Chapter VI.

Chapter VI.Of the Diseases of the Throat.Sect.102.The Throat is subject to many Diseases: One of the most frequent and the most dangerous, is that Inflammation of it, commonly termed a Quinsey. This in Effect is a Distemper of the same Nature with an Inflammation of the Breast; but as it occurs in a different Part, the Symptoms, of Course, are very different. They also vary, not a very little, according to the different Parts of the Throat which are inflamed.§ 103. The general Symptoms of an Inflammation of the Throat are, the Shivering, the subsequent Heat, the Fever, the Head-ach, red high-coloured Urine, a considerable Difficulty, and sometimes even an Impossibility, of swallowing any thing whatever. But if the nearer Parts to theGlottis, that is, of the Entrance into the Windpipe, or Conduit through which we breathe, are attacked, Breathing becomes excessively difficult; the Patient is sensible of extreme Anguish, and great Approaches to Suffocation; the Disease is then extended to theGlottis, to the Body ofthe Wind-pipe, and even to the Substance of the Lungs, whence it becomes speedily fatal.The Inflammation of the other Parts is attended with less Danger; and this Danger becomes still less, as the Disease is more extended to the outward and superficial Parts. When the Inflammation is general, and seizes all the internal Parts of the Throat, and particularly the Tonsils or Almonds, as they are called, theUvula, or Process of the Palate, and theBasis, or remotest deepest Part of the Tongue, it is one of the most dangerous and dreadful Maladies. The Face is then swelled up and inflamed; the whole Inside of the Throat is in the same Condition; the Patient can get nothing down; he breathes with a Pain and Anguish, which concur, with a Stuffing or Obstruction in his Brains, to throw him into a kind of furiousDelirium, or Raving. His Tongue is bloated up, and is extended out of his Mouth; his Nostrils are dilated, as tho' it were to assist him in his Breathing; the whole Neck, even to the Beginning of the Breast, is excessively tumified or swelled up; the Pulse is very quick, very weak, and often intermits; the miserable Patient is deprived of all his Strength, and commonly dies the second or third Day. Very fortunately this Kind, or Degree of it, which I have often seen inLanguedoc, happens very rarely inSwisserland, where the Disease is less violent; and where I have only seen People die of it, in Consequence of itsbeing perniciously treated; or by Reason of some accidental Circumstances, which were foreign to the Disease itself. Of the Multitude of Patients I have attended in this Disorder, I have known but one to fail under it, whose Case I shall mention towards the Close of this Chapter.§ 104. Sometimes the Disease shifts from the internal to the external Parts: the Skin of the Neck and Breast grows very red, and becomes painful, but the Patient finds himself better.At other Times the Disorder quits the Throat; but is transferred to the Brain, or upon the Lungs. Both these Translations of it are mortal, when the best Advice and Assistance cannot be immediately procured; and it must be acknowledged, that even the best are often ineffectual.§ 105. The most usual kind of this Disease is that which affects only the Tonsils (the Almonds) and the Palate; or rather its Process,commonly calledthe Palate. It generally first invades one of the Tonsils, which becomes enlarged, red and painful, and does not allow the afflicted to swallow, but with great Pain. Sometimes the Disorder is confined to one Side; but most commonly it is extended to theUvula, (the Palate) from whence it is extended to the other Tonsil. If it be of a mild kind, the Tonsil first affected is generally better, when the second is attacked. Whenever they are both affected at once, the Pain and the Anguish of the Patient are very considerable; he cannot swallow, but with great Difficulty and Complaint; and the Torment ofthis is so vehement, that I have seen Women affected with Convulsions, as often as they endeavoured to swallow their Spittle, or any other Liquid. They continue, even for several Hours sometimes, unable to take any thing whatever; all the upper inward Part of the Mouth, the Bottom of the Palate, and the descending Part of the Tongue become lightly red, or inflamed.A considerable Proportion of Persons under this Disease swallow Liquids more difficultly than Solids; by Reason that Liquids require a greater Action of some Part of the Muscles, in order to their being properly directed into their Conduit or Chanel. The Deglutition (the Swallowing) of the Spittle is attended with still more Uneasiness than that of other Liquids, because it is a little more thick and viscid, and flows down with less Ease. This Difficulty of swallowing, joined to the Quantity thence accumulated, produces that almost continual hawking up, which oppresses some Patients so much the more, as the Inside of their Cheeks, their whole Tongue, and their Lips are often galled, and even flead as it were. This also prevents their Sleeping, which however seems no considerable Evil; Sleep beingsometimesbut of little Service in Diseases attended with a Fever; and I have often seen those, who thought their Throats almost entirely well in the Evening, and yet found them very bad after some Hours Sleep.The Fever, in this Species of the Disease, is sometimes, very high; and the Shivering oftenendures for many Hours. It is succeeded by considerable Heat, and a violent Head-ach, which yet is sometimes attended with a Drowsiness. The Fever is commonly pretty high in the Evening, though sometimes but inconsiderable, and by the Morning perhaps there is none at all.A light Invasion of this Disease of the Throat often precedes the Shivering; though most commonly it does not become manifest 'till after it, and at the same Time when the Heat comes on.The Neck is sometimes a little inflated, or puffed up; and many of the Sick complain of a pretty smart Pain in the Ear of that Side, which is most affected. I have but very seldom observed that they had it in both.§ 106. The Inflammation either disappears by Degrees, or an Abscess is formed in the Part which was chiefly affected. It has never happened, at least within my Knowledge, that this Sort of the Disease, prudently treated, has ever terminated either in a Mortification, or a Scirrhus: but I have been a Witness to either of these supervening, when Sweating was extorted in the Beginning of it, by hot Medicines.It is also very rare to meet with those highly dangerous Translations of this Disease upon the Lungs, such as are described in that Species of it from§ 103,104. It is true indeed it does not occur more frequently, even in that Species, whenever the Disease is thrown out upon the more external Parts.