GEN. VII. SPEC. IV. Empresma Paristhmitis. Quinsy. a E. Paristhmitis tonsillaris. Common quinsy. racter. Esophagi. painful and difficult: fever a cauma. The impediment to deglutition felt below the pharynx, with a circumscribed pain, and rejection of food when it reaches the seat of obstruction. In the FIRST VARIETY or COMMON QUINSY, the swallowing is, for the most part, greatly impeded: and the speech, and sometimes even the respiration rendered General cha- highly troublesome: the mucus is excreted sparingly, and consequently there is a considerable clamminess in the mouth; and the pain sometimes spreads to the ears. The disease is never contagious, and, though violent while it lasts, is comparatively of short duration. It terminates by resolution, or suppuration; hardly ever by gangrene; though a few sloughy spots sometimes appear upon the fauces. Causes. Treatment. The usual cause is cold; and it is hence found most frequently in spring and autumn, when vicissitudes of heat and cold are most common. It is supposed to affect particularly the young and the sanguine-but, in my own practice, it has occurred as often at other ages and in other temperaments. When it has been re-produced several times within short intervals of each other, it is apt to establish a peculiar diathesis or habit, so as to be excited readily and by very slight occasional causes. If attacked by a medical process early, much benefit has been derived from astringent and acid gargles, and vapours inhaled by any simple machine for this purpose. Blisters to the throat or behind the ear, ought also to form a part of the curative plan; and if bleeding be had recourse to, it should be by scarification or leeches applied to the tonsils or fauces. An early use of leeches I have often found highly successful, and can distinctly corroborate Dr. Crampton's remark, that leeches fix far more readily on moist internal surfaces than on the skin. GEN. VII. E. Paristhmitis SPEC. IV. tonsillaris, Process in Dr. Crampton, by way of caution, passes a thread of silk through the lower half of the body of the leech, but I have never found this necessary. Cooling purgatives, and a low regimen should also enter into the ge- Common neral plan of treatment. If suppuration cannot hereby quinsy. be prevented, the better way will be to expedite this termination by the steam of warm water, or water impregnated with the leaves of rosemary or chamomile: and where the fluctuation is clear to the touch, if the abscess do not of its own accord break readily, it ought by all means to be opened with the lancet. puration. case of sup minations. In a few instances the suppuration has pointed and Singular terbroken externally, and the termination has been favourablet. And, occasionally, from the extent and violence of the inflammation, there has been so much danger of suffocation, that it has been found necessary to make an opening into the trachea ‡: which has been done sometimes as high as the larynx, and sometimes considerably lower; and under both kinds of operation the patient has recovered §. nant sore In the MALIGNANT or second VARIETY, the inflamma- & E. Partion passes at once into the ulcerative stage; and is con- ligna. isthmitis masequently characterized by the symptoms stated in the Ulcerative, definition: the sloughing often takes place rapidly, and or, maligspreads widely, and the fever is a typhus. This variety throat. is frequently epidemic; generally contagious; and found Frequently often as an alarming symptom in rosalia, or scarlet-fever. epidemic. In its idiopathic form it is usually ushered in with a Description. sense of stiffness in the neck, accompanied with some hoarseness of the voice, and occasionally with symptoms of a coryza. It is in effect a quinsy, taking an erythe Explanation. matic or erysipelatous, instead of a phlegmonous turn, in consequence of the peculiar temperament of the atmosphere, or of the patient, or of some unknown cause. The sloughs at first appear whitish, or cinereous; but Dublin Medical Reports, Vol. 1. p. 229. + Schenck. Lib. II. Obs. 36. Ballonius, 1. p. 182. Fernire, Journ. de Med. Tom. LXII. § Fienus, Chir. Tract. iv. v. c. 1. Musgrave, Phil. Trans. N. 258. GEN. VII. SPEC. IV. B E. Par soon become brown, and often black; and spread over the whole of the fauces, and mouth, into the nostrils, and often down the esophagus; the ulceration has, also, sometimes passed up the Eustachian tubes and affected the ears. And, as the sloughs appear to carry contagion with them, on being swallowed they have communicated the disease through the entire range of the alirange of the mentary canal. isthmitis maligna. Ulcerative, or, malig nant sore throat. Extensive ulceration. Hence often highly dangerous. Erythematic character sometimes very striking. The danger is hence very great if the ulceration cannot be checked; and it is peculiarly so to children and adults of relaxed and delicate frames. The disease makes its appearance most commonly in the autumn, though it has appeared in every season. The erythematic character is sometimes very striking, the intumescence spreading widely yet limiting itself to the cellular tissue. Even externally the throat is swollen, hard, and tender; while such is the constriction within that deglutition is impossible, and there is great danger of suffocation. Dr. G. Gregory has given a wellmarked instance of this modification, in a young woman in whom it