Part 12

_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.

Sec. 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 the Glottis, 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 the Glottis, to the Body of the 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, the Uvula, or Process of the Palate, and the Basis, 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 furious Delirium, 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 in Languedoc, happens very rarely in Swisserland, where the Disease is less violent; and where I have only seen People die of it, in Consequence of its being 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.

Sec. 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.

Sec. 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 called the 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 the Uvula, (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 of this 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 being sometimes but 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 often endures 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.

Sec. 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 Sec. 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.

Sec. 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 Sec. 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 Drinks No. 2 and 4. But as the Quantity they are able to swallow is often very inconsiderable; the Glyster No. 5 should be repeated every three Hours; and their Legs should be put into a Bath of warm Water, thrice a Day.

Sec. 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.

Sec. 109. In that kind, and those Circumstances, of this Disease described Sec. 105 we 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, only for 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 Ptisan No. 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. Some 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.

The English avail themselves considerably, in this Disease, of a Mixture of equal Parts of Sallad Oil, and Spirit of Sal Ammoniac; or of Oil and Spirit of Hartshorn, as a Liniment and Application round the Neck. This Remedy corresponds with many Indications; and deserves, perhaps, the first Place amongst local Applications against the inflammatory Quinsey. E. L.

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

Dr. Pringle is apprehensive of some ill Effects from Acids in Gargarisms [which is probably from their supposed repelling Property] and prefers a Decoction of Figs in Milk and Water, to which he adds a small Quantity of Spirit of Sal Ammoniac. E. L.

3. The Steam of hot Water, as directed Sec. 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 should breathe out, rather than inspire, during the Injection.

Sec. 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 at a 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.

Sec. 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.

Sec. 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 a small 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 of Pus, of the most intolerable Savour and Smell. The Patient should gargle himself after the Discharge of it with the detersive, or cleansing Gargarism No. 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.

Sec. 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; a Pain 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.