DISEASES OF AIR-PASSAGES.
PARENCHYMATOUS INFLAMMATION OF THE
FAUCES.
ANGINA TONSILLARIS; TONSILLITIS; AMYGDALITIS: QUINSY.
C. P. HART, M. D., WYOMING, OHIO, EDITOR.
AMERICAN OBSERVER, 1880, Vol. VII, PRACTICE OF MEDICINE
Under this head we shall, for the sake of convenience, include all deep-seated inflammations of the throat, whether simple or phlegmonous as the tonsils are most affected in these cases, it is customary to call the disease tonsillitis, or inflammation of the tonsils; but we prefer the common name quinsy, as being more applicable to the various structures involved in the inflammation.
This form of inflammation, though frequently originating in the tonsils, is seldom limited to those organs, but generally spreads to the surrounding tissues, constituting the affection under consideration. It is only when it ceases to be superficial, and involves the parenchyma, that it is entitled to the name quinsy; so long as the inflammation is confined to the mucous coat, it belongs to the simple form already described.
SYMPTOMS
The disease generally announces itself by some uneasiness and difficulty in swallowing, with a sense of heat and fullness in the fauces, accompanied with dryness, and a feeling of constriction, as though there was something there which needed to be dislodged.
On examination the parts are found to be red and swollen, one of the tonsils being usually larger than the other. As the inflammation progresses the tonsils continue to swell, and the difficulty of swallowing increases, until in many cases liquids regurgitate through the nose, and deglutition becomes almost, if not quite, impossible. The dryness is now succeeded by a copious secretion of viscid, ropy mucus, which adheres so closely as greatly to annoy the patient, and leads to constant and painful efforts to remove it by swallowing, or by hawking and spitting; but as the pain at this stage is great, whenever any movement of the affected parts is made, the patient frequently allows it to dribble out of his half-open mouth. The pain occasionally extends along the Eustachian tubes to the ears, which is said to be of importance as a sign of suppuration, or abscess. The voice becomes altered, assuming more or less of a nasal sound; and is often sufficiently peculiar to alone characterize the disease.
The enlargement may continue until it produces not only extreme dysphagia, but more or less dyspnea, in which case it almost always ends in abscess. The suppuration is generally limited to one tonsil, the other undergoing resolution. Sometimes, however, both tonsils gather, either simultaneously or in succession, and after producing much local suffering, sleeplessness, and high fever, at last burst, giving instant and complete relief. The discharge is generally so small as not to attract special attention; but sometimes it is so copious and fetid as to nauseate the stomach, and even produce retching and vomiting.
Abscesses also occasionally form in the velum, the uvula, and the posterior wall of the pharynx. The latter, called retro-pharyngeal, is the most important.” In these cases there is sometimes the most distressing dyspnea, from pressure on the larynx, together with loss of voice, inability to swallow, and pain and tenderness in the pharyngeal region. Abscess in this situation is said to occur most frequently in children under seven years of age.
Repeated attacks of quinsy are apt to leave the tonsils in an enlarged, or hypertrophied, and indurated state. Especially in scrofulous subjects, though this condition sometimes results from a chronic inflammation of the parts, unattended by any acute symptoms. Sometimes this chronic enlargement is so great as to cause serious inconvenience, producing more or less alteration of the voice, difficulty of swallowing and irritation, congesting the neighboring parts, and, by irritating the glottis and larynx, inducing a dry and hacking cough, which tends still further to confirm the throat affection. The inflammation in these cases, though of a low and chronic character, is liable sooner or later to spread both upward and downward, giving rise on the one hand to nasal catarrh, and on the other to laryngitis and bronchitis, all generally of a chronic character.
