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Quinsy

QUINSY or Cynanche, or Angina, is an inflammation of the throat. Nosologists, having applied the name of cynanche to nearly all the inflammatory diseases in this part, have been obliged to distinguish the different affections of the several organs included in it, by specific names; hence we have cynanche parutidaja, another name for mumps; C. trachealis, which is croup; C. pharyngea, or inflammation of the pharynx; C. tonsillaris, or inflammation of the tonsils; and many other species, named either from the organ chiefly affected, or the character of the inflammation. Of these, mumps and croup having been treated of m separate articles, the present may be devoted to the two last mentioned, which are indeed those that are commonly intended by the popular name quinsy.

Cynanche pharyngea, or inflammation of the mucous membrane lining the back of the mouth and the upper part of the throat, is that which usually exists in a common sorethroat, brought on, as it most frequently is, by a change in tuo weather, or bv sitting in cold or. damp air. It is usually a mild disease, and chiefly annoyin; from its liability to recur on slight occasions. The extent of the inflammation varies greatly in different cases; it may be confined to the pharynx, or it may spread from it over the soft palate and the tonsils, and into the cavities of the nose, where it produces the additional symptoms of a cold, or into the tympanum [ear], giving rise to deafness. On examination, the back of the mouth and fauces, when thus inflamed, will be found unnaturally red and swollen, and often covered with tough mucus or lymph; and from the^o changes there result dryness and soreness of the throat, pain on swallowing, and a sensation as if the diseased pans were closely constricted.

A common sore-throat does not need much treatment; warmth, gentle purgatives, and sweating medicines, the avoidance of stimulating food, and the inhaling of the vapour of hot water, or hot vinegar and water, or the application of a largo poultice round the throat, will usually effect its removal in a few days. Sometimes however the d^ea-se is prolonged in a slight hut obstinate form, which is commonly called a relaxed sore-throat. In this condition the redness of the parts affected is still observed, but it is of a less vivid colour, and is irregularly streaky, instead of being evenly diffused; the velum also, which is commonly implicated, is elongated, and it is from its unnatural contact with the back of the tongue and the epiglottis that the tickling sensation in the throat arises, and excites a constant desire to swallow or to cough. For this condition the necessary treatment consists of stimulating gargles, such as hot wine, infusion of Cayenne pepper, very diluted mineral acids, &c, and if the patient be in general ill health, tonics and appropriate alteratives.

In more severe cases of inflammation of the pharynx and adjacent parts, matter sometimes forms either around or near the pharynx, or in the soft palate or the uvula. Wherever the existence of matter can be determined, it should be immediately let out, as from an abscess in any other part of the body. In other severe, and in some measure peculiar, cases, the intensity of the inflammation is marked by the formation of false membranes on the affected surface. This form of ths disease has been named angina membranacea, and has been especially described byM. Bretonneau and other French physicians under the name of diphtherite. In its essential nature this affection resembles croup, with which also it is sometimes connected, the false membrane being not only spread over the mucous surfaces of the pharynx and fauces, but extending down into the trachea. In some cases the inflammation is very acute, and, being accompanied by common inflammatory fever, requires for its reduction the most active antiphlogistic treatment; the same measures, in short, as are applicable in cases of croup. [croup.] In another severe form of quinsy, the inflammation and formation of false membranes are accompanied by a low typhoid state with great prostration 'of strength, and requiring all the remedies that are used in cases of low typhus fever, in malignant scarlet fever, and other dangerous diseases of the same class. It is this form of disease which is usually called putrid or malignant sorethroat, and by nosologists, cynanche or augina maligna. It sometimes occurs as an epidemic, and was long regarded as attended by sloughing of the throat, the layers of false membrane being mistaken for the inflamed tissue in a slate of gangrene.

In cynanche tonsillaris or tonsillitis, the inflammation is entirely or nearly limited to the tonsils. Its symptoms are scarcely distinguishable from those of the common form of the preceding disease, but on examining the throat the redness is seen to be less diffused, and the tonsils, being more or less increased in size, are approximated to each other so as nearly to block up the posterior aperture of the mouth, and render any effort to swallow extremely painful. Hence, to avoid the pain, the patient usually lets the saliva flow from his mouth, and often, in attempting to swallow, is unable to overcome the obstacle presented by the enlarged tonsils, and discharges the fluid back through the nose. In many cases also the inflammation extends to the eustachian tube and tympanum [ear], producing deafness, antl to the parts immediately around the larynx, giving rise to difficulty of breathing and a harsh hoarse sound of the voice. With these local symptoms there is usually more or less fever, with headache, loss of appetite, &c.

The milder cases of inflammation of the tonsils may be treated in the same manner as those of the preceding disease; leeches applied to the sides of the throat where the pain is most severely felt, are probably the most beneficial means that can be employed. With a higher degree of inllammation abscesses often form in the tonsils, accompanied by all their usual signs, and with still greater obstruction in the throat. In time these will break of themselves, but it will materially shorten the patient's sufferings if they be opened as soon as matter has distinctly collected. The operation should be performed with a guarded knife, or with one that slips through a canula and can have the length of its cutting part fixed.

The most annoying result of repeated inflammation of the tonsils (and those who have once suffered are peculiarly liable to a recurrence of the disease from very slight causes), is, that they become permanently enlarged. In this state, although swallowing is not painful, it is often attended with difficulty, and by the partial closure of the fauces the respiration is always obstructed and requires an effort for its effectual performance. From this, in children, a peculiar deformity of the chest often results, the breast-bone and the fronts of the ribs becoming elevated and very much arched forwards, in a form which is commonly called chickenbreasted. But if this do not occur, the patient always suffers inconvenience from hoarseness and a kind of nasal sound of the voice; he cannot avoid snoring very loud in his sleep, and often starts up from it with a feeling of impending suffocation. The best means for the removal of this state are astringent gargles, as those with alum, oak-bark, mineral acids, Sec. Iodine also, administered internally and rubbed on the throat, often proves useful; but in many cases nothing will alleviate the condition of the patient but cutting off a portion of each tonsil, so as to reduce them to their natural dimensions.

Note - this article incorporates content from Encyclopaedia Britannica, Eleventh Edition, (1910-1911)

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