Part 13

Sec. 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.

Sec. 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.

In Diseases of the Throat, which have been preceded by such Excesses in Food or strong Drink, as occur too often in many Countries, when the Patient has very strong Reachings to vomit, and the Tongue is moist at the same Time; we should not hesitate, after appeasing the first Symptoms of the Inflammation [by sufficient Bleedings, &c.] to assist the Efforts of Nature, and to give a small Dose of Tartar emetic, dissolved in some Spoonfuls of Water. This Remedy in this Case, promotes the Dispersion of the Inflammation, beyond any other. E. L.

Sec. 116. We often see in Swisserland a Disorder different from these of the Throat, of which we have just treated; though, like these, attended with a Difficulty of swallowing. It is termed in French the Oreillons, and often the Ourles, or swelled Ears. It is an Overfulness and Obstruction of those Glands and their Tubes, which are to furnish the Saliva or Spittle; and particularly of the two large Glands which lie between the Ear and the Jaw; which are called the Parotides; and of two under the Jaw, called the Maxillares. 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 same Regimen has often cured me of other light Complaints of the Throat.

Sec. 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 common Sort 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 a Delirium, 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. Almost 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, or rising 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 genuine purpura, or white miliary Eruption.

This seems to have been the same kind of Quinsey, of which Drs. Huxham, Fothergil, Cotton and others wrote, though under different Appellations. K.

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 Acrimony or 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 Powder No. 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 to glandular Scirrhosity or Knottiness, relapsed and died, after being recovered of the Disease itself for some Days.

Sec. 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 Powders No. 25 have often effected both these Discharges, and with entire Success. In other Cases I have made Use of Ipecacuanha, as directed No. 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.

Sec. 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.