ETIOLOGY
Quinsy is just as much a catarrhal affection as the simple or erythematous form of angina, inasmuch as it is always caused by exposure to cold or damp. We also find in these cases a similar predisposition to ” take cold,” but why the same influences always cause (simple angina in some cases and the parenchymatous form in others, is not so clear. It is certain, however, that one attack of quinsy predisposes the patient to another; and· that those who live in damp, gloomy, and badly ventilated dwellings .are most subject to relapses. Tonsillitis is a frequent complication of other diseases, especially scarlatina and diphtheria.
TREATMENT
Belladonna, Mercurius and Baryta carb. are specifics in this disease, and if properly and timely given will almost always prevent suppuration, a result seldom obtained by allopathic treatment, even when the most “heroic” remedies are employed. Belladonna, however, is only suitable at the commencement of the disease, or before the inflammatory engorgement becomes extreme: When this , state occurs Mercurius is generally indicated, and will, if the process is not too far advanced, prevent the forrmation of an abscess, although, if the symptoms are very acute, Baryta is generally the rnost reliable remedy.
THERAPEUTIC INDICATIONS.
Belladonna.
– inflammatory redness of the fauces, including the uvula, tonsils and velum palate, with or without swelling, shooting, stabbing pains in the throat, constant disposition to swallow, and difficult deglutition. Fever, cerebral congestion, etc., are additional indications, but only at the commencement of the disease, as Belladonna is seldom of any great use after the first forty-eight hours or so.
Baryta carb.
– Dryness and rawness of the fauces, with or without swelling ; painful stitches or shooting pains on swallowing or attempting to swallow ; alternate chills and heat; great swelling of the tonsils, with obstructions to speech and deglutition. If given early this remedy will almost always disperse the engorgement and prevent suppuration. It is also of great service when the angina lingers or remains stationary; also after it has become chronic.
Hepar sulph.
– Great swelling of the tonsils, with difficult or impossible deglutition; sensation of a plug in the throat, with violent pressure, lancinating pains, and a feeling of impending suffocation. Given sufficiently early this remedy will often prevent suppuration, but is inferior in this respect to Baryta. It is of the greatest use in cases where an abscess is about forming and we wish to hasten the process.
Lachesis.
– Great swelling of the tonsils, associated with considerable swelling of the outer neck, obstructed deglutition, and a livid redness of the fauces, Most useful in lingering or stationary cases, in which the left tonsil is most affected, and in which Belladonna and Mercurius are indicated but have proved insufficient.
Mercurius.
– Inflammatory swelling of the fauces in which the tonsils are specially involved, and of a deep red or bluish color; copious accumulation of tenacious saliva; fetid breath; ulcers on the tonsils or sides of the mouth; shooting pains on swallowing: difficult deglutition; swelling of the gums and tongue; disagreeable taste; profuse perspirations and nightly exacerbations. This remedy is generally most useful after the pains have been abated by the administration of Belladonna; bat if the case is not seen at the very outset, it may very properly be alternated with the latter remedy.
Phytolacca.
– Chills alternating with fever, and attended with great weakness; pain in the throat, extending to the ears; aching in the back, neck, head and limbs; ulceration of the tonsils and fauces, with greyish-white sloughs and little or no fetor of the breath. This remedy is specially adapted to the ulcerative form of the disease, and
in large doses may be regarded as specific; it is also suited to the
suppurative process.
AUXILIARY TREATMENT
Local treatment is seldom required, provided the case has been subjected to homeopathic treatment from the beginning. Some practitioners, however, recommend the local application of ice, by sucking, from the very commencement. Used in this way it will without doubt materially lessen the inflammation and abate the pain ; it is also useful in checking the secretion of mucus, the adhesiveness of which renders it very annoying to the patient, arid difficult to dislodge. Others prefer the steam of hot water, which serves both to clear the throat and promote resolution; it also favors suppuration in case that process is impending. This application is best made by means of the steam atomizer represented in Pl. IV, Fig. 3. In most cases, a warm milk-and-water gargle, by clearing the throat of the tenacious mucus, and by acting as a mild fomentation, will be found both useful and soothing. Water compresses, poultices, gargles of chlorate of potash,. etc., are also recommended, and may be used according to the judgment of the practitioner.
