A very painful form of sore throat is that called quinsy. It is inflammation of the tonsils, two glands situated at the back of the mouth. This inflammation is principally observed in changeable climates; and seems to attack, by preference, young adults. Children rarely suffer from quinsy. Persons who have once been the subjects of this ailment are very liable to a recurrence of the disorder. The most common exciting cause is exposure to wet and cold, with a chilly east wind.
Those who are liable to this form of sore throat, and know from the premonitory symptoms what is impending, ought at once to adopt preventive measures. These consist in using strong astringent gargles; in the administration of single drop doses of tincture of aconite, every hour, for half a day, and a brisk saline purgative in the morning, such as a dose of Rochelle salts. For gargle, one of the best is the old-fashioned homely mixture, consisting of 3 tablespoonfuls red wine (port or claret), 1 of vinegar, ½ teaspoonful powdered alum, and a little sugar, in a tumbler of cold water. This to be used every hour. If, however, the affection has gone too far for this abortive treatment, then the patient must be confined to bed; hot poultices must be kept constantly applied to the throat; steam from hot water should be inhaled often; a gargle of hot milk and water should be used hourly; and ice, if grateful, may be constantly sucked. A sal prunelle ball may be allowed slowly to dissolve in the mouth. The diet should be in semi-solid form, e.g. arrowroot made with milk, soup thickened with rice-flour, or better still, beef-jelly, if the patient can be persuaded to swallow at all. If the abscess do not speedily rupture, and more particularly if both tonsils be simultaneously affected, then it may be necessary to call in the aid of the surgeon to lance it. The necessity for this will be evident by continued and increasing distress of the sufferer, great difficulty in breathing, and extreme restlessness and feverishness. In a first attack, too great delay ought not to be allowed to take place before getting professional assistance.
Every one has a cure for sore throat, but simple remedies appear to be most effectual. Salt and water is used by many as a gargle, but a little alum and honey dissolved in sage tea is better. An application of cloths wrung out of hot water and applied to the neck, changing as often as they begin to cool, has the most potency for removing inflammation. It should be kept up for a number of hours; during the evening is the usually most convenient time for applying this remedy.
For loss of voice in singers and speakers, Dr. Corson recommends the patient to put a small piece of borax (2-3 gr.) into the mouth and let it dissolve slowly. An abundant secretion of saliva follows. Speakers and singers about to make an unusual effort should the night before take a glass of sugared water containing 2 dr. potassium nitrate (saltpetre) in order to induce free perspiration. In similar circumstances this gargle may also be used:—6 oz. barley water, 1-2 dr. alum, ½ oz. honey. Mix, and use as a gargle. Or an infusion of jaborandi, made by putting 2 scr. of the leaves in a small cup of boiling water, drunk in the morning before getting up. The free sweating is said very quickly to restore the strength of the voice.
Constipation.—Short of mechanically obstructive disease, there are many states in which constipation is the most marked feature. On the nature of these, apart from the mere symptom, the possibility of permanent relief by treatment must of course largely depend. We may procure comfort with a pill, but often we cannot retain it with many. Habit cannot be reformed or expelled by purges. Accordingly, when we proceed against the fault of habit, now under notice, we must take account of the constitution and circumstances in which it is formed. By so doing we do much to ensure the desired relief, though it may be that even then we fail somewhat of complete success. A bowel long deficient in activity, dilated irregularly, with torpid though thickened walls, does not soon, if ever, renew its original tone and contractility. The difficulty is a pathological one, and arises from structural as well as functional perversion. The natural efforts to obtain relief are hindered and enfeebled by the effects of some cause which may still be operative. If we would undo the past or prevent further mischief, we must seek and treat that cause. Aperients of different kinds, however potent at the time, are but temporary palliatives of discomfort so long as no pains are taken to trace the trouble to its origin. Whether it be a sedentary habit of life, an excess of food overloading and overworking the viscus, purgation draining and depleting it, gout, diabetes, struma, chlorosis, altering either the structure of the intestinal wall or the consistence of its contents, it must be sought for as a chief guide to the means of cure. It is not likely that constipation