In diphtheria, the ash-coloured leathery appearance of the false mem brane is different from the curdy patches of quinsy ; and in the former disease there is early swelling of the cervical glands. In inflammation of the tonsils these glands are not usually affected.
Prognosis.—In quinsy, the prognosis is rarely otherwise than favourable. Cases are said occasionally to have happened in which suffocation has re sulted from the inflammation. Rilliet and Barthez have referred to such a case, in which a little girl, aged thirteen, died of suffocation on the second day ; • but it is very doubtful if this was an uncomplicated case of quinsy, and the accident-is one not greatly to be dreaded.
In cases of chronic enlargement of the tonsils, the glands, if left alone, usually become smaller after puberty. But while they remain swollen they give rise to so much inconvenience as well as induce so much interference with the nutritive processes, that measures should be always adopted for their early reduction or removal.
Treatment.—In every case of quinsy it is advisable, as an important preliminary to further treatment, to clear out the bowels with a good mer curial purge, followed by a saline draught. Linseed-meal poultices, or a cold water compress, must be kept applied to the throat, and if old enough to gargle, the child may use a weak solution of chlorate of potash sweetened with glycerine. If the case is seen early, aconite given frequently, small doses, is found in many cases to have a distinctly beneficial effect. It reduces the temperature, promotes the action of the skin, and often quickly brings the inflammation to a close. The tincture should be used in doses of one drop in a teaspoonful of water every hour. Guaiacum is greatly praised by some authors. It can be given in doses of three or four grains in a teaspoonful of glycerine several times in the day ; or the child may suck a guaiacum lozenge every three or four hours. The salicy late of soda is another remedy which has been lately held up as a specific in certain cases of quinsy. This drug, like the preceding, is especially adapted for cases which arise under the influence of cold and damp, and may therefore be supposed to be allied in their nature to rheumatism. To a child of ten years old it may be given in doses of ten or fifteen grains every four hours ; or half that quantity every two hours. If the salt be
suspended in mucilage flavoured with tincture of oiange peel, and sweet ened with spirits of chloroform, the resulting mixture is not unpleasant to a child. If given sufficiently early, it is often found to shorten, in a re markable manner, the course of the inflammation, and prevent suppuration. The old-fashioned treatment by salines, with moderate doses of antimonial wine, following the indispensable purge, finds favour with many practition ers, and is no doubt often very successful. Attention to the bowels, in deed, must never be neglected. A good dose of calomel, or gray powder, with colocynth or jalapine, renders the after-course of the disease much less harassing, and, if all irritation of the throat is avoided, greatly helps the patient along in his path to recovery.
Astringent gargles can only be allowed in the early stage of the disease. A solution of alum (twenty grains to the ounce) may be used in this way, but is only admissible if the febrile action is mild, and if the case is seen within the first twenty-four hours. At a later period, ordinary astringent applications often do much more harm than good. There is, however, an exception to this rule, for brushing the surface of the inflamed tonsils with the pure solution of the subacetate of lead is often attended with sur prising relief to the discomfort. This application may be used once in the day, whatever be the period of the Miles'. Another application which is often of service is the hi-carbonate of soda, applied in the powder. An or dinary throat brush, well charged with the powder, may be used to convey the latter to the tonsil.
Directly signs of suppuration are noticed, the child should be made to in hale the steam of hot water, and hot poultices should be sedulously applied to the throat. If old enough, the child should be directed to gargle fre quently with warm water, to which, if there be any fcetor, a little Condy's fluid has been added. If necessary, the matter when it forms can be let out by a touch of the lancet, but in most cases it will be safe to allow it to find its own way to the surface. Still, if signs of dyspncea are noticed, or the swelling is very large, operative interference is advisable. After the abscess has been evacuated, quinine should be given in full closes.