Acute Suppurative Tonsillitis.

Synonyms.—Quinsy; Angina Tonsillaris.

Definition.—An inflammation of the parenchyma of the tonsil, with tendency to abscess formation.

Etiology.—The predisposing causes are such as have been mentioned for follicular tonsillitis. Tuberculosis may be added as influencing unfavorably the tonsillar structures. We might say truly that any disease which lowers vitality and impoverishes the blood renders the glands more susceptible to disease. Bad hygienic surroundings and exposure to cold are the exciting causes. A previous attack and hypertrophy of the glands also render them more susceptible. Age also influences the disease, it being rarely seen in persons under fifteen years of age, or in those past middle life.

Pathology.—The tonsils become red, swollen, and sometimes enormously distended, occluding the throat when both tonsils are affected at the same time. The inflammation often extends to the pharyngeal tissues, and the uvula becomes relaxed and edematous, resembling a small bladder. The connective tissue surrounding the gland becomes greatly enlarged, followed by suppuration.

Symptoms.—The initial symptoms are so characteristic that the patient, if he has had several previous attacks, is able to diagnose the case even before the local symptoms are very marked. The chilly sensations accompanied by headache, backache, general aching of the whole body, flushed, hot face, and dryness of throat, tell him of an attack of tonsillitis as plainly as though he had consulted a physician.

The throat becomes sore and stiff, and there is a sensation as though some foreign body were in the throat, which causes the patient frequent swallowing in hopes of relief. As the inflammation progresses, the gland becomes very much swollen, and if both sides are affected at the same time, the throat is almost occluded, rendering respiration difficult, deglutition very painful and almost impossible.

The parts are bathed with a ropy mucus, which gives rise to a guttural cough in its removal. The tongue is coated with a dirty, offensive fur, the skin is dry and constricted, the urine scanty and highly colored, and the bowels constipated. The temperature is quite high, 103°, 104°, or 105°. Within forty-eight or seventy-two hours, the glands are enormously enlarged, the adjoining tissues share in the inflammation, and inspection reveals tonsils kissing across the chasm, and the edematous uvula, like a small bladder, resting upon the surface.

The submaxillary glands become enlarged, and the opening of the mouth is attended with great pain, and is sometimes impossible owing to locking of the jaws. A throbbing pain, together with chilly sensations, announces the suppurative stage. Dyspnea is now a marked feature; the patient is unable to lie down, and his distress is painful to look upon. At this juncture, when he fears he will choke to death, the tonsils rupture spontaneously, followed by immediate relief.

Quite often the patient, weary and worn with suffering, drops asleep, to be aroused by a strangling sensation, to find his mouth full of pus and blood. With the rupture of the abscess, the gland soon returns to its normal condition, and the disease terminates in a week or ten days. The suppurative process may extend to the cellular tissues between the tonsils and the pterygoid muscles, giving rise to a peritonsillar abscess, which may point above the clavicle.

Diagnosis.—The disease is readily recognized upon inspection; the swollen gland, the guttural voice, the immobile jaws, can not be mistaken for any other affection.

Prognosis.—This is almost always favorable, the principal danger being from entrance of pus into the larynx during a spontaneous rupture, while the patient is asleep.

Treatment.—If seen early, under specific medication, nearly every case can be terminated by resolution.

Aconite 5 drops.
Belladonna 10 drops.
Water 4 ounces. M.

Sig. Teaspoonful every hour or half-hour, will terminate a majority of cases in from forty-eight to seventy-two hours.

Guaiac ½ to 1 drachms.
Water 4 ounces. M.

Sig. Teaspoonful every hour. This is also quite a successful treatment.

Where there is swelling of the lymphatics, and the throat presents a spotted appearance, follicular complication, phytolacca will replace the belladonna. Locally, we may spray the throat with aconite one dram, to water four ounces, requesting the patient to empty the mouth and throat of the aconite. This, of course, is to be used only with adult patients. Painting the tonsils with veratrum has also been highly recommended. A gargle of potassium chlorate and hydrastin will be found useful.

Externally the cold pack and dry binder must be used where the fever is active. After escape of pus, the throat may be cleansed with listerine, pyrozone, or the above-mentioned gargle.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.