§ 107. The Treatment of the Quinsey, as well as of all other inflammatory Diseases, is the same with that of an Inflammation of the Breast.The Sick is immediately to be put upon a Regimen; and in that Sort described§ 103, Bleeding must be repeated four or five Times within a few Hours; and sometimes there is a Necessity to recur still oftner to it. When it assaults the Patient in the most vehement Degree, all Medicines, all Means, are very generally ineffectual; they should be tried however. We should give as much as can be taken of the DrinksNº. 2and4. But as the Quantity they are able to swallow is often very inconsiderable; the GlysterNº. 5should be repeated every three Hours; and their Legs should be put into a Bath of warm Water, thrice a Day.§ 108. Cupping Glasses, with Scarification, applied about the Neck, after bleeding twice or thrice, have often been experienced to be highly useful. In the most desperate Cases, when the Neck is excessively swelled, one or two deep Incisions made with a Razor, on this external Tumour, have sometimes saved a Patient's Life.§ 109. In that kind, and those Circumstances, of this Disease described§ 105we must have very frequent Recourse to Bleeding; and it should never be omitted, when the Pulse is very perceivably hard and full. It is of the utmost Consequence to do it instantaneously; since it is the only Means to prevent the Abscess, which forms very readily, if Bleeding has been neglected, onlyfor a few Hours. Sometimes it is necessary to repeat it a second Time, but very rarely a third.This Disease is frequently so gentle and mild, as to be cured without Bleeding, by the Means of much good Management. But as many as are not Masters of their own Time, nor in such an easy Situation, as to be properly attended, ought, without the least Hesitation, to be bled directly, which is sometimes sufficient to remove the Complaint; especially if, after Bleeding, the Patient drinks plentifully of the PtisanNº. 2.In this light Degree of the Disease, it may suffice to bathe the Legs, and to receive a Glyster, once a Day each; the first to be used in the Morning, and the last in the Evening. Besides the general Remedies against Inflammations, a few particular ones, calculated precisely for this Disease, may be applied in each kind or Degree of it. The best are, first the emollient Poultices,Nº. 9, laid over the whole Neck.27Some have highly extolled the Application of Swallows Nests in this Disease; and though I make no Objection to it, I think it certainly less efficacious than any of those which I direct.2. Of the Gargarisms (Nº. 19) a great Variety may be prepared, of pretty much the same Properties, and of equal Efficacy. Those Idirect here are what have succeeded best with me and they are very simple.283. The Steam of hot Water, as directed§ 55, should be repeated five or six Times a Day; a Poultice should be constantly kept on, and often renewed; and the Patient should often gargle.There are some Persons, besides Children, who cannot gargle themselves: and in fact the Pain occasioned by it makes it the more difficult. In such a Case, instead of gargling, the same Gargarism (Nº. 19) may be injected with a small Syringe. The Injection reaches further than Gargling, and often causes the Patient to hawk up a considerable Quantity of glarey Matter (which has grown still thicker towards the Bottom of the Throat) to his sensible Relief. This Injection should be often repeated. The little hollowed Pipes of Elder Wood, which all the Children in the Country can make, may be conveniently employed for this Purpose. The Patient shouldbreatheout, rather than inspire, during the Injection.§ 110. Whenever the Disease terminates without Suppuration, the Fever, the Head-ach, the Heat in the Throat, and the Pain in swallowing, begin to abate from the fourth Day, some times from the third, often only from the fifth; and from such Period that Abatement increases ata great Rate; so that at the End of two, three, or four Days, on the sixth, seventh, or eighth, the Patient is entirely well. Some few however continue to feel a light Degree of Pain, and that only on one Side, four or five Days longer, but without a Fever, or any considerable Uneasiness.§ 111. Sometimes the Fever and the other Symptoms abate, after the Bleeding and other Remedies; without any subsequent Amendment in the Throat, or any Signs of Suppuration. In such Cases we must chiefly persist in the Gargarisms and the Steams; and where an experienced and dexterous Surgeon can be procured, it were proper he should scarify the inflamed Tonsils. These discharge, in such Cases, a moderate Quantity of Blood; and this Evacuation relieves, very readily, as many as make use of it.§ 112. If the Inflammation is no ways disposed to disperse, so that an Abscess is forming, which almost ever happens, if it has not been obviated at the Invasion of the Disease; then the Symptoms attending the Fever continue, though raging a little less after the fourth Day: the Throat continues red, but of a less florid and lively Redness: a Pain also continues, though less acute, accompanied sometimes with Pulsations, and at other Times intirely without any; of which it is proper to take Notice: the Pulse commonly grows a little softer; and on the fifth or sixth Day, and sometimes sooner, the Abscess is ready to break. This may be discovered by the Appearance of asmall white and soft Tumour, when the Mouth is open, which commonly appears about the Centre or Middle of the Inflammation. It bursts of itself; or, should it not, it must be opened. This is effected by strongly securing a Lancet to one End of a small Stick or Handle, and enveloping, or wrapping up the whole Blade of it, except the Point and the Length of one fourth or a third of an Inch, in some Folds of soft Linnen; after which the Abscess is pierced with the Point of this Lancet. The Instant it is opened, the Mouth is filled with the Discharge of a Quantity ofPus, of the most intolerable Savour and Smell. The Patient should gargle himself after the Discharge of it with the detersive, or cleansing GargarismNº. 19. It is surprising sometimes to see the Quantity of Matter discharged from this Imposthumation. In general there is but one; though sometimes I have seen two of them.