464 THE TREATMENT OP DISEASES. 



nature became modified, and gave way in great part to the more usual, less compli- 

 cated process of preparing the food off-hand for admixture with the gastric juice, 

 and for the processes of digestion and assimilation. 



QUINSY INFLAMMATORY SORE THROAT, OR TONSILLITIS. 



This complaint consists essentially of inflammation of the tonsils and adjacent 

 parts. 



It is said to occur most commonly among young people, but it is frequently 

 enough met with in middle-aged adults. Some individuals appear to have naturally 

 a strong predisposition to this disease, and in them the attacks are usually more or 

 less periodical, recurring at particular seasons, commonly during the variable weather 

 of spring and autumn. The exciting cause is usually exposure to cold or damp, or 

 both combined. At some seasons it is so prevalent that it might almost be said to 

 be epidemic. At one time it was supposed to be contagious, but there is not the- 

 slightest evidence to show that such is the case. One attack usually predisposes to- 

 another. 



The symptoms vary very much in different cases, according to the extent of the 

 disease and the parts involved. In all but very mild attacks the invasion of the 

 complaint is marked by a general feeling of malaise, by headache, and aching pains, 

 in the limbs, and a sense of chilliness, or even distinct rigors. The constitutional 

 symptoms are usually severe, the temperature rising to 102 Fahr., and the pulse 

 reaching 120 beats in the minute, or even more. The skin is moist, the tongue is. 

 covered with a thick yellowish creamy fur, and there is often headache. The bowels, 

 are confined, and there is generally much restlessness, particularly at night. 



The local symptoms keep pace with the constitutional disturbance. At first a 

 little clryness or uneasiness in the throat is experienced, but this gradually increases, 

 until it amounts to severe pain. Swallowing soon becomes very difficult and 

 extremely painful, the pain shooting up towards the ears. There is considerable- 

 tenderness behind the jaws, and on this account some difficulty may be experienced 

 in opening the mouth. The glands of the neck become enlarged and hardened, and 

 very frequently the whole neck itself is stiff and swollen. Later on swallowing 

 becomes still more difficult, fluids return through the nose, and the throat feels as if 

 it were completely blocked up. The speech is altered, and is not uncommonly thick, 

 guttural, and inarticulate. There is often more or less deafness on one or both sides,, 

 particularly if the tonsils are much enlarged. In some instances there may be a 

 sense of suffocation on lying down, but in adults this is not common. 



If the tongue be depressed with the handle of the spoon so that the back of the 

 throat may be examined, it will be found to be redder than natural, and the tonsils, 

 greatly enlarged, will be seen projecting, perhaps to such an extent as almost to 

 meet in the middle line. 



In mild cases the inflammation may gradually subside, but far more frequently 

 it runs on to the formation of matter. After a few days a pale yellowish spot is 

 seen on the surface of the tonsil, indicating the point at which the matter tends to 

 escape. The abscess usually bursts during some effort made by the patient in 



