REMARKS ON ACUTE TONSILLITIS AND ITS TREATMENT. By Surgeon PATRICK IIEHIR, si.d., f.b.c.s., Ed., Bengal Service.
There
more are few diseases distressing, and painful, depressing whilst they last than acute tonsillitis. For the time being it creates intense misery. The usual cause is a chill, or the effluvia emanating from a foul drain, a sewer, or some other collection of putrefying animal refuse, more rarely a disordered condition of the primes vice?especially fecal accumulations. The distress is chiefly local, and mainly due to the inflammatory infiltration* into the substance of a gland (having normally a somewhat dense structure) compressing the delicate plexus of nerves that supplies it, and to a minor degree to the swelling ou the external aspect of the gland compressing the sensory nerves, with which it is in relation.0 The inflammation, although concentrated in, is rarely confined to the tonsil. Ifc affects the corresponding half of the soft palate, the uvula, and the pharynx, often travelling up the Eustachian tube, occasionally giving rise to & catarrh in that canal, followed by some deafness. The pharyngeal share in the inflammatory process gives rise to the secretion of a thick irritating mncus, which excites reflex swallowing, or hawking. This symptom causes much pain, and in pilocarpin, we find a remedy capable of relieving it to a considerable extent. Under its influence, although the secretion is increased, its tenacity is greatly lessened, and the difficulty in getting rid of it is proportionately decreased. One-eighth of a grain in a teaspoonful of water every two hours, or one-sixth hypodermically every four hours until salivation is produced,
slight
the desired result.
brings about
I have found but few cases in which Rinoei->s method of administering tincture of aconite effects the speedy result claimed for it. Iu two in cases 17 which it was tried stances of the both children, it certainly produced ?
rapid relief
beueficial effects beiug manifest after five
or
824
THE INDIAN MEDICAL GAZETTE.
[Nov.
1890.
sixdrop doses. In the otliers it failed, but even pain in the neck when 110 pus is present, the exin those cases in which it appeared to be success- planation of which is probably the same as that ful, it did not lesson the actual duration of the in connection with inflammatory processes in the disease. Ordinarily the following local aud synovial sheaths of tendons in deep whitlows and beneath tense fascia;?the closer relation ot were adopted :? measures general the enlarged gland in its inflamed state, to the The local measures consisted of repeated poulinternal carotid and ascending pharyngeal artmeans of a of boilticing, steaming by degchie eries adds to this subjective symptom. Actual to close water the of head the kept patient's ing bed, application of a 6 per cent, solution of co- pus formation is not frequent, at least, I have met caine every six hours, and of powdered guaia- with only two instances of its occurrence in the on which these notes are based. In neither cum resin occasionally. Internally,one-sixteenth 33 these two cases did the quantity of pus exceed of of a grain of antimonium tartaratum, every I believe that severe astringent two hours to adults, and proportionately small half a drachm. doses to children, gives a more uniform result gargles do very little good during the acute than any other remedy I have tried, not except- stage, although when the acute stage is retarding the much-lauded salicylate of soda. If any ed, they appear to expedite resolution. The same excessive depression arises, which is very un- objection does not hold good with regard to likely with such small doses of antimony, a few tepid antiseptic gargles. The same may be said grains of ammonite carbonas, or a few drops of with regard to the application of severe caustics, mixture of strophauthus remove it. Good port although occasionally one hears of speedy wine is probably the best form of stimulant relief after a single application of strong nitrate when one is needed. I believe the port wine has of silver solution, tincture of iodine, or perof iron. Bits of ice to suck are often some local beneficial action on the inflamed chloride to difficult it is see how it grateful to the superheated throat. Doubtless tonsils, although remedies will have been found the it be from unless acts, constriuging action many additional of the alcohol and astringent principles of the useful in the hands of other physicians, but the Mistura Gruuiaci is sometimes exceed- above is a general outline of the plan of treatwine. in relieving the sharp " shootiug " ment with which one has occasion to be well useful ingly It reduces the duration of the dispain, complained of when the patient swallows, satisfied. but it is an unpleasant remedy, combine it how ease from five or six to three days, and I venit occasionally excites, ture to think that there are very few cases of we will, aud further, nausea and even vomiting. genuine acute quinsy that will recover in a than this. There is little that is of concentrated consist should food The liquid shorter period in line of treatment advocated. the I The pain produced by swallowing original nourishment. to Lawrie for indebted what am Surgeon-Major that the patient is is usually so excruciating, be looked upon as the two most important literally unable to take a sufficiency of ordinary may factors in it?the repeated small doses of antisoups, broths, and milk to maintain his strength. the use of pilocarpin. In Brand's essence of beef and condensed milk mony and this in valuable have we respect. ngents Although it is good practice to begin with an
aperient (especially a mercurial one followed by saline draught) when it is needed, we should guard against mistaking the coated tongue, almost invariably met with, to be an indication of of the the state of the epithelial coating The white curdy matestomach and intestines. a
rial that is frequently seen covering the inner surface of the tonsil in irregular patches, must " false membrane "?it can not be mistaken for a be readily removed, leaving behind an entire nonulcerated surface. I have repeatedly found marked relief follow a simple puucture of, or small incision into, the to loz. of gland, which gives exit to from blood, and this is done whenever the glaud is much swollen, or threatens to bulge beyond the middle liue. It is infinitely preferable to the use of leeches in the sub-maxillary region, which, unless applied in large numbers, cannot have much effect on the seat of the disease, besides the great of scars. leaving disadvantage The patient often complains of a "throbbing"
There
more are few diseases distressing, and painful, depressing whilst they last than acute tonsillitis. For the time being it creates intense misery. The usual cause is a chill, or the effluvia emanating from a foul drain, a sewer, or some other collection of putrefying animal refuse, more rarely a disordered condition of the primes vice?especially fecal accumulations. The distress is chiefly local, and mainly due to the inflammatory infiltration* into the substance of a gland (having normally a somewhat dense structure) compressing the delicate plexus of nerves that supplies it, and to a minor degree to the swelling ou the external aspect of the gland compressing the sensory nerves, with which it is in relation.0 The inflammation, although concentrated in, is rarely confined to the tonsil. Ifc affects the corresponding half of the soft palate, the uvula, and the pharynx, often travelling up the Eustachian tube, occasionally giving rise to & catarrh in that canal, followed by some deafness. The pharyngeal share in the inflammatory process gives rise to the secretion of a thick irritating mncus, which excites reflex swallowing, or hawking. This symptom causes much pain, and in pilocarpin, we find a remedy capable of relieving it to a considerable extent. Under its influence, although the secretion is increased, its tenacity is greatly lessened, and the difficulty in getting rid of it is proportionately decreased. One-eighth of a grain in a teaspoonful of water every two hours, or one-sixth hypodermically every four hours until salivation is produced,
slight
the desired result.