§ 113. It happens, and not seldom, that the Matter is not collected exactly in the Place, where the Inflammation appeared, but in some less exposed and less visible Place: whence a Facility of swallowing is almost entirely restored; the Fever abates; the Patient sleeps; he imagines he is cured, and that no Inconvenience remains, but such as ordinarily occurs in the earliest Stage of Recovery. A Person who is neither a Physician, nor a Surgeon, may easily deceive himself, when in this State. But the following Signs may enable him to discover that there is an Abscess, viz. A certain Inquietude and general Uneasiness; aPain throughout the Mouth; some Shiverings from Time to Time; frequently sharp, but short and transient, Heat: a Pulse moderately soft, but not in a natural State; a Sensation of Thickness and Heaviness in the Tongue; small white Eruptions on the Gums, on the Inside of the Cheek, on the Inside and Outside of the Lips, and a disagreeable Taste and Odour.§ 114. In such Cases Milk or warm Water should frequently be retained in the Mouth; the Vapour of hot Water should be conveyed into it; and emollient Cataplasms may be applied about the Neck. All these Means concur to the softening and breaking of the Abscess. The Finger may also be introduced to feel for its Situation; and when discovered, the Surgeon may easily open it. I happened once to break one under my Finger, without having made the least Effort to do it. Warm Water may be injected pretty forcibly, either by the Mouth or the Nostrils: this sometimes occasions a kind of Cough, or certain Efforts which tend to break it. I have seen this happen even from laughing. As to the rest, the Patient should not be too anxious or uneasy about the Event. I never saw a single Instance of a Person's dying of a Quinsey of this kind, after the Suppuration is truly effected; neither has it happened perhaps after the Time it is forming for Suppuration.§ 115. The glairy Matter with which the Throat is over-charged, and the very Inflammation of that Part, which, from its Irritation,produces the same Effect, as the Introduction of a Finger into it, occasions some Patients to complain of incessant Propensities to vomit. We must be upon our Guard here, and not suppose that this Heart-Sickness, as some have called it, results from a Disorder of, or a Load within, the Stomach, and that it requires a Vomit for its Removal. The giving one here would often prove a very unfortunate Mistake. It might, in a high Inflammation, further aggravate it; or we might be obliged (even during the Operation of the Vomit) to bleed, in order to lessen the Violence of the Inflammation. Such Imprudence with its bad Consequences, often leaves the Patient, even after the Disease is cured, in a State of Languor and Weakness for a considerable Time. Nevertheless, there are some particular Disorders of the Throat, attended with a Fever, in which a Vomit may be prudently given. But this can only be, when there is no Inflammation, or after it is dispersed; and there still remains some putrid Matter in the first Passages. Of such Cases I shall speak hereafter.29§ 116. We often see inSwisserlanda Disorder different from these of the Throat, of which wehave just treated; though, like these, attended with a Difficulty of swallowing. It is termed in French theOreillons, and often theOurles, or swelled Ears. It is an Overfulness and Obstruction of those Glands and their Tubes, which are to furnish theSalivaor Spittle; and particularly of the two large Glands which lie between the Ear and the Jaw; which are called theParotides; and of two under the Jaw, called theMaxillares. All these being considerably swelled in this Disease, do not only produce a great Difficulty of swallowing; but also prevent the Mouth from opening; as an Attempt to do it is attended with violent Pain. Young Children are much more liable to this Disease than grown Persons. Being seldom attended with a Fever, there is no Occasion for Medicines: It is sufficient to defend the Parts affected from the external Air; to apply some proper Poultice over them; to lessen the Quantity of their Food considerably, denying them Flesh and Wine; but indulging them plentifully in some light warm Liquid, to dilute their Humours and restore Perspiration. I cured myself of this Disorder in 1754, by drinking nothing, for four Days, but Balm Tea, to which I added one fourth part Milk, and a little Bread. The sameRegimenhas often cured me of other light Complaints of the Throat.§ 117. In the Spring of 1761, there were an astonishing Number of Persons attacked with Disorders of the Throat, of two different Kinds. Some of them were seized with that commonSort which I have already described. Without adding any thing more particularly, in Respect to this Species, it happened frequently to grown Persons, who were perfectly cured by the Method already recited. The other Species, on which I shall be more particular in this Place (because I know they have abounded in some Villages, and were very fatal) invaded Adults, or grown Persons also, but especially Children, from the Age of one Year, and even under that, to the Age of twelve or thirteen.The first Symptoms were the same with those of the common Quinsey, such as the Shivering, the ensuing Heat or Fever, Dejection, and a Complaint of the Throat: but the following Symptoms distinguished these from the common inflammatory Quinseys.1. The Sick had often something of a Cough, and a little Oppression.2. The Pulse was quicker, but less hard, and less strong, than generally happens in Diseases of the Throat.3. The Patients were afflicted with a sharp, stinging and dry Heat, and with great Restlessness.4. They spat less than is usual in a common Quinsey; and their Tongues were extremely dry.5. Though they had some Pain in swallowing, this was not their principal Complaint, and they could drink sufficiently.6. The Swelling and Redness of the Tonsils, of the Palate, and of its Process were not considerable; but the parotid and maxillary Glands, and especially the former, being extremely swelled and inflamed, the Pain they chiefly complained of, was this outward one.7. When the Disease proved considerably dangerous, the whole Neck swelled; and sometimes even the Veins, which return the Blood from the Brain, being overladen, as it were, the Sick had some Degree of Drowsiness, and of aDelirium, or Raving.8. The Paroxysms, or Returns, of the Fever were considerably irregular.9. The Urine appeared to be less inflamed, than in other Diseases of the Throat.10. Bleeding and other Medicines did not relieve them, as soon as in the other kind; and the Disease itself continued a longer Time.11. It did not terminate in a Suppuration like other Quinsies, but sometimes the Tonsils were ulcerated.12.30Almost every Child, and indeed a great many of the grown Persons assaulted with this Disease, threw out, either on the first Day, or on some succeeding one, within the first six Days, a certain