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DOMESTIC MEDICINE

CHAP. XXVIII.

OF THE QUINSEY, OR INFLAMMATION OF THE THROAT.

THIS disease is very common in Britain, and is frequently attended with great danger. It prevails in the winter and spring, and is most fatal to young people of a sanguine temperament.

CAUSES - In general it proceeds from the same causes as other inflammatory disorders, viz, an obstructed perspiration, or whatever heats or inflames the blood. An inflammation of the throat is often occasioned by omitting some parts of the covering usually worn about the neck, by drinking cold liquor when the body is warm, by riding or walking against a cold northerly wind, or any thing that greatly cools the throat, and parts adjacent. It may likewise proceed from the neglect of bleeding, purging, or any customary evacuation.

SINGING, speaking loud and long, or whatever strains the throat, may likewise cause an inflammation of that organ. I have often known the quinsey prove fatal to jovial companions, who, after sitting long in a warm room drinking hot liquors, and singing with vehemence, were so imprudent as to go abroad in the cold night-air. Sitting with wet feet, or keeping on wet cloths, are very apt to occasion this malady. It is likewise frequently occasioned by continuing long in a moist place, sitting near an open window, sleeping in a damp bed, sitting in a room that has been newly plastered, &c. I know people who never fail to have a sore throat if they sit even but a short time in a room that has been lately washed.

ACRID or irritating food may likewise inflame the throat, and occasion a quinsey. It may also proceed from bones, pins, or other sharp substances sticking in the throat, or from the caustic fumes of metals or minerals, as arsenic, antimony, &c. taken in by the breath. This disease is sometimes epidemic and infectious.

SYMPTOMS - The inflammation of the throat is evident from inspection, the parts appearing red and swelled; besides, the patient complains of pain in swallowing. His pulse is quick and hard, with other symptoms of a fever. If blood be let, it is generally covered with a tough coat of a whitish colour, and the patient spits a tough phlegm. As the swelling and inflammation increase, the breathing and swallowing become more difficult; the pain affects the ears; the eyes generally appear red; and the face swells. The patient is often obliged to keep himself in an erect posture, being in danger of suffocating; there is a constant nausea, or inclination to vomit, and the drink, instead of passing into the stomach, is often returned by the nose. The patient is frequently starved at last, merely from an inability to swallow any kind of food.

WHEN the breathing is laborious, with straitness of the breast, and anxiety, the danger is great. Though the pain in swallowing be very great, yet while the patient breathes easy, there is not so much danger. An external swelling is no unfavourable symptom; but if it suddenly falls, and the disease affects the breast, the danger is very great. When a quinsey is the consequence of some other disease, which has already weakened the patient, his situation is dangerous. A frothing at the mouth, with a swelled tongue, a pale, ghastly countenance, and coldness of the extremities, are fatal symptoms.

REGIMEN. - The regimen in this disease is in all respects the same as in the pleurisy, or peripneumony. The food must be light, and in small quantity, and the drink plentiful, weak, and diluting, mixed with acids.

IT is highly necessary that the patient be kept easy and quiet. Violent affections of the mind, or great efforts of the body, may prove fatal. He should not even attempt to speak but in a low voice. Such a degree of warmth as to promote a constant, gentle sweat, is proper. When the patient is in bed, his head ought to be raised a little higher than usual.

IT is peculiarly necessary that the neck be kept warm; for which purpose several folds of soft flannel may be wrapt round it. That alone will often remove a slight complaint of the throat, especially if applied in due time. We cannot here omit observing the propriety of a custom which prevails amongst the peasants of this country. When they feel any uneasiness of the throat, they wrap a stocking about it all night. So effectual is this remedy that in many places it passes for a charm, and the stocking is applied with particular ceremonies: The custom, however, is undoubtedly a good one, and should never be neglected. When the throat has been thus wrapt up all night it must not be exposed to the cold air through the day, but a handkerchief or a piece of flannel kept about it till the inflammation be removed.

