In case of a violent looseness, the patient must be supported with chicken broth, jellies of hartshorn, and the like; and he may use the white decoction for his ordinary drink[101]. If a bloody flux should accompany this fever, it must be treated in the manner recommended under the article Dysentery.
When there is a burning heat, and the patient does not sweat, that evacuation may be promoted by giving him, three or four times a day, a table-spoonful of Mindererus’s spirit[102] mixed in a cup of his ordinary drink.
If the bilious fever be attended with the nervous, malignant, or putrid symptoms, which is sometimes the case, the patient must be treated in the same manner as directed under these diseases.
After this fever, proper care is necessary to prevent a relapse. For this purpose the patient