Efflorescence, or Eruptions, resembling the Measles considerably in some, but of a less lively Colour, and without any Elevation, orrising above the Skin. It appeared first in the Face, next in the Arms, and descended to the Legs, Thighs and Trunk; disappearing gradually at the End of two or three Days, in the same Order it had observed in breaking out. A few others (I have seen but five Instances of it) suffered the most grievous Symptoms before the Eruption; and threw out the genuinepurpura, or white miliary Eruption.13. As soon as these Efflorescences or Eruptions appeared, the Sick generally found themselves better. That, last mentioned, continued four, five, or six Days, and frequently went off by Sweats. Such as had not these Ebullitions, which was the Case of many Adults, were not cured without very plentiful Sweats towards the Termination of the Disease: those which occurred at the Invasion of it being certainly unprofitable, and always hurtful.14. I have seen some Patients, in whom the Complaint of the Throat disappeared entirely, without either Eruptions or Sweats: but such still remained in very great Inquietude and Anguish, with a quick and small Pulse. I ordered them a sudorific Drink, which being succeeded by the Eruption, or by Sweating, they found themselves sensibly relieved.15. But whether the Sick had, or had not, these external Rednesses or Eruptions, every one of them parted with their Cuticle or Scarf Skin, which fell off, in large Scales, from the whole Surface of the Body: so great was the Acrimonyor Sharpness of that Matter, which was to be discharged through the Skin.16. A great Number suffered a singular Alteration in their Voice, different from that which occurs in common Quinsies, the Inside of their Nostrils being extremely dry.17. The Sick recovered with more Difficulty after this, than after the common Quinsies: and if they were negligent or irregular, during their Recovery; particularly, if they exposed themselves too soon to the Cold, a Relapse ensued, or some different Symptoms; such as a Stuffing with Oppression, a Swelling of the Belly, windy Swellings in different Parts; Weakness, Loathings, Ulcerations behind the Ears, and something of a Cough and Hoarseness.18. I have been sent for to Children, and also to some young Folks, who, at the End of several Weeks, had been taken with a general Inflammation of the whole Body, attended with great Oppression, and a considerable Abatement of their Urine, which was also high-coloured and turbid, or without Separation. They seemed also in a very singular State of Indifference, or Disregard, with Respect to any Object, or Circumstance. I recovered every one of them entirely by Blisters, and the PowderNº. 25. The first Operation of this Medicine was to vomit them: to this succeeded a Discharge by Urine, and at last very plentiful Sweating, which compleated the Cure. Two Patients only, of a bad Constitution, who were a little ricketty, and disposed toglandular Scirrhosity or Knottiness, relapsed and died, after being recovered of the Disease itself for some Days.§ 118. I have bled some adult Persons, and made Use of the cooling Regimen, as long as there was an evident Inflammation: it was necessary after this to unload the first Passages; and at last to excite moderate Sweats. The same PowdersNº. 25have often effected both these Discharges, and with entire Success. In other Cases I have made Use of Ipecacuanha, as directedNº. 35.In some Subjects there did not appear any inflammatory Symptom; and the Distemper resulted solely from a Load of putrid Matter in the first Passages. Some Patients also discharged Worms. In such Cases I never bled; but the Vomit had an excellent Effect, at the very Onset of the Disease; it produced a perceivable Abatement of all the Symptoms; Sweating ensued very kindly and naturally, and the Patient recovered entirely a few Hours after.§ 119. There were some Places, in which no Symptom or Character of Inflammation appeared; and in which it was necessary to omit Bleeding, which was attended with bad Consequences.I never directed Infants to be bled. After opening the first Passages, Blisters and diluting Drinks proved their only Remedies. A simple Infusion of Elder Flowers, and those of the LimeTree, has done great Service to those who drank plentifully of it.§ 120. I am sensible that in many Villages a great Number of Persons have died, with a prodigious Inflation or Swelling of the Neck. Some have also died in the City, and among others a young Woman of twenty Years of Age, who had taken nothing but hot sweating Medicines and red Wine, and died the fourth Day, with violent Suffocations, and a large Discharge of Blood from the Nose. Of the great Number I have seen in Person, only two died. One was a little Girl of ten Months old. She had anEfflorescencewhich very suddenly disappeared: at this Time I was called in; but the Humour had retreated to the Breast, and rendered her Death inevitable. The other was a strong Youth from sixteen to seventeen Years old, whose sudden Attack from the Disease manifested, from the very Beginning, a violent Degree of it. Nevertheless, the Symptoms subsiding, and the Fever nearly terminating, the Sweats which approached would probably have saved him. But he would not suffer them to have their Course, continually stripping himself quite naked. The Inflammation was immediately repelled upon the Lungs, and destroyed him within the Space of thirty Hours. I never saw a Person die with so very dry a Skin. The Vomit affected him very little upwards, and brought on a purging. His own bad Conduct seems to have been the Occasion of his Death; and may this serve as one Example of it.§ 121. I chose to expatiate on this Disease, as it may happen to reach other Places, where it may be useful to have been apprized of its Marks, and of its Treatment, which agrees as much with that of putrid Fevers, of which I shall speak hereafter, as with that of the inflammatory Diseases I have already considered: since in some Subjects the Complaint of the Throat has evidently been a Symptom of a putrid Fever, rather than of the chiefly apparent Disease, a Quinsey.31§ 122. Disorders of the Throat are, with Respect to particular Persons, an habitual Disease returning every Year, and sometimes oftner than once a Year. They may be prevented by the same Means, which I have directed for the Preservation from habitual Pleurisies§ 100; and by defending the Head and the Neck from the Cold; especially after being heated by Hunting, or any violent Exercise, or even by singing long and loud, which may be considered as an extraordinary Exercise of some of the Parts affected in this Disease.