CLINICAL OBSERVATIONS
“Dr. Ransford states that he has found Baryta carb. of the most signal service in Angina Tonsillaris. Its action is said to be more prompt than that of either Bell, Apis, or Merc. sol. Dr. Harvey also writes that he has seen this remedy of great use in chronic glandular swelling, and also in Acute Tonsillitis of the left side. The dilutions found most serviceable are the 6th and 12th.
“Hartmann says of Ignatia, “The following symptoms of angina are characteristic of Ignatia, as has already been stated by Hahnemann in his remarks on this drug: Stinging in the throat between the acts of deglutition; sensation when swallowing as if the patient were swallowing over a bone, with a rolling sound; sensation of a plug or tumor in the throat, only between the acts of deglutition. Ignatia will never prove useful if the stinging is only felt during deglutition, but very certainly when the stinging is felt between the· acts of deglutition, or when it passes off by continuing the act of swallowing; of course the others symptoms must likewise correspond to Ignatia. On looking at the buccal cavity the fauces look inflamed and red, the tonsils are swollen and inflamed, covered with small ulcers. Another kind of angina, which also yields to Ignatia, consists in a painful soreness of the throat, which is only felt during deglutition; or in the sensation when swallowing as if a tumor had formed in the throat which hurts when swallowing. The sensation of a swelling in the throat, with painful soreness during deglutition, is therefore a chief criterion for the use of Ignatia.”
Dr. Hughes says of Hepar sulph. that it is particularly indicated in “strumous enlargement of glands, especially where these can only be cured through suppuration, especially the tonsils.”
Dr. Burt says: ”To arrest suppuration of the tonsils, nothing can equal Mercurius cor., first decimal trituration, applied locally with a camel’s hair brush; two or three applications will cure it in half a day. Its action is so quick that no physician will believe it until he tries it for himself. I have cured them in two hours when suppuration seemed inevitable.”
Apis mel.
Dr. Guernsey’s indications are: “Red and highly inflamed tonsils; dryness of the mouth and throat, with stinging, burning pain when swallowing.”
Dr. Ruddock lays down the following indications for treatment:
Aconitum.
Feverishness, headache, dizziness and restlessness; stinging, pricking fullness, or even choking, the throat looking as if scorched.
Belladonna.
Bright redness and rawness of the affected parts; flushed face, glistening of the eye, headache, and pain and difficulty in swallowing. Belladonna may follow or be alternated with Aconite.
Hepar sulph
When matter has formed. It is especially useful in the scrofulous, in constitutions injured by Mercury, and when a liability to the disease has become established. Given sufficiently early it often prevents suppuration.
Mercurius iod.
Swollen throat; copious accumulation of saliva; swelling of the gums and of the tongue; shooting pain on swallowing; a disagreeable taste ; fetid breath; ulcers on the side of the mouth; pains from the throat extending to the ear. Profuse perspiration, and nightly exacerbations, also point to Merc. iod. Merc cyan. is also promptly curative.
Baryta carb.
If given early, before suppuration can supervene, this remedy is said to disperse the engorgement; it is also useful in chronic Tonsillitis.
Lachesis.
Where the left tonsil is affected, and the mucous membrane is of a livid color, etc.
Arsenicum.
Severe attacks, with much general prostration, the tonsils becoming putrid or gangrenous.
Nux vom., or Pulsatilla
When gastric derangements cause, or are associated with, quinsy.
