The entire class of salicylate preparations including Aspirin, Novaspirin, Solol, Saloquinine, Rheumatin, etc.. have been employed in a routine manner.
Large doses of Quinine are recommended, hut this treatment often fails. and the deafness and buzzing of the ears add to the patient's discomfort without markedly reducing the fever.
A smart saline purge should be administered at the commencement of treatment. The patient should he put to bed and placed upon thin farinaceous foods, which are more easily swallowed than fluids. Rarely will alcoholic stimulants be indicated, hut strong. thick soups should be freely given to weak subjects.
Local treatment should consist of the application of weak unirritating antiseptics, as i dr. Carbolic Acid dissolved in 12 oz. Rose Water, which may be more easily employed as a spray than as a gargle. This may be used every hour if the patient depresses his chin so that the condensed spray will flow out through the open mouth. Fettero extols the applica tion of Aspirin in dry powder on the point of a probe covered with cotton wool.
Where much pultaceous secretion blocks the orifices of the lacunze a swab of Peroxide of Hydrogen may be used two or three times a day; the old plan of applying strong nitrate of silver solution or other caustic should be discarded. When the tonsillar swelling is great and much pain in swallowing is present, nothing is so efficacious as the inhalation of the vapour of boiling water under a sheet loosely thrown over the patient's head.
At a later stage a gargle of Chlorate of Potassium (r in 5o) assists in altering and cutting short the unhealthy condition of the mucous mem brane, and Boric Acid solution or Glycerin of Borax diluted (r in 2o) may be frequently employed as a mouth-wash.
Ice may be sucked or applied to the outside of the jaws when pain is severe. More frequently a of dry cotton-wool under oiled silk affords relief.
In mild cases with little fever a Carbolic Acid or Guaiacum Lozenge slowly sucked in the mouth or a tabloid of Chlorate of Potassium with Cocaine used in the same manner is all that is necessary. The advantage of using carbolic acid lies in its action as a local anesthetic independent of its antiseptic qualities, and by paralysing the sensation of the mucous membrane of the palate it prevents the painful and unnecessary attempts at swallowing the saliva. Cocaine is a disappointing drug in throat affections; its application is liable to be followed afterwards by dryness and toxic effects.
Parenchymatous Tonsillitis and Peritonsillitis.—These are also known as the Suppurathic types, and in the severe form as Quinsy or Cynanche Tonsillaric. As already stated, suppuration may supervene upon the
follicular or catarrhal types, but in its severe form it is always the result of a streptococcal invasion, and the symptoms are formidable from the start.
The constitutional treatment should be conducted upon the same lines as in the severe variety of the follicular type, and as soon as the malaise has been somewhat relieved by Antipvrine, large doses of Quinine and iron should be freely administered. The best preparation is the Tincture of the Perchloride, which may he administered in doses of 3o mins. with dr. of Glycerin and r oz. water every 4 hours. To this in adynamic cases 5 grs. Quinine may lie added.
Feeding is important owing to the speedy exhaustion caused by the action of the toxins, and strong, thick soups and beef juice should be administered as frequently as the difficulty and pain of swallowing permit.
The best local treatment is the Carbolic Acid spray (r in too), as gargling is often impossible. The frequent steaming of the throat is, however, the only agent to be relied upon to relieve pain and ineffectual attempts at swallowing, and it should be resorted to every 2 or 3 hours, by which means pointing of the abscess is also hastened. A large hot poultice applied round the jaws usually affords some degree of relief.
As soon as an abscess has formed the pus should be evacuated. This may he accomplished by taking a sharp-pointed bistoury and protecting its blade with a layer of strapping to within f; to linch of its tip, after which it may be thrust into the most prominent part of the tonsil, the cutting edge being directed inwards so as to avoid danger to the internal carotid artery. The opening of large abscesses may be imperative, as deaths have occurred from suffocation caused by their pressure or by the pus being discharged into the air passages, especially during sleep or by the super vention of oedema of the glottis, Some surgeons dispense with the knife and open the abscess by plunging a fine pair of dressing forceps into the bulging tonsil through the soft palate near to the base of the uvula. The best procedure is to use the forceps after making the incision with the bistoury, and by opening the blades thorough evacuation of the pus is accomplished through the enlarged opening. Before using either knife or forceps the mucous membrane should be well cocainised, which will enable the surgeon to insert his index finger against the swollen gland, whilst the fingers of the opposite hand are made to cause firm pressure against the tonsil from without at the angle of the jaw its be feels for fluctuation.