§ 182. Inflammation of the fauces, angina, cynanche, pharyngitis.

By angina faucium, we understand an inflammatory affection of the various parts composing the palate and fauces, velum pendulum palati, soft palate, tonsils, uvula, mucous membrane, and muscles of the posterior wall of the fauces. These parts are at times affected singly, at others, all at the same time. We distinguish hyperoitis (inflammation of the soft palate and velum pendulum palati); amygdalitis or angina tonsillaris (inflammation of the tonsils); staphylitis (inflammation of the uvula); pharyngitis superior et inferior (inflammation of the upper and lower part of the mucous membrane of the fauces.)

To ascertain the seat of the inflammation, the patient should open his mouth, after which the palate and fauces are examined by depressing the tongue with a spatula, or the handle of a spoon. If the articulations of the jaws should be swollen, or in infants and awkward patients, such an examination is frequently impossible, in which case the physician has to be guided by the external phenomena.

§ 183. The symptoms which are the usual characteristics of inflammation, are here likewise present: redness, heat, dryness, swelling and pain of the affected parts; difficulty of swallowing, the pain is increased by swallowing, and yet there is a constant desire to swallow: on swallowing food, it sometimes returns by the mouth; solid food is sometimes swallowed with more ease than liquid. There is a constant accumulation of tenacious mucus in the posterior part of the mouth, with constant desire to hawk it up. The patient finds it difficult to talk or breathe, he breathes with his mouth open. In a high degree of angina the jugular veins swell, the face becomes purple-coloured and livid, there is headache and delirium. The inflammation is generally attended with bad taste, and fetid breath, even with desire to vomit and ptyalism.

The organism is generally disturbed in most cases; the general symptoms preceding the local affection for some days. The patients complain of weariness, pain in the limbs, chilliness, heat, headache, fever. This is a synocha, when the inflammation has a phlegmonous character, and depends greatly upon the constitution of the patient, the exciting cause, etc.

In tonsilitis, the mucous membrane exhibits a more or less vivid redness, or red spots, is swollen, dry, or covered with a pappy, gray, white, yellow mucus, which extends to the tongue. One tonsil is generally inflamed first, the left sooner, and more violently than the right.

If the uvula be inflamed, it is likewise more or less swollen, red, elongated, the point generally resting on the root of the tongue.

We have no particular remarks to make on pharyngitis mucosa.

§ 184. Such an angina generally disperses in from five to fourteen days, with decrease of all the general and local symptoms. If the cellular tissue of the tonsils should be the seat of the inflammation, it readily terminates in suppuration; in this case the swelling, and the difficulty of breathing and swallowing increase, and it is frequently impossible to open the jaws; in many cases the pus discharges suddenly in hawking, coughing, etc., with immediate relief. Ulceration and gangrenous degeneration, only take place in individuals with syphilitic, scorbutic, scroph-ulous. etc., dyscrasias. Induration and hypertrophy result from chronic angina, which had developed itself in consequence of frequent relapses.

A predisposition for such inflammations exists in young people, in persons who had been attacked with angina, in scrofulous subjects, and in individuals of feeble and "sickly constitutions. Exciting causes are: a cold, getting wet, exposure to wind, cold drinking when the body is heated, unfavourable state of the weather, cold north and east winds. Angina may result from wounding the throat by mechanical or chemical substances, from inhaling acrid substances, from aphthae, syphilitic ulcers, and abuse of Mercury.

§ 185. The principal remedies for angina faucium are: Acon., Bellad., Merc, sol., Merc, subl., Hep. sulp., Rhus t., Bryon., Ignat., Chamom., Puls., Cocc., Arg., Caps, an., Nux vom., Ars., Sulph., Acid, nit., Acid, phosph., Baryt, etc.

Angina faucium most frequently involves the root of the tongue, the soft palate and the pillars, the uvula, tonsils, and the mucous membrane of the fauces, either singly or all together. The most frequent kind of angina, is an angina tonsillaris and uvularis. The patient is troubled with a constant accumulation of saliva, inducing constant and painful efforts to swallow or hawk. When this inflammation is accompanied with synochal fever, and congestion of the blood to the head, Aconite is the suitable specific.

Chamomilla will prove useful in some mild cases of angina tonsillaris and pharyngea characterized by a burning, stinging pain in the region of the larynx, and attended with roughness of the voice, some tightness of the chest, titillation and hacking cough; the tonsils and submaxillary glands are sometimes involved.

Belladonna is indicated by the following symptoms: bright, phlegmonous redness of the soft palate, velum pendulum palati, root of the tongue, uvula and tonsils, without much swelling; dryness of the fauces, stinging pain during deglutition, which is difficult and frequently attended with a sensation as if the fauces were spasmodically constricted; between the acts of 5 deglutition a tearing pain is frequently experienced, extending to the temple and jaw, and particularly the submaxillary gland, which is frequently swollen. Aco-nite should be given first if there be synochal fever. Rummel states that Bellad. and Dulc. act most rapidly in angina if a dose of Merc, is given previous to or in alternation with those remedies. Dulc. is more suitable to the pituitous stage.

Belladonna is likewise suitable for angina, which is attended with swelling of the neck, impeding the motion of those parts.

Pulsatilla corresponds to the group of symptoms for which Belladonna is indicated, when, instead of the bright redness, the parts exhibit a dark redness, with varicose distention of the vessels. The patients generally experience a shivering towards evening, mixed with flushes of heat; they feel a scraping and roughness in the throat, with dryness or burning; they feel as if the fauces were swollen; empty deglutition is painful, attended with stinging and pressure. They frequently experience a darting, tearing pain in the neck and stinging pain in the ear. The symptoms are worse towards evening; the night is restless, sleep is disturbed by frightful dreams, the pains abate on the breaking out of sweat.

Ignatia is indicated by stinging in the throat between the acts of deglution, sensation during deglutition as if the food were passing over a bone, with cracking noise. The sensation of a lump in the throat is experienced only between the acts of swallowing. Ignatia is scarcely ever indicated when the stinging is experienced only during deglutition, but in most cases when a stinging is felt between the acts of deglutition, or when it passes off after continued swallowing. The fauces are inflamed and red, the tonsils swollen and inflamed, and covered with little ulcers.

Ignatia is likewise indicated by soreness during deglutition, or by the sensation of a lump in the throat, which feels sore when swallowing.

Nux vom. is indicated by stinging in the uvula and rhe submaxillary glands during deglutition, with swelling of the uvula, occasioning a sensation of a lump in the throat. Nux v. is likewise indicated by pressure in the throat as from a swelling, which is only felt when swallowing saliva, not when swallowing food or drink; or by a scraping and sore feeling in the fauces and larynx, inducing constant hawking. Na-trum sulph. and Nitrum may prove suitable for those symptoms.

Mercurius is a specific for angina when the inner mouth and fauces, tonsils, uvula, velum palati, root of the tongue, gums, inner cheeks are inflamed and swollen, impeding deglutition and speech. If the salivary glands should be involved, the patient frequently spits up a tenacious saliva. Hahnemann was in the habit of using the first trituration of Merc. sol. for the cure of those kinds of angina. This remedy is frequently suitable in anginas accompanying purpura miliaria. Belladonna is sometimes suitable after Mercury to hasten the cure.