It is an inflammation in the parts of the throat subservient to respiration, speech, and deglutition; it is called a strangulation of the fauces; more properly, an inflammation of the internal fauces. Aretaeus supposes that it is named cynanche, from dogs being subject to it; or else, because in this species of quinsy it has been said the tongue is inflamed and so swelled, tha,t it hangs out beyond the teeth like a dog's. Coelius Aurelianus says, that the voice of the patient in the quinsy resembles that of a dog, or a wolf; hence called lycanche: or, perhaps, the word cynanche is derived from canis, and stran- .
gulo; because a set of symptoms affect the patient in a species of quinsy, not unlike the appearances observable in hanging dogs.
If the disorder is epidemic, it is so usually between the spring and summer, and after long continuance of cold and rainy weather.
The true quinsy', the cynanche tonsillaris of Cullen, is an acute inflammatory disorder. The bastard quinsy is a milder catarrhal one; and its fever chronical, of the catarrhal kind.
The Greeks give different names to the-true quinsy, according to the respective parts on which this disorder falls: the Latins, considering the disorder as one, wherever its violence might have more peculiarly been manifest, included them all under the name angina; as we under that of quinsy. The curious may see the various appellations given to the different circumstances of this disorder in the writings of Aretaeus, Coelius Aurelianus, Hildanus, and Alexander Trallian.
The cynanche of Dr. Cullen is placed in the class pyrexia:, and order phlegmasia: and defined a fever, sometimes of the typhoid kind; redness and pain of the fauces; deglutition and breathing difficult, with a sense of straitness in the throat. This genus contains five species:
1. Cynanche tonsillaris, when the inflammation begins in the tonsils, and affects only the mucous membrane of the fauces with redness and tumour, having an inflammatory fever attending.
2. Cynanche maligna, also ulcerosa gangraenosa, and ulcerosa when, it affects the tonsils and mucous membrane of the fauces, with tumour, redness, and mucous sloughs of a white or ash colour, spreading and covering ulcers; attended with a typhoid fever, and eruptions.
3. Cynanche trachealis, when it is attended with difficult respiration, shrill inspiration, hoarse voice, harsh sounding cough, scarcely any tumefaction appearing in the fauces, little or no difficulty of swallowing, and the fever inflammatory. This among the Scotch is called the croup. See Suffocatio stridula.
4. Cynanche Pharyngea oesophagea, when there appears a redness, particularly at the lower part of the fauces, and swallowing becomes extremely difficult and painful; the respiration sufficiently free, and the fever inflammatory.
5. Cynanche parotidaea, when the external parotid and maxillary glands are tumefied, respiration and deglutition slightly affected, and the fever a mild inflammatory one. This species is called the mumps amongst the English; in Scotland, the branks; with the French, ourles. There is also a species of quinsy to which children are subject, called pcf.dan-chone.
The seat of the cynanche tonsillaris is properly in the mucous membrane of the upper part of the throat, and all the surrounding parts of the muscles which move the jaws. The young, the sanguine, and those of an inflammatory diathesis, are most disposed to the true quinsy; and a disposition to it is often acquired by a few repetitions. The causes are the same as are productive of inflammation in general; particular constitutions and former habits determine the inflammation to particular parts.
If all or most of these parts are inflamed, the case is desperate; for the return of the blood through the compressed jugulars being intercepted, the fauces, lips, tongue, and face swell; the tongue is inflamed, and hangs from the mouth; the eyes are red, prominent, and ghastly; the brain is filled with blood; and delirium, yawning, stertor, strangulation on lying down, with a manifest redness, tumour, pain, and pulsation in the breast and neck, supervene.
The proper symptom of a quinsy is, the difficulty of swallowing solids or fluids; for if a large tumour affects the top of the oesophagus, and contracts it, liquids, but not solids, may pass through it; but if the tumour be seated in the top of the larynx, where it is covered with the epiglottis, solid substances, by pressing the tumid epiglottis, find a way to the oesophagus; while' liquids, not pressing with equal force, slide through the gaping space, by the tumour, into the as-peria arteria, and cause great uneasiness.
The complaint is generally obvious to the senses, and can but in few instances be mistaken. Shivering, and other symptoms of inflammatory fever, often precede; but very frequently the difficulty of swallowing is the first inconvenience felt. The florid redness round the fauces, and on every part of the throat, at once points out the disease; and this, with a flow of saliva, often constitutes the whole. When however more violent, the upper part of the larynx, the muscles of the neck, and the oesophagus itself, in a great portion of its track, suffer. The soreness externally is very acute; the breathing difficult, with a wheezing noise; the pain violent, extending to the ear; and deglutition,from the swelling, almost wholly obstructed. The different parts affected are known from the inconvenience attending the performance of their different functions; but we need not distinguish them, as the practice will not differ.