G CAL • In more severe cases of inflammation of the pharynx and adjacent parts, matter sometime* forms either around or near the pharynx, or in the soft palate of the uvula. Wherever the existence of matter can be determined. it should be inuntdiately let out, as from an abscess in any other part of the body. In other severe, and in some measure peculiar eases, the intensity of the inflammation is marked by the formation of false membranes on the affected surface. This form of the disease has been named angina seembraaaera, and has been (specially described by 31. llretonneau and other French physicians under the name of dipAtherite. [Dienvntets.] In its essential nature this affection resembles croup, with which also It is sometimes con nected, the false membrane being not only spread over the mucous surfaces of the pharynx and faeces, but extending down into the trachea. In some eases the inflammation is very acute, and, being xcconipenied by common inflammatory fever, requires for its reduc tion the most active antiphlogistic treatment; the same measures, in short, as are applicable in canes of croup. [Cnour.] In another sevens form of quinsy, the inflammation and formation of false membranes are accompanied by a low typhoid state with great pros tration 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 sore throat, and by nosologists, C'yna riche or A nyina nialigna. It sometimes occurs aa 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 state of gangrene. In other cases of this form of cynancho there is a tendency to the production of ulcers. These may be distinguished from diphtheria by the circumscribed character of the inflammation. The accompanying fever is of a more or leas low form. The ulcers should be touched with nitrate of silver, and afterwards a most effectual remedy is a lotion of chlorate of potash with hydrochloric acid. In these cases the system requires support, and beef tea, port wine, and quinine should be administered.
In Cynanche tonsilloris, or tonsillitis, the inflammation is entirely or nearly limited to the tonsils. Its symptoms are scarcely distinguish able from those of the common form of the preceding disease, but on examining tho 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 euatachian tube and tympanum, producing deafness, and 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. The direct application of powdered alma to the tonsils is very useful. With a higher degree of inflammation abscesses often form in the tensile, 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 guardedknife, or with one that slips through a canula and can have the length of its cutting part fixed.
The moat 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 perma nently enlarged. In this state, although swallowing is not painful, it is often attended with difficulty, and by the partial closure of the fatless 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 Doming elevated and very much arched forwards, in a form which is commonly called chicken-breasted. But if this do not occur, the patient always suffers inconvenience from hoarseness and a kind of nasal nomad of the voice ; he cannot avoid snoring very loud in his Bleep, and often (starts up from it with a feeling of impending suffocation. The bent means for the removal of this state are astrin gent gargles, as those with alum, oak-bark, mineral acids, &c. Iodine also, administered internally and rubbed on the throat, often proves useful ; but in ninny 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 (Buten/done.