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The symptoms already described as accompanying pharyngitis- pain, soreness upon swallowing, dryness of the throat - are pre sent. In addition there are certain symptoms due to the excessive enlargement of the tonsils. The voice acquires a nasal twang; the patient is often compelled to keep the mouth open in order to get sufficient air for breathing; he is usually unable to swallow solid food, and may even find difficulty in swallowing liquids, which are frequently returned through the nostrils upon an attempt at swal lowing. If the patient can open his mouth sufficiently, we observe at the commencement of the disease that the tonsils are red, swollen and dry; a few days later the tonsils and the back part of the mouth are bathed in profuse secretion, which may contain also a little blood. But the important point to be remembered with regard to quinsy is that the surface of the tonsils is frequently covered with a grayish layer, quite suggestive to an inexperienced person of the false membrane of diphtheria. Doubtless many cases of quinsy are for this very reason miscalled diphtheria. It is always easy to distinguish one from the other in this way: if we take a camel's hair brush and gently raise the whitish matter lying upon the tonsil, we find that in quinsy it is easily detached, leaving a smooth red surface beneath ; whilst in diphtheria the grayish material can be raised from the tonsil with considerable difficulty, and when it is thus removed there remains a raw, uneven surface, on which a few drops of blood become visible. It is important that we make this distinction for the benefit both of the patient and of his neighbors. For if the disease be quinsy, we may anticipate a speedy recovery and no spread of the disease; while if it be diphtheria, we must take the best care of the patient and prevent the communication of the disease to others in the vicinity.
The constitutional symptoms accompanying quinsy are often more severe than we would expect from the insignificance of the local disease in the throat. The fever is often very high, there is great headache, and pain in various parts of the body; there may occur also a decided chill and vomiting. The patient is greatly prostrated, a fact which becomes evident during convalescence, for even after the throat difficulty has subsided he remains for several days unable to resume his usual employment.
The disease appears to result from simple exposure to cold ; it is most frequent in young persons and during the changeable weather of spring and fall. If the inflammation be severe, and the swelling of the tonsils extreme, matter may be formed in the tonsils ; in many instances it becomes necessary to give exit to the matter thus formed by an incision into the tonsil. This operation, slight as it is, should not be performed by any but a professional hand, since it is easily possible, by a little awkwardness, to occasion serious damage.
Treatment.-The patient who has the disease for the first time will not, of course, recognize its nature until the tonsils have become swollen and sore, and may even then remain in ignorance of the true nature of the complaint. Many individuals, however, suffer repeatedly from quinsy, and usually know what they are to ex pect a day or two before the throat affection has become prominent. During the premonitory stage-that is, before the fever has become high - much good may be done by simply provoking profuse per spiration. To accomplish this the patient should take a hot foot bath in the evening before retiring, covering himself meanwhile with a blanket or comforter ; after fifteen or twenty minutes, free perspiration will be excited, upon which the patient's skin may be carefully dried, and he should be warmly covered in bed ; at the same time ten grains of Dover's powder may be administered. So soon as the inflammation has been developed in the throat, a gargle should be employed, either the chlorate of potash, or alum and myrrh, as stated above. If it can be accomplished, the most satisfactory results will be obtained from the inhalation of steam. If there be no steam atomizer at hand, it will be a simple matter to arrange a tube so that the steam issuing from a kettle of boiling water can be conducted into the patient's throat. If the patient be a child, and therefore unmanageable, the steam may be conducted into a tent surrounding the bed. The throat may be enveloped in cloths wrung out in hot water, or in light linseed poultices.
An important item in treatment is to sustain the patient's strength by nourishing food, which must, of course, be liquid. Milk is the staple article of diet, reinforced, if necessary, by whisky or brandy. It may be necessary also to administer the following pre scription:
Sulphate of quinine, - - 30 grains.
Tincture of the chloride of iron, - Half an ounce.
Water to make two ounces.
Mix ; take a teaspoonful in water every four hours.
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