brings about
I have found but few cases in which Rinoei->s method of administering tincture of aconite effects the speedy result claimed for it. Iu two in cases 17 which it was tried stances of the both children, it certainly produced ?
rapid relief
beueficial effects beiug manifest after five
or
824
THE INDIAN MEDICAL GAZETTE.
[Nov.
1890.
sixdrop doses. In the otliers it failed, but even pain in the neck when 110 pus is present, the exin those cases in which it appeared to be success- planation of which is probably the same as that ful, it did not lesson the actual duration of the in connection with inflammatory processes in the disease. Ordinarily the following local aud synovial sheaths of tendons in deep whitlows and beneath tense fascia;?the closer relation ot were adopted :? measures general the enlarged gland in its inflamed state, to the The local measures consisted of repeated poulinternal carotid and ascending pharyngeal artmeans of a of boilticing, steaming by degchie eries adds to this subjective symptom. Actual to close water the of head the kept patient's ing bed, application of a 6 per cent, solution of co- pus formation is not frequent, at least, I have met caine every six hours, and of powdered guaia- with only two instances of its occurrence in the on which these notes are based. In neither cum resin occasionally. Internally,one-sixteenth 33 these two cases did the quantity of pus exceed of of a grain of antimonium tartaratum, every I believe that severe astringent two hours to adults, and proportionately small half a drachm. doses to children, gives a more uniform result gargles do very little good during the acute than any other remedy I have tried, not except- stage, although when the acute stage is retarding the much-lauded salicylate of soda. If any ed, they appear to expedite resolution. The same excessive depression arises, which is very un- objection does not hold good with regard to likely with such small doses of antimony, a few tepid antiseptic gargles. The same may be said grains of ammonite carbonas, or a few drops of with regard to the application of severe caustics, mixture of strophauthus remove it. Good port although occasionally one hears of speedy wine is probably the best form of stimulant relief after a single application of strong nitrate when one is needed. I believe the port wine has of silver solution, tincture of iodine, or perof iron. Bits of ice to suck are often some local beneficial action on the inflamed chloride to difficult it is see how it grateful to the superheated throat. Doubtless tonsils, although remedies will have been found the it be from unless acts, constriuging action many additional of the alcohol and astringent principles of the useful in the hands of other physicians, but the Mistura Gruuiaci is sometimes exceed- above is a general outline of the plan of treatwine. in relieving the sharp " shootiug " ment with which one has occasion to be well useful ingly It reduces the duration of the dispain, complained of when the patient swallows, satisfied. but it is an unpleasant remedy, combine it how ease from five or six to three days, and I venit occasionally excites, ture to think that there are very few cases of we will, aud further, nausea and even vomiting. genuine acute quinsy that will recover in a than this. There is little that is of concentrated consist should food The liquid shorter period in line of treatment advocated. the I The pain produced by swallowing original nourishment. to Lawrie for indebted what am Surgeon-Major that the patient is is usually so excruciating, be looked upon as the two most important literally unable to take a sufficiency of ordinary may factors in it?the repeated small doses of antisoups, broths, and milk to maintain his strength. the use of pilocarpin. In Brand's essence of beef and condensed milk mony and this in valuable have we respect. ngents Although it is good practice to begin with an
aperient (especially a mercurial one followed by saline draught) when it is needed, we should guard against mistaking the coated tongue, almost invariably met with, to be an indication of of the the state of the epithelial coating The white curdy matestomach and intestines. a
rial that is frequently seen covering the inner surface of the tonsil in irregular patches, must " false membrane "?it can not be mistaken for a be readily removed, leaving behind an entire nonulcerated surface. I have repeatedly found marked relief follow a simple puucture of, or small incision into, the to loz. of gland, which gives exit to from blood, and this is done whenever the glaud is much swollen, or threatens to bulge beyond the middle liue. It is infinitely preferable to the use of leeches in the sub-maxillary region, which, unless applied in large numbers, cannot have much effect on the seat of the disease, besides the great of scars. leaving disadvantage The patient often complains of a "throbbing"