Baehr discriminates as follows: In angina tonsillaris Belladonna is only suitable at the commencement of the disease, and in a form of angina which can scarcely be distinguished from angina catarrhalis. In general, however, it is scarcely possible in practice to establish a strict difference between these two forms of angina, nor is this essential to successful treatment. The darker the redness of the fauces, the more marked a bluish tint, the more considerable the inflammatory swelling, the less is Belladonna suitable; and even the presence of cerebral symptoms would no longer justify its use. The presence of such symptoms might tempt us to continue the 
exhibition of Belladonna, for the reason that we attach more importance to the congestive symptoms than they really merit. In many cases Belladonna will suffice to control the disease and prevent suppuration; this result ought to be obtained: however, in forty-eight hours at the longest, otherwise we cannot depend upon it. In other cases the febrile symptoms disappear, but the tonsils remain red and swollen; in such cases the continued use of Belladonna would only involve a loss of time, for we should miss the favorable moment of preventing exudation. In the acute paroxysms of the chronic form, Belladonna removes with certainty the pain and the vascular engorgement, and in milder attacks suffices to restore the tonsils to the former condition.
In view of the certainty with which we can cure an angina, in a comparatively short period, it is to be regretted that a physician is not called to such a case at the very commencement of the attack, when the suitable period for the efficient exhibition of Belladonna is not yet passed. Persons who are liable to attacks of amygdalitis should be recommended to keep a vial of the proper medicine on hand, with a view of using it as soon as they begin to experience the symptoms of the trouble.
Mercurius
will rarely be suitable at the onset of the disease, unless it should be accompanied by violent catarrh of the buccal cavity, or originate in it. Usually, however, the physician is not called till the inflammatory swelling has reached a higher degree, in which case Mercurius is generally indicated. The more particular phenomena which indicate this remedy are: The whole of the fauces have a deep red or a
bluish-red tint, more particularly the tonsils, which are darker than any other part, and usually show small ulcers, with pseudo-membranous exudations. The saliva is very tenacious and slimy, obliges the patient to swallow frequently, and the buccal cavity exhibits the symptoms of a highly developed catarrh. The breath has a peculiar foul odor. The pains are generally less than when Belladonna is indicated, but the general health is worse. All those symptoms are present of which we can say with positive certainty that they precede suppuration. Generally, however, unless the process is too far advanced, we succeed in preventing the formation of an abscess. The most suitable preparation of Mercurius is the Mercurius solubilis in one of the lower triturations, frequently repeated. It should not be given up too soon if no striking improvement sets in all at once, or the disease seems to increase in intensity, for not unfrequently the symptoms threatening suppuration recede, although this result seemed unavoidable.
Hepar sulphuris calcareum
is the most important remedy next to Mercurius; that is to say, Hepar may be given when an abscess is evidently on the point of forming and we simply desire to hasten the suppurative process and the breaking of the abscess. The abscess is generally seen in one tonsil as a roundish prominence reaching beyond the swelling, having sometimes a dark and sometimes a lighter color. Sometimes, however, it is impossible to determine, in the misshapen, flabby swelling formed by the tonsils, the exact spot of the abscess, which not unfrequently is located entirely on the side of the pharynx. Sometimes there are several abscesses, each abscess being small. In this case the morbid symptoms continue for a longer period, because the abscesses discharge only little by little. That Hepar exerts an influence over the suppurative process and the emptying, of the abscess, is evident from the fact that under its use the disease scarcely ever lasts eight days, which is the common duration under any other treatment.
Phytolacca.
Dr. G. C. Brown says: “I have been experimenting a little with Phytolacca in enlarged tonsils, and so far have found it very beneficial. In two cases they were so much enlarged as to materially interfere with deglutition, and had surface ulcers; were speedily reduced by the use of Phytolacca, a few drops of the tincture in a tumbler of water; teaspoonful every two hours.”
Baryta iod.
Dr. Hale says he has prescribed this remedy in hypertrophy of the tonsils with very gratifying results. It effected, he says, a rapid diminution in the size of the glands, even when they had been indurated for some years. The same writer also says, “I have been informed, by intelligent persons, that they have been permanently cured of recurring quinsy by a gargle of Sanguinaria canadensis. Upon testing it in practice I found it quite equal to Hepar sulphuris in its power of preventing attacks of tonsillitis.”