XIV. Diseases of the Pharynx.
Acute Pharyngitis.
Synonyms:—Sore throat; pharyngitis acuta simplex.
Definition:—An acute inflammation of the mucous membrane of the pharynx, characterized by a catarrhal secretion, by local congestion, and infiltration of the sub-mucous tissues, and occasionally involving the entire pharyngeal structures.
Etiology:—Exposure to cold is the most common exciting cause of this form of sore throat. Damp atmosphere in the fall or spring, or when the vitality of the patient is somewhat reduced, will bring on an attack. It occurs also during the progress of infectious fevers, especially scarlet fever and measles and la grippe. Chronic nasal or gastric catarrh will predispose to attacks of pharyngitis. Those addicted to the use of alcohol and tobacco are especially liable to it.
Occasionally it will occur in epidemic form when the infectious origin cannot be questioned. It is common to those who are confined in poorly ventilated apartments and those who inhale dust or irritating vapors; also to those who have a tendency to rheumatism or gout, and it sometimes accompanies chronic tonsillitis.
Symptomatology:—Soreness of the throat experienced upon an attempt to swallow is the first symptom of this disease. This is accompanied with dryness and stiffness of the muscular structures of the throat, with fulness and ultimately with pain. The membranes will be seen to be red and swollen, and the capillaries injected. Soon a thick mucous secretion induces frequent hawking to clear the throat. There may be hoarseness, and some roaring in the ears or temporary deafness, from closure of the Eustachian tubes.
Later the inflammation extends to the posterior pillars of the fauces or to the tonsils or larynx. The lymph glands swell, the muscles of the neck are stiff, and movement induces pain.
Very early in the history of the disease, usually about the time the soreness of the throat is first observed, there is a slight chill, with a rise of temperature, some malaise and indisposition, a slight headache, dry skin, and arrest of other secretions. The tongue is coated and the appetite is lost.
Diagnosis:—The reddened and swollen appearance of the throat, and the absence of a coating or exudate except that of an ordinary catarrhal discharge, are the characteristic appearances. The constitutional impression is mild, not extreme or accompanied with depression, as in tonsillitis or in the exudative forms of throat disease.
Prognosis:—The prognosis is always favorable, as the disease is readily amenable to treatment. A severe attack, especially in one of feeble constitution, predisposes to future attacks from simple causes.
Treatment:—The patient should have a hot mustard footbath, and hot drinks should be taken to induce gentle perspiration. He should then be put to bed and warmly covered, and the mild perspiration should be encouraged for several hours. A compress wrung out of equal parts of vinegar and water should be applied to the throat, cold, and covered with a warm, thick flannel bandage. It should not be removed until nearly dry, when it should be replaced as before, unless there has been a prompt and conspicuous abatement of the symptoms.
The tendency to acute congestion, with the chill and fever, will be met with aconite and belladonna. I have often given no other internal treatment. Ten drops of the tincture of each in three ounces of water, a teaspoonful every hour, will meet the indications in the uncomplicated cases. There seems to be a peculiar susceptibility to aconite in all throat cases, as the agent has an affinity for these structures. Belladonna dispels the local engorgement and induces an equalization of the circulation, and thus obliterates the underlying pathological elements of the disease. It is indicated if there is a bright redness of the tissues. If there is a dull purplish redness, capsicum, locally and internally, will be found to exercise a better influence. If the tongue is coated with a yellowish or brownish coat, and the membranes are dusky red, baptisia or echinacea should be given with aconite. Later in the history of the case collinsonia should be given with aconite.
The internal use of the tincture of iron was popular with the older physicians to antagonize the tendency to sepsis in these cases. Because of the excess of hydrochloric acid which it contains, it is useful when an acid is indicated—where the membranes are deep red and where the tongue is pointed, thin, dry and red, and coated with a dirty or brownish coat. If the mouth is persistently dry, two or three drop doses of jaborandi should be given, and a gargle may be used of glycerin and water. For extreme hoarseness the patient should inhale over a cube of loaf sugar which is allowed to slowly dissolve on the tongue, on which two drops of dilute nitric acid, or two drops of oil of turpentine, or two drops of the stillingia liniment, are dropped. If the sense of tightness and constriction in the throat is great, a few drops of stillingia liniment should be applied externally under the wet compress.
Throat washes or gargles are needed only in the severe cases of this disease. A mild infusion of white oak bark and hydrastis, to which a little sodium borate or potassium chlorate is added, will be useful, or a saturated solution of boric acid, three parts and distilled extract of witch-hazel one part, makes an excellent gargle. Severe gargles or irritating applications to the inflamed membranes are contra-indicated. The inhalation of steam from water on which four or five drops of the oil of turpentine or the oil of eucalyptus are dropped, is very soothing. A spray is sometimes useful, but I have seldom found this method of treatment necessary.
To prevent a return of the disease the patient should avoid cold, damp air, and especially night air, for quite a period. He should improve the general tone of the system, and it is a good plan to bathe the throat and upper part of the chest with cold water every morning, followed with a rubbing of dry salt. A cold salt-and-water gargle should be used twice daily, and if the tendency to return is strong, or if there have been two or three previous attacks, the patient should take internally for some weeks a mixture which contains ten minims of specific collinsonia, five minims of specific hamamelis, and one grain of ammonium chlorid. This is especially indicated if the membranes continue red, engorged and irritable.