terminated fatally on the sixth day: and has referred to other cases of a similar kind, and mostly with a similar result, from Dr. Kirkland, Dr. Wells and Mr. James. From its being chiefly seated in the cellucellularis of lar membrane Dr. Gregory has given it the name of cynanche cellularis*. Cynanche Gregory. Whether scarlet fever is a patho ptom. Dr. Cullen regards the eruption of scarlet fever as a gnomic sym- pathognomic symptom of this disease; but this is to confound two complaints that are very clearly distinct, as we shall have farther occasion to observe when discussing rosalia, or scarlet fever. It is at present sufficient to remark that, even in the opinion of Dr. Cullen himself, quinsy is not essential to scarlet fever, or, in Does not al- other words, does not always accompany it; and that, on the other hand, a scarlet eruption is not essential to the malignant quinsy, or does not always accompany it, though he contends that it does almost always + ;-to ways accompany it. * Med. and Phys. Journ. Vol. XLVIII. p. 287. Pract of Phys. Part 1. Book III. Ch. IV. Sect. DCLI. show the proper bearing of these two diseases upon each GEN. VII. other. SPEC. IV. 6 E. Par The malignant or ulcerated sore throat may be with- isthmitis maligna. out a scarlet eruption, or attended with it: if the former, Ulcerative, it is an idiopathic affection, and constitutes a variety of or, maligparisthmitis or cynanche. If the latter, it is a sympto- throat. matic affection, and constitues a variety of rosalia or scarlatina. nant sore Both may exist separately. General re Cleanliness, pure air, and a free ventilation, are here of the utmost importance: and as the contagion is often gimen: very active, the nurses should be cautious to remove speedily the sloughs and foul mucus that are washed or wiped from the mouth. Emetics. The general treatment will necessarily be the same and treatas that we have already pointed out for typhus. Eme- ment. tics are often employed with great advantage at the commencement of the complaint; and the bowels should be gently opened, but not irritated with drastic purges. acids. Here, also, as a mean of abstracting blood locally, Leeches. leeches have been often found of peculiar advantage when timely applied*; and the throat should be soon afterwards gargled with port wine, made still more sti- Port wine. mulant by spices or other aromatics: or with a strong Aromatics. decoction of bark, rhatany, or catechu, very sharply acidulated with mineral acids, the aromatic or pungent Mineral Cayenne vinegar, or charged with an addition of Cayenne pepper in substance. Gargles of the mineral, and even the metallic astringents, have also been tried, but Astringents. in general they want poignancy. Lunar caustic, in the proportion of one part to a thousand parts of water, has sometimes been found useful+: as has the tincture of capsicum with infusion of roses, in the proportion of an ounce of the former to seven or eight ounces of the latter. A strong decoction of mezereon root may, also, advan- Stimulant gargles. * See Dr. Crampton, on the Application of Leeches to Internal Surfaces. Dubl. Rep. Vol. III. + Journ. de Med. Nov. 1789. SPEC. IV. 6 E. Paristhmitis ma ligna. or, malig nant sore. throat. Liniments. GEN. VII. tageously form the basis of a gargle; though even this will be improved by an addition of capsicum or Cayenne pepper*, or the aromatic or mineral acids. The stimulus Ulcerative, of mezereon is less acrid than that of Cayenne pepper, but is more permanent, and acts more immediately on the fauces. The leaves of the flammula Jovis (clematis Treatment. recta, Linn.) or, the upright traveller's joy, may be masticated for the same purpose when fresh, for their acrimony considerably diminishes by drying. They excite a pungent heat in the mouth and fauces, and if chewed in a large quantity, produce a blister. In Persia, a gargle is obtained by boiling the leaves of the water-pepper (polygonum Hydropiper, Linn.) better known in the pharmacopoeias by the name of persicaria urens, which, in many instances, answers very effectually. And, in conjunction with these, camphor or ammonia has often been found beneficial when externally applied in the form of a liniment+. Both may be used internally; and the latter will be found, as Dr. Peart has well observed ‡, one of the best stimulants we can employ, in doses of half a scruple of the sub-carbonate every three or four hours. Bark and wine, should also be taken jointly and large doses. in as large a quantity as the system will bear. Even sleep is less necessary than both these; nor should the patient be suffered to rest for a period of three hours at a time, without fresh doses of both, though we wake him for the purpose.. Time, indeed, is here every thing: if we make no progress in the first thirty-six hours we may tremble for the event; if we lose ground in twentyfour hours we shall have to hope against hope. Women, unaccustomed to wine, have taken it successfully under this disease in the proportion of two bottles a-day for more than a fortnight. Bark and wine, in y E. Paristhmitis QUINSY OF THE PHARYNX is, properly speaking, that pharyngea. which commences in this organ. It is met with but Paristhmitic sore-throat. * Collin. Med. Comment. 11. 27. Stephen, Med. Comment. Edin. v. † Rumsey, Lond. Med. Journ. x.-Medicus, Beobachtungen, II. 505. ‡ Practical Information on the Malignant Sore Throat, &e. |