will ever form the chosen hobby of a specialist. A far too general view of medicine and its adjuvant sciences is necessary for successful treatment to encourage such appropriation. We are not, however, outside the sphere of nostrums. There is in our time, if anything too much reliance on physic-taking for constipation. More might be done by appropriate dieting and by inculcating active habits of life than is customary. It may be noted, with regard to diet in particular, that a free use of simple fluids, as water, or mild mineral waters, is of distinct advantage in assisting both digestion and evacuation. There are also many aperient vegetable foods which, with the same end in view, we should like to see in daily use at the table. Almost any kind of wholesome fruit and green vegetable might thus be made serviceable. When, again, we come to medicines, we must remember that the disorder which we have to combat is a complex one. We cannot in this case, more than in any other morbid state, put a finger on one tissue as alone or invariably at fault. Thus in the costiveness of anæmia we have atony of the intestinal muscle combined with defective secretion, and both but part of a general tissue starvation; in the gouty disorder of elderly people the same conditions appear, though due to a very different dyscrasia; and so on. We may say, therefore, speaking generally, that no single drug can be relied on to meet the intestinal difficulty. An agent which aids secretion either of bowel or liver will not alone suffice. The long-inactive muscular coat likewise requires assistance. A free purge may have its value now and then, but when the object to be attained is the correction of a habit, a milder remedy used regularly is much more effective. To meet these various necessities, perhaps no combination is superior to the time-honoured union of belladonna with the compound rhubarb pill and nux vomica, or the most recent mixture of the fluid extract of cascara with the last-named drug. An agreeable change of remedy is afforded by many aperient mineral waters. The effect of these latter, however, is unfortunately apt to pass off after a time, probably from their causing a too copious intestinal secretion. The action of saline or other enemata is not quite similar. More strictly local, and exerted rather on the fæces than the bowel, it gives relief without so much exhausting the latter by secretion or peristalsis; while the very rest which the colon thus easily obtains is itself a help to the recovery of normal nutrition and muscular tone. The chief points which we would therefore bear in mind, whatever the remedies used in combating the habit of costiveness, are the need for recognition of its primary cause, and the fact that its proximate condition is an atonic bowel. (Lancet.)
Dr. Mortimer Granville gives 3 prescriptions for habitual constipation. It is indispensable to regard persistent inactivity of the bowels, when not demonstrably due to other causes, as the result of, either defect of peristaltic action; deficient glandular secretion; or interruption of the habit of periodic evacuation.
When there is a lax and torpid condition of the muscular coat of the alimentary canal, we get food retained in the stomach or intestines until it ferments, or sometimes “decomposes,” with the result of distension, pain mechanically induced, and either eructations or incarcerated flatus. In a considerable number of cases this last-mentioned trouble is so great, and at the same time so masked, as to give rise to the impression that grave disease exists; whereas every anomalous symptom has quickly disappeared as soon as the muscular tone has been restored, and the contents of the bowels have commenced to pass naturally on their course. The essential fault is partial, in some instances almost complete, loss of the reflex contractility of the muscular coat, so that the presence of ingesta at any part of the canal does not excite the intestine to contract and propel it onwards. It is worse than useless to employ ordinary aperients in such a condition as this; they only irritate without strengthening the nerves, on the healthy activity of which everything depends. When, therefore, there is the form of “constipation” which requires treatment, use a prescription something like the following; and it is, in the majority of instances, successful:—
Sodæ valerianatis gr. xxxvi.; tincturæ nucis vomicæ ♏ lx.; tincturæ capsici ♏ xlviii.; syrupi aurantii ℥iss.; aquâ ad ℥vj. Misce, fiat mistura, cujus sumatur cochleare magnum ex aquâ ter die, semihorâ ante cibum.
The second form of constipation, in which there is a deficiency of glandular secretions generally throughout the intestine, manifested by a peculiarly dry and earthy character of the dejecta when the bowels do act, may be treated by a mixture such as this:—
Aluminis ʒiij.; tincturæ quassiæ ℥j.; infusi quassiæ ℥vij. Misce, fiat mistura, cujus sumantur cochlearia duo magna ter quotidie, post cibum.