Of the Diseases of the Throat.

Sect.102.

The Throat is subject to many Diseases: One of the most frequent and the most dangerous, is that Inflammation of it, commonly termed a Quinsey. This in Effect is a Distemper of the same Nature with an Inflammation of the Breast; but as it occurs in a different Part, the Symptoms, of Course, are very different. They also vary, not a very little, according to the different Parts of the Throat which are inflamed.

§ 103. The general Symptoms of an Inflammation of the Throat are, the Shivering, the subsequent Heat, the Fever, the Head-ach, red high-coloured Urine, a considerable Difficulty, and sometimes even an Impossibility, of swallowing any thing whatever. But if the nearer Parts to theGlottis, that is, of the Entrance into the Windpipe, or Conduit through which we breathe, are attacked, Breathing becomes excessively difficult; the Patient is sensible of extreme Anguish, and great Approaches to Suffocation; the Disease is then extended to theGlottis, to the Body ofthe Wind-pipe, and even to the Substance of the Lungs, whence it becomes speedily fatal.

The Inflammation of the other Parts is attended with less Danger; and this Danger becomes still less, as the Disease is more extended to the outward and superficial Parts. When the Inflammation is general, and seizes all the internal Parts of the Throat, and particularly the Tonsils or Almonds, as they are called, theUvula, or Process of the Palate, and theBasis, or remotest deepest Part of the Tongue, it is one of the most dangerous and dreadful Maladies. The Face is then swelled up and inflamed; the whole Inside of the Throat is in the same Condition; the Patient can get nothing down; he breathes with a Pain and Anguish, which concur, with a Stuffing or Obstruction in his Brains, to throw him into a kind of furiousDelirium, or Raving. His Tongue is bloated up, and is extended out of his Mouth; his Nostrils are dilated, as tho' it were to assist him in his Breathing; the whole Neck, even to the Beginning of the Breast, is excessively tumified or swelled up; the Pulse is very quick, very weak, and often intermits; the miserable Patient is deprived of all his Strength, and commonly dies the second or third Day. Very fortunately this Kind, or Degree of it, which I have often seen inLanguedoc, happens very rarely inSwisserland, where the Disease is less violent; and where I have only seen People die of it, in Consequence of itsbeing perniciously treated; or by Reason of some accidental Circumstances, which were foreign to the Disease itself. Of the Multitude of Patients I have attended in this Disorder, I have known but one to fail under it, whose Case I shall mention towards the Close of this Chapter.

§ 104. Sometimes the Disease shifts from the internal to the external Parts: the Skin of the Neck and Breast grows very red, and becomes painful, but the Patient finds himself better.

At other Times the Disorder quits the Throat; but is transferred to the Brain, or upon the Lungs. Both these Translations of it are mortal, when the best Advice and Assistance cannot be immediately procured; and it must be acknowledged, that even the best are often ineffectual.

§ 105. The most usual kind of this Disease is that which affects only the Tonsils (the Almonds) and the Palate; or rather its Process,commonly calledthe Palate. It generally first invades one of the Tonsils, which becomes enlarged, red and painful, and does not allow the afflicted to swallow, but with great Pain. Sometimes the Disorder is confined to one Side; but most commonly it is extended to theUvula, (the Palate) from whence it is extended to the other Tonsil. If it be of a mild kind, the Tonsil first affected is generally better, when the second is attacked. Whenever they are both affected at once, the Pain and the Anguish of the Patient are very considerable; he cannot swallow, but with great Difficulty and Complaint; and the Torment ofthis is so vehement, that I have seen Women affected with Convulsions, as often as they endeavoured to swallow their Spittle, or any other Liquid. They continue, even for several Hours sometimes, unable to take any thing whatever; all the upper inward Part of the Mouth, the Bottom of the Palate, and the descending Part of the Tongue become lightly red, or inflamed.

A considerable Proportion of Persons under this Disease swallow Liquids more difficultly than Solids; by Reason that Liquids require a greater Action of some Part of the Muscles, in order to their being properly directed into their Conduit or Chanel. The Deglutition (the Swallowing) of the Spittle is attended with still more Uneasiness than that of other Liquids, because it is a little more thick and viscid, and flows down with less Ease. This Difficulty of swallowing, joined to the Quantity thence accumulated, produces that almost continual hawking up, which oppresses some Patients so much the more, as the Inside of their Cheeks, their whole Tongue, and their Lips are often galled, and even flead as it were. This also prevents their Sleeping, which however seems no considerable Evil; Sleep beingsometimesbut of little Service in Diseases attended with a Fever; and I have often seen those, who thought their Throats almost entirely well in the Evening, and yet found them very bad after some Hours Sleep.

The Fever, in this Species of the Disease, is sometimes, very high; and the Shivering oftenendures for many Hours. It is succeeded by considerable Heat, and a violent Head-ach, which yet is sometimes attended with a Drowsiness. The Fever is commonly pretty high in the Evening, though sometimes but inconsiderable, and by the Morning perhaps there is none at all.

A light Invasion of this Disease of the Throat often precedes the Shivering; though most commonly it does not become manifest 'till after it, and at the same Time when the Heat comes on.

The Neck is sometimes a little inflated, or puffed up; and many of the Sick complain of a pretty smart Pain in the Ear of that Side, which is most affected. I have but very seldom observed that they had it in both.

§ 106. The Inflammation either disappears by Degrees, or an Abscess is formed in the Part which was chiefly affected. It has never happened, at least within my Knowledge, that this Sort of the Disease, prudently treated, has ever terminated either in a Mortification, or a Scirrhus: but I have been a Witness to either of these supervening, when Sweating was extorted in the Beginning of it, by hot Medicines.

It is also very rare to meet with those highly dangerous Translations of this Disease upon the Lungs, such as are described in that Species of it from§ 103,104. It is true indeed it does not occur more frequently, even in that Species, whenever the Disease is thrown out upon the more external Parts.

