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tonsils, sometimes, throat, hot and pain

QUINSY, an acute inflammation of the tonsils; acute parenchymatous tonsilitis. It is attended by fever, pain, headache, difficulty in swallowing (dysphagia), and frequently by sup puration. One attack seems to predispose to another. It is not uncommon for individuals to have attacks year after year at about the same time of the year. Disturbances of the digestive organs — diarrhoea, constipation, loss of appetite, nausea, vomiting, etc., are predis posing causes. Sudden changes of weather, exposure to damp and cold, especially after coming out of a heated room, are exciting causes.

Quinsy sets in with an uncomfortable feeling in the throat, and fever sometimes high, pre ceded at times by chilliness. The patient is restless and irritable, the tongue becomes cov ered with a thick yellowish coating, the breath is unpleasant, saliva drools from the mouth, there is difficulty in opening the mouth, swal lowing is attended with great effort and pain and sometimes food returns through the nose. Pain may be severe most of the time, shooting toward the ear upon the affected side. Swelling externally behind the ears and involv ing the glands of the neck may be marked. A thick tone of the voice, thirst, headache, ing and dryness of the throat are common symptoms. Sometimes breathing is impeded, especially if both tonsils are involved. On ex amination of the throat one or both tonsils are seen to be bright red and sometimes covered with patches of yellow secretion. The soft palate is red, greatly swollen and oedematous, as is also the uvula, which not infrequently adheres to the tonsil. Quinsy may terminate

either in resolution or suppuration. If resolu tion is to take place, in about four or five days the inflammation begins to subside, and the patient in from 10 days to a fortnight may re-• sume his ordinary employments. If suppura tion is to occur, the tonsilar swelling becomes greater, and if both tonsils are inflamed they may meet, causing great discomfort. When pain and discomfort become almost unbearable, an inflamed tonsil generally breaks and great relief and speedy convalescence follow.

Occasionally, if the disease is taken at the outset, it can be absorbed by a saline purgative or an emetic and the use of one or two drops of tincture of aconite every hour. If it oon-: tinues in 'spite of early treatment, it will prob.,. ably run its course, though much can be done to palliate. Keep the patient quiet (sometimes in bed), and give hot or cold liquid foods, whichever he can swallow best. Washing out throat with hot water every hour may be com forting, as also may inhalations of the steam of hot water, cooled by passing through a towel or a long tube. Saline laxatives are useful; so are hot compresses about the neck. Ice and cool drinks have an efficacious value. Local applications and the use of medicines and stimulants should be left to diejudgment of the physician. Abscesses should be opened (not left to mature) and astringent gargles af terward used. Diseased tonsils should be excised.