PHARYNGITIS, Acute.
Acute catarrhal sore throat is probably always a mixed microbic disorder. Local treatment is in the majority of cases only required. though the constitutional symptoms may in severe cases require the administration of Antipyrine, Aspirin or Salicylates. and the grave septic or phlegmonous forms of the disease will demand large doses of Quinine and Iron with stimulants. A weak solution of Carbolic Acid answers most of the indications. The following may be employed as a gargle or spray, and used every 2 or 3 hours: Carbolici 5j.
Cocaine Hvdrochlor. gr. iv. Givcerini Boracis Aqua Rosa ad sij. Misce.
Where pain is severe, between the applications of the above spray or gargle, the throat may be steamed by ..ausing the patient to hold his head over a basin filled with boiling water. with a lar.:e sheet thromn loosely over all. Any volatile sedative may be added to the water as Conium. Creosote, Friar's Balsam. Menthol, .
As soon as pain or difficulty of swallowing i- relieved the cocaine -hould be stopped, as it tends to keep up a ongestive state of the membrane; where it fails to speedily relieve the distress it should be dirs. arded for a 3 per tent. Menthol solution in pure paraffin. After the subsidence of all acute symptoms the throat may be painted with Mandl's Pigment, which consists of Iodine 6 grs., K.I. 20 grs., 01. M. Pip. ruins.. Glycerin to i oz., or with t per cent. Formalin solution. or any astringent gargle fas Tannin, I in 3o) may be used to tone up the relaxed membrane.
In the acute phlegmonous types of pharyngitis the inflammation causes much c2.deina of the mucous membrane. which spreads to the tonsils and. invading the larynx, may produce asphyxia. Th.:: appli..ation of strong Nitrate of filer is dangerous. The best procedure is to freely s• arbv the swollen membrane by a fine pointed bi'toury protected tr. ithin about inch from the point. Tracheotomy or laryngotomy may be needed.
Abscesses should be opened as soon as they appear. In the grave septic disorder known as Ludwig's Angina. or submaxillary ..ellulitis. caused by streptococcic invasion, antistreptocorck serum or vaccine should be injected and the brawny swellim;s in the neck and about the jaws should he incised and further opened up by thrusting a dressin:_, forceps down into the wound and the blades.
is liable to appear in these grave forms of ,o called erysipelatous pharyngitis. The may be cautiously opened from within, the patient'zIned being brought hanging over the end of the operating-table in order to avoid asphyxia by the pus entering the larynx and trachea. A safer procedure in Ludwig's angina is to make a short incision in the upper part of the neck, and by the blades of a forceps reach the abscess cavity from without behind the sterno-mastoid muscle as in dealing with the collections of pus in the retropharyngeal tissue which are caused by caries of the cervical vertebra;.