§ 107. The Treatment of the Quinsey, as well as of all other inflammatory Diseases, is the same with that of an Inflammation of the Breast.

The Sick is immediately to be put upon a Regimen; and in that Sort described§ 103, Bleeding must be repeated four or five Times within a few Hours; and sometimes there is a Necessity to recur still oftner to it. When it assaults the Patient in the most vehement Degree, all Medicines, all Means, are very generally ineffectual; they should be tried however. We should give as much as can be taken of the DrinksNº. 2and4. But as the Quantity they are able to swallow is often very inconsiderable; the GlysterNº. 5should be repeated every three Hours; and their Legs should be put into a Bath of warm Water, thrice a Day.

§ 108. Cupping Glasses, with Scarification, applied about the Neck, after bleeding twice or thrice, have often been experienced to be highly useful. In the most desperate Cases, when the Neck is excessively swelled, one or two deep Incisions made with a Razor, on this external Tumour, have sometimes saved a Patient's Life.

§ 109. In that kind, and those Circumstances, of this Disease described§ 105we must have very frequent Recourse to Bleeding; and it should never be omitted, when the Pulse is very perceivably hard and full. It is of the utmost Consequence to do it instantaneously; since it is the only Means to prevent the Abscess, which forms very readily, if Bleeding has been neglected, onlyfor a few Hours. Sometimes it is necessary to repeat it a second Time, but very rarely a third.

This Disease is frequently so gentle and mild, as to be cured without Bleeding, by the Means of much good Management. But as many as are not Masters of their own Time, nor in such an easy Situation, as to be properly attended, ought, without the least Hesitation, to be bled directly, which is sometimes sufficient to remove the Complaint; especially if, after Bleeding, the Patient drinks plentifully of the PtisanNº. 2.

In this light Degree of the Disease, it may suffice to bathe the Legs, and to receive a Glyster, once a Day each; the first to be used in the Morning, and the last in the Evening. Besides the general Remedies against Inflammations, a few particular ones, calculated precisely for this Disease, may be applied in each kind or Degree of it. The best are, first the emollient Poultices,Nº. 9, laid over the whole Neck.27Some have highly extolled the Application of Swallows Nests in this Disease; and though I make no Objection to it, I think it certainly less efficacious than any of those which I direct.

2. Of the Gargarisms (Nº. 19) a great Variety may be prepared, of pretty much the same Properties, and of equal Efficacy. Those Idirect here are what have succeeded best with me and they are very simple.28

3. The Steam of hot Water, as directed§ 55, should be repeated five or six Times a Day; a Poultice should be constantly kept on, and often renewed; and the Patient should often gargle.

There are some Persons, besides Children, who cannot gargle themselves: and in fact the Pain occasioned by it makes it the more difficult. In such a Case, instead of gargling, the same Gargarism (Nº. 19) may be injected with a small Syringe. The Injection reaches further than Gargling, and often causes the Patient to hawk up a considerable Quantity of glarey Matter (which has grown still thicker towards the Bottom of the Throat) to his sensible Relief. This Injection should be often repeated. The little hollowed Pipes of Elder Wood, which all the Children in the Country can make, may be conveniently employed for this Purpose. The Patient shouldbreatheout, rather than inspire, during the Injection.

§ 110. Whenever the Disease terminates without Suppuration, the Fever, the Head-ach, the Heat in the Throat, and the Pain in swallowing, begin to abate from the fourth Day, some times from the third, often only from the fifth; and from such Period that Abatement increases ata great Rate; so that at the End of two, three, or four Days, on the sixth, seventh, or eighth, the Patient is entirely well. Some few however continue to feel a light Degree of Pain, and that only on one Side, four or five Days longer, but without a Fever, or any considerable Uneasiness.

§ 111. Sometimes the Fever and the other Symptoms abate, after the Bleeding and other Remedies; without any subsequent Amendment in the Throat, or any Signs of Suppuration. In such Cases we must chiefly persist in the Gargarisms and the Steams; and where an experienced and dexterous Surgeon can be procured, it were proper he should scarify the inflamed Tonsils. These discharge, in such Cases, a moderate Quantity of Blood; and this Evacuation relieves, very readily, as many as make use of it.

§ 112. If the Inflammation is no ways disposed to disperse, so that an Abscess is forming, which almost ever happens, if it has not been obviated at the Invasion of the Disease; then the Symptoms attending the Fever continue, though raging a little less after the fourth Day: the Throat continues red, but of a less florid and lively Redness: a Pain also continues, though less acute, accompanied sometimes with Pulsations, and at other Times intirely without any; of which it is proper to take Notice: the Pulse commonly grows a little softer; and on the fifth or sixth Day, and sometimes sooner, the Abscess is ready to break. This may be discovered by the Appearance of asmall white and soft Tumour, when the Mouth is open, which commonly appears about the Centre or Middle of the Inflammation. It bursts of itself; or, should it not, it must be opened. This is effected by strongly securing a Lancet to one End of a small Stick or Handle, and enveloping, or wrapping up the whole Blade of it, except the Point and the Length of one fourth or a third of an Inch, in some Folds of soft Linnen; after which the Abscess is pierced with the Point of this Lancet. The Instant it is opened, the Mouth is filled with the Discharge of a Quantity ofPus, of the most intolerable Savour and Smell. The Patient should gargle himself after the Discharge of it with the detersive, or cleansing GargarismNº. 19. It is surprising sometimes to see the Quantity of Matter discharged from this Imposthumation. In general there is but one; though sometimes I have seen two of them.