THE jelly of black currants is a medicine very much in esteem for complaints of the throat; and indeed it is of some use. It should be almost constantly kept in the mouth, and swallowed down leisurely. It may likewise be mixed in the patient's drink, or taken any other way. When it cannot be obtained, the jelly of red currants, or of mulberries, may be used in its stead.

GARGLES for the throat are very beneficial. They may be made of sage-tea, with a little vinegar and honey, or by adding to half an English pint of the pectoral decoction two or three spoonfuls of honey, and the same quantity of currant jelly. This may be used three or four times a-day; and if the patient be troubled with tough viscid phlegm, the gargle may be rendered more sharp and cleansing, by adding to it a tea-spoonful of the spirit of sal ammoniac. Some recommend gargles made of a decoction of the leaves or bark of the blackberry bush; but where the jeIly can be had, these are unnecessary.

THERE is no disease wherein the benefit of bathing the feet and legs in lukewarm water is more apparent: That practice ought therefore never to be neglected. If people were careful to keep warm, to wrap up their throats with flannel, to bathe their feet and legs in warm water, and to use a spare diet, with diluting liquors, at the beginning of this disease, it would seldom proceed to a great height, or be attended with any danger; but when these precautions are neglected, and the disease becomes violent, more powerful medicines are necessary.

MEDICINE - An inflammation of the throat being a most accute and dangerous distemper, which sometimes takes off the patient very suddenly, it will be proper, as soon as the symptoms appear, to bleed in the arm, or rather in the jugular vein, and to repeat the operation if circumstances require.

THE body should likewise be kept gently open. This may either be done by giving the patient for his ordinary drink a decoction of figs and tamarinds, or small doses of rhubarb and nitre, as recommended in the erysipelas. These may be increased according to the age of the patient, and repeated till they have the desired effect.

I HAVE often known very good effects from a bit of sal prunel, or purified nitre, held in the mouth, and swallowed down as it melted. This promotes the discharge of saliva, by which means it answers the end of a gargle, while at the same time it abates the fever, by promoting the discharge of urine, &c.

THE throat ought likewise to be rubbed twice or thrice a day with a little of the volatile liniment. This seldom fails to produce some good effects. At the same time the neck ought to be carefully covered with wool or flannel, to prevent the cold from penetrating the skin, as this application renders it very tender. Many other external applications are reccommended in this disease, as a swallows nest, poultices made of the fungus called Jews ears, album Graecum, &c. But as we do not look upon any of these to be preferable to a common poultice of bread and milk, we shall take no farther notice of them.

SOME recommend the gum guaiacum as a specific in this disease. Half a dram of the gum in powder may be made into an electuary with the rob of elderberries, or the jelly of currants for a dose, and repeated occasionally

BLISTERING upon the neck or behind the ears in violent inflammations of the throat, is very beneficial; and in bad cases it will be necessary to lay a blistering-plaster quite across the throat, so as to reach from ear to ear. After the plasters are taken off, the parts ought to be kept running by the application of issue ointment, till the inflammation is gone; otherwise, upon their drying up, the patient will be in danger of a relapse.

WHEN the patient has been treated as above, a suppuration seldom happens. This however is sometimes the case in spite of all endeavours to prevent it. When the inflammation and swelling continue, and it is evident that a suppuration will ensue, it ought to be promoted by drawing the steam of warm water into the throat through a funnel, or the like. Soft poultices ought likewise to be applied outwardly, and the patient may keep a roasted fig constantly in his mouth.

IT sometimes happens, before the tumour breaks, that the swelling is so great, as entirely to prevent any thing from getting down into the stomach. In this case the patient must inevitably perish, unless he can be supported in some other way. This can only be done by nourishing clysters of broth, or gruel with milk, &c. Patients have often been supported by these for several days, till the tumour has broke; and afterwards they have recovered.

NOT only the swallowing, but the breathing, is often prevented by the tumour. In this case nothing can save the patient's life, but opening the trachea or wind-pipe. As that has been often done with success, no person, in such desperate circumstances, ought to hesitate a moment about the operation; but as it can only be performed by a surgeon, it is not necessary here to give any directions about it.

WHEN a difficulty of swallowing is not attended with an acute pain or inflammation, it is generally owing to an obstruction of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with something that may gently stimulate the glands, as a decoction of figs with vinegar and honey; to which may be added a little mustard, or a small quantity of spirits. But this gargle is never to be used where there are signs of an inflammation. This species of angina has various names among the common people, as the pap of the throat, the falling down of the almonds of the ears, &c. Accordingly, to remove it, they lift the patient up by the hair of the head, and thrust their fingers under the jaws, &c. all which practices are at best useless, and often hurtful.

THOSE who are subject to inflammations of the throat, in order to avoid that disease, ought to live temperate. Such as do not chuse to observe this rule, must have frequent recourse to purging and other evacuations, to discharge the superfluous humours. They ought likewise to beware of catching cold, and should abstain from aliment and medicines of an astringent or stimulating nature.

VIOLENT exercise, by increasing the motion and force of the blood, is apt to occasion an inflammation of the throat, especially if cold liquor be drank immediately after it, or the body suffered suddenly to cool. Those who would avoid this disease ought therefore, after speaking aloud, singing, running, drinking warm liquor, or doing any thing that may strain the throat, or increase the circulation of the blood towards it, to take care to cool gradually, and to wrap some additional coverings about their necks.

I HAVE often known persons who had been subject to sore throats, entirely freed from that complaint by only wearing a ribband, or a bit of flannel, constantly about their necks, or by wearing thicker shoes, a flannel waistcoat, or the like. These may seem trifling, but they have great effect. There is danger indeed in leaving them off after persons have been accustomed to them; but surely the inconveniency of using such things for life, is not to be compared with the danger that may attend the neglect of them.

SOMETIMES, after an inflammation, the glands of the throat continue swelled, and become hard and callous. This complaint is not easily removed, and is often rendered dangerous by the too frequent application of strong stimulating and styptic medicines. The best method is to keep it warm, and to gargle it twice a-day with a decoction of figs sharpened a little with the elixir or spirit of vitriol.

OF THE MALIGNANT QUINSEY, OR PUTRID, ULCEROUS SORE THROAT.

THIS kind of quinsey is but little known in the northern parts of Britain, though, for some time past, it has been very fatal in the more southern counties. Children are more liable to it than adults, females than males, and the delicate than those who are hardy and robust. It prevails chiefly in autumn, and is most frequent after a long course of damp, or sultry weather.

CAUSES - This is evidently a contagious distemper, and is generally communicated by infection. Whole families, and even entire villages, often receive the infection from one person. This ought to put people upon their guard against going near such patients as labour under the disorder; as by that means they endanger not only their own lives, but likewise those of their friends and connexions. Whatever tends to produce putrid or malignant fevers, may likewise occasion the putrid ulcerous sore throat, as unwholesome air, damaged provisions, neglect of cleanliness, &c.

SYMPTOMS - It begins with alternate fits of shivering and heat. The pulse is quick, but low and unequal, and generally continues so through the whole course of the disease. The patient complains greatly of weakness and oppression of the breast; his spirits are low and he is apt to faint away when set upright; he is troubled with a nausea, and often with a vomiting or purging. The two latter are most common in children. The eyes appear red and watery, and the face swells. The urine is at first pale and crude; but, as the disease advances, it turns more of a yellowish colour. The tongue is white, and generally moist, which distinguishes this from an inflammatory disease. Upon looking into the throat it appears swelled, and of a florid red colour. Pale or ash coloured spots, however, are here and there interspersed, and sometimes one broad patch or spot, of an irregular figure, and pale white colour, surrounded with florid red, only appears. These whitish spots or sloughs cover so many ulcers.

AN efflorescence, or eruption upon the neck, arms, breast, and fingers, about the second or third day, is a common symptom of this disease. When it appears, the purging and vomiting generally cease.

THERE is often a slight degree of delirium, and the face frequently appears bloated, and the inside of the nostrils red and inflamed. The patient complains of a disagreeable putrid smell, and his breath is very offensive.

THE putrid, ulcerous sore throat may be distinguished from the inflammatory by the vomiting and looseness with which it is generally ushered in; the foul ulcers in the throat covered with a white or livid coat; and by the excessive weakness of the patient; with other symptoms of a putrid fever.

UNFAVOURABLE symptoms are, an obstinate purging, extreme weakness, dimness of the sight, a livid or black colour of the spots, and frequent shiverings, with a weak, fluttering pulse. If the eruption upon the skin suddenly disppears, or becomes of a livid colour, with a discharge of blood from the nose or mouth, the danger is very great.

IF a gentle sweat break out about the third or fourth day, and continue with a slow firm and equal pulse; if the sloughs cast off in a kindly manner, and appear clean and florid at the bottom; and if the breathing is soft and free, with a lively colour of the eyes, there is reason to hope for a salutary crisis.

REGIMEN. - The patient must be kept quiet, and, for the most part, in bed, as he will be apt to faint when taken out of it. His food must be nourishing and restorative; as sago-gruel with red wine, jellies, strong broths, &c. His drink ought to be generous, and of an antiseptic quality; as red-wine negus, white-wine whey, and such like.

MEDICINE. - The medicine in this kind of quinsey is entirely different from that which is proper in the inflammatory. All evacuations, as bleeding, purging, &c. which weaken the patient, must be avoided. Cooling medicines, as nitre and cream of tartar, are likewise hurtful. Strengthening cordials alone can be used with safety; and these ought never to be neglected.

IF, at the beginning, there is a great a nausea, or inclination to vomit, the patient must drink an infusion of green tea, camomile flowers, or carduus benedictus, in order to cleanse the stomach. If these are not sufficient, he may take a few grains of the powder of ipecacuanha, or any other gentle vomit.

IF the disease is mild, the throat may be gargled with an infusion of sage and rose leaves, to a gill of which may be added a spoonful or two of honey, and as much vinegar as will make it agreeably acid; but when the symptoms are urgent, the sloughs large and thick, and the breath very offensive, the following gargle may be used:

TO six or seven ounces of the pectoral decoction, when boiling, add half an ounce of contrayerva-root; let it boil for some time, and afterwards strain the liquor; to which add two ounces of white-wine vinegar, an ounce of fine honey, and an ounce of the tincture of myrrh. This ought not only to be used as a gargle, but a little of it should frequently be injected with a syringe to clean the throat, before the patient takes any meat or drink. This method is peculiarly necessary for children, who cannot use a gargle.

IT will be of great benefit if the patient frequently receives into his mouth, through an inverted funnel, the steams of warm vinegar, myrrh, and honey.

BUT when the putrid symptoms run high, and the disease is attended with danger, the only medicine that can be depended upon is the Peruvian bark. It may be taken in substance, if the patient's stomach will bear it. If not, an ounce of bark grossly powdered, with two drachms of Virginian snake-root, may be boiled in an English pint and a half of water to half pint; to which a tea-spoonful of the elixir of vitriol may be added and an ordinary tea cupful of it taken every three or four hours. Blistering plasters are very beneficial in this disease, especially when the patient's pulse and spirits are low. They may be applied to the throat, behind the ears, or upon the back part of the neck.

SHOULD the vomiting prove troublesome, it will be proper to give the patient two table-spoonfuls of the saline julep every hour. Tea made of mint and a little cinnamon, will be very proper for his ordinary drink, especially if an equal quantity of red-wine be mixed with it.

IN case of a violent looseness, the size of a nutmeg of diascordium, or the japonic confection, may be taken two or three times a-day, or oftener if necessary.

IF a discharge of blood from the nose happens, the steams of warm vinegar may be received up the nostrils frequently; and the drink must be sharpened with spirits of vitriol, or tincture of roses.

IN case of a stranguary, the belly must be fomented with warm water, and emollient clysters given three or four times a-day.

AFTER the violence of the disease is over, the body should still be kept open with mild purgatives; as manna, senna, rhubarb, or the like.

IF great weakness and dejection of spirits, or night-sweats, with other symptoms of a consumption, should ensue, we would advise the patient to continue the use of the Peruvian bark, with the elixir of vitriol, and to take frequently a glass of generous wine. These, together with a milk-diet, and riding on horseback, are the most likely means for recovering his strength.

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