abuse of mercury, or too long a subsistence on salt food, and when the gums bleed very much and smell very offensively.
DOSE. - One drop, or four globules, every six hours.
Dulcamara
may be given in the first onset of the disease, when the canker results from taking cold, and the glands of the throat are swollen and hard. This remedy is useful after Mercurius fails of effecting a cure.
DOSE. - One drop, or four globules, every four hours.
Hepar sulphur
is for the most part a collateral remedy, and never to be used in scurvy or canker of the mouth, only when Mercurius proves insufficient, from the fact that the disease first originated from the use of Calomel. This remedy may follow Mercurius, and also it may follow Carbo veg. when this remedy has failed.

DOSE. - One drop, or four globules, dissolved in a spoonful of water, twice a day.
Mercurius solubilis
is useful in almost every case, and may for the most part be given at the commencement of the disease, unless calomel or some other form of mercury has produced the disease, in which case resort to Hepar sulph. and Carbo veg. or Nitric acid.
DOSE. - Of a solution of one drop, or six globules, in four tablespoonfuls of water; give a teaspoonful every three hours.
Natrium muriaticum
When the ulcers spread very slowly, and when the canker is so torpid that none of the preceding remedies seem to have any great effect in removing it. The gums appear swollen, bleeding and sensitive; every thing cold or warm, or eating or drinking affects them; when blisters and small ulcers appear on the tongue, which burn so as to render it painful to speak.
DOSE. - One drop, or four globules, two or three times a day.
Diet and regimen
Animal food should never be taken either in the solid form or in that of broth or soup, so long as the virulence of the disease remains; food entirely of a farinaceous or a vegetable form may be used. All stimulants should be avoided, as drink. The mouth may be washed with brandy and water, or even with lemon juice in water, with a soft brush.
And also, the mouth may be washed with a decoction of sage, as this is an old domestic remedy, which experience proves to be generally useful.
The mouth may also be washed with a solution of borax in water.