§ 113. It happens, and not seldom, that the Matter is not collected exactly in the Place, where the Inflammation appeared, but in some less exposed and less visible Place: whence a Facility of swallowing is almost entirely restored; the Fever abates; the Patient sleeps; he imagines he is cured, and that no Inconvenience remains, but such as ordinarily occurs in the earliest Stage of Recovery. A Person who is neither a Physician, nor a Surgeon, may easily deceive himself, when in this State. But the following Signs may enable him to discover that there is an Abscess, viz. A certain Inquietude and general Uneasiness; aPain throughout the Mouth; some Shiverings from Time to Time; frequently sharp, but short and transient, Heat: a Pulse moderately soft, but not in a natural State; a Sensation of Thickness and Heaviness in the Tongue; small white Eruptions on the Gums, on the Inside of the Cheek, on the Inside and Outside of the Lips, and a disagreeable Taste and Odour.

§ 114. In such Cases Milk or warm Water should frequently be retained in the Mouth; the Vapour of hot Water should be conveyed into it; and emollient Cataplasms may be applied about the Neck. All these Means concur to the softening and breaking of the Abscess. The Finger may also be introduced to feel for its Situation; and when discovered, the Surgeon may easily open it. I happened once to break one under my Finger, without having made the least Effort to do it. Warm Water may be injected pretty forcibly, either by the Mouth or the Nostrils: this sometimes occasions a kind of Cough, or certain Efforts which tend to break it. I have seen this happen even from laughing. As to the rest, the Patient should not be too anxious or uneasy about the Event. I never saw a single Instance of a Person's dying of a Quinsey of this kind, after the Suppuration is truly effected; neither has it happened perhaps after the Time it is forming for Suppuration.

§ 115. The glairy Matter with which the Throat is over-charged, and the very Inflammation of that Part, which, from its Irritation,produces the same Effect, as the Introduction of a Finger into it, occasions some Patients to complain of incessant Propensities to vomit. We must be upon our Guard here, and not suppose that this Heart-Sickness, as some have called it, results from a Disorder of, or a Load within, the Stomach, and that it requires a Vomit for its Removal. The giving one here would often prove a very unfortunate Mistake. It might, in a high Inflammation, further aggravate it; or we might be obliged (even during the Operation of the Vomit) to bleed, in order to lessen the Violence of the Inflammation. Such Imprudence with its bad Consequences, often leaves the Patient, even after the Disease is cured, in a State of Languor and Weakness for a considerable Time. Nevertheless, there are some particular Disorders of the Throat, attended with a Fever, in which a Vomit may be prudently given. But this can only be, when there is no Inflammation, or after it is dispersed; and there still remains some putrid Matter in the first Passages. Of such Cases I shall speak hereafter.29

§ 116. We often see inSwisserlanda Disorder different from these of the Throat, of which wehave just treated; though, like these, attended with a Difficulty of swallowing. It is termed in French theOreillons, and often theOurles, or swelled Ears. It is an Overfulness and Obstruction of those Glands and their Tubes, which are to furnish theSalivaor Spittle; and particularly of the two large Glands which lie between the Ear and the Jaw; which are called theParotides; and of two under the Jaw, called theMaxillares. All these being considerably swelled in this Disease, do not only produce a great Difficulty of swallowing; but also prevent the Mouth from opening; as an Attempt to do it is attended with violent Pain. Young Children are much more liable to this Disease than grown Persons. Being seldom attended with a Fever, there is no Occasion for Medicines: It is sufficient to defend the Parts affected from the external Air; to apply some proper Poultice over them; to lessen the Quantity of their Food considerably, denying them Flesh and Wine; but indulging them plentifully in some light warm Liquid, to dilute their Humours and restore Perspiration. I cured myself of this Disorder in 1754, by drinking nothing, for four Days, but Balm Tea, to which I added one fourth part Milk, and a little Bread. The sameRegimenhas often cured me of other light Complaints of the Throat.

§ 117. In the Spring of 1761, there were an astonishing Number of Persons attacked with Disorders of the Throat, of two different Kinds. Some of them were seized with that commonSort which I have already described. Without adding any thing more particularly, in Respect to this Species, it happened frequently to grown Persons, who were perfectly cured by the Method already recited. The other Species, on which I shall be more particular in this Place (because I know they have abounded in some Villages, and were very fatal) invaded Adults, or grown Persons also, but especially Children, from the Age of one Year, and even under that, to the Age of twelve or thirteen.

The first Symptoms were the same with those of the common Quinsey, such as the Shivering, the ensuing Heat or Fever, Dejection, and a Complaint of the Throat: but the following Symptoms distinguished these from the common inflammatory Quinseys.

1. The Sick had often something of a Cough, and a little Oppression.

2. The Pulse was quicker, but less hard, and less strong, than generally happens in Diseases of the Throat.

3. The Patients were afflicted with a sharp, stinging and dry Heat, and with great Restlessness.

4. They spat less than is usual in a common Quinsey; and their Tongues were extremely dry.

5. Though they had some Pain in swallowing, this was not their principal Complaint, and they could drink sufficiently.

6. The Swelling and Redness of the Tonsils, of the Palate, and of its Process were not considerable; but the parotid and maxillary Glands, and especially the former, being extremely swelled and inflamed, the Pain they chiefly complained of, was this outward one.

7. When the Disease proved considerably dangerous, the whole Neck swelled; and sometimes even the Veins, which return the Blood from the Brain, being overladen, as it were, the Sick had some Degree of Drowsiness, and of aDelirium, or Raving.

8. The Paroxysms, or Returns, of the Fever were considerably irregular.

9. The Urine appeared to be less inflamed, than in other Diseases of the Throat.

10. Bleeding and other Medicines did not relieve them, as soon as in the other kind; and the Disease itself continued a longer Time.

11. It did not terminate in a Suppuration like other Quinsies, but sometimes the Tonsils were ulcerated.

12.30Almost every Child, and indeed a great many of the grown Persons assaulted with this Disease, threw out, either on the first Day, or on some succeeding one, within the first six Days, a certain Efflorescence, or Eruptions, resembling the Measles considerably in some, but of a less lively Colour, and without any Elevation, orrising above the Skin. It appeared first in the Face, next in the Arms, and descended to the Legs, Thighs and Trunk; disappearing gradually at the End of two or three Days, in the same Order it had observed in breaking out. A few others (I have seen but five Instances of it) suffered the most grievous Symptoms before the Eruption; and threw out the genuinepurpura, or white miliary Eruption.

13. As soon as these Efflorescences or Eruptions appeared, the Sick generally found themselves better. That, last mentioned, continued four, five, or six Days, and frequently went off by Sweats. Such as had not these Ebullitions, which was the Case of many Adults, were not cured without very plentiful Sweats towards the Termination of the Disease: those which occurred at the Invasion of it being certainly unprofitable, and always hurtful.

14. I have seen some Patients, in whom the Complaint of the Throat disappeared entirely, without either Eruptions or Sweats: but such still remained in very great Inquietude and Anguish, with a quick and small Pulse. I ordered them a sudorific Drink, which being succeeded by the Eruption, or by Sweating, they found themselves sensibly relieved.

15. But whether the Sick had, or had not, these external Rednesses or Eruptions, every one of them parted with their Cuticle or Scarf Skin, which fell off, in large Scales, from the whole Surface of the Body: so great was the Acrimonyor Sharpness of that Matter, which was to be discharged through the Skin.

16. A great Number suffered a singular Alteration in their Voice, different from that which occurs in common Quinsies, the Inside of their Nostrils being extremely dry.

17. The Sick recovered with more Difficulty after this, than after the common Quinsies: and if they were negligent or irregular, during their Recovery; particularly, if they exposed themselves too soon to the Cold, a Relapse ensued, or some different Symptoms; such as a Stuffing with Oppression, a Swelling of the Belly, windy Swellings in different Parts; Weakness, Loathings, Ulcerations behind the Ears, and something of a Cough and Hoarseness.

18. I have been sent for to Children, and also to some young Folks, who, at the End of several Weeks, had been taken with a general Inflammation of the whole Body, attended with great Oppression, and a considerable Abatement of their Urine, which was also high-coloured and turbid, or without Separation. They seemed also in a very singular State of Indifference, or Disregard, with Respect to any Object, or Circumstance. I recovered every one of them entirely by Blisters, and the PowderNº. 25. The first Operation of this Medicine was to vomit them: to this succeeded a Discharge by Urine, and at last very plentiful Sweating, which compleated the Cure. Two Patients only, of a bad Constitution, who were a little ricketty, and disposed toglandular Scirrhosity or Knottiness, relapsed and died, after being recovered of the Disease itself for some Days.

§ 118. I have bled some adult Persons, and made Use of the cooling Regimen, as long as there was an evident Inflammation: it was necessary after this to unload the first Passages; and at last to excite moderate Sweats. The same PowdersNº. 25have often effected both these Discharges, and with entire Success. In other Cases I have made Use of Ipecacuanha, as directedNº. 35.

In some Subjects there did not appear any inflammatory Symptom; and the Distemper resulted solely from a Load of putrid Matter in the first Passages. Some Patients also discharged Worms. In such Cases I never bled; but the Vomit had an excellent Effect, at the very Onset of the Disease; it produced a perceivable Abatement of all the Symptoms; Sweating ensued very kindly and naturally, and the Patient recovered entirely a few Hours after.

§ 119. There were some Places, in which no Symptom or Character of Inflammation appeared; and in which it was necessary to omit Bleeding, which was attended with bad Consequences.

I never directed Infants to be bled. After opening the first Passages, Blisters and diluting Drinks proved their only Remedies. A simple Infusion of Elder Flowers, and those of the LimeTree, has done great Service to those who drank plentifully of it.

§ 120. I am sensible that in many Villages a great Number of Persons have died, with a prodigious Inflation or Swelling of the Neck. Some have also died in the City, and among others a young Woman of twenty Years of Age, who had taken nothing but hot sweating Medicines and red Wine, and died the fourth Day, with violent Suffocations, and a large Discharge of Blood from the Nose. Of the great Number I have seen in Person, only two died. One was a little Girl of ten Months old. She had anEfflorescencewhich very suddenly disappeared: at this Time I was called in; but the Humour had retreated to the Breast, and rendered her Death inevitable. The other was a strong Youth from sixteen to seventeen Years old, whose sudden Attack from the Disease manifested, from the very Beginning, a violent Degree of it. Nevertheless, the Symptoms subsiding, and the Fever nearly terminating, the Sweats which approached would probably have saved him. But he would not suffer them to have their Course, continually stripping himself quite naked. The Inflammation was immediately repelled upon the Lungs, and destroyed him within the Space of thirty Hours. I never saw a Person die with so very dry a Skin. The Vomit affected him very little upwards, and brought on a purging. His own bad Conduct seems to have been the Occasion of his Death; and may this serve as one Example of it.

§ 121. I chose to expatiate on this Disease, as it may happen to reach other Places, where it may be useful to have been apprized of its Marks, and of its Treatment, which agrees as much with that of putrid Fevers, of which I shall speak hereafter, as with that of the inflammatory Diseases I have already considered: since in some Subjects the Complaint of the Throat has evidently been a Symptom of a putrid Fever, rather than of the chiefly apparent Disease, a Quinsey.31

§ 122. Disorders of the Throat are, with Respect to particular Persons, an habitual Disease returning every Year, and sometimes oftner than once a Year. They may be prevented by the same Means, which I have directed for the Preservation from habitual Pleurisies§ 100; and by defending the Head and the Neck from the Cold; especially after being heated by Hunting, or any violent Exercise, or even by singing long and loud, which may be considered as an extraordinary Exercise of some of the Parts affected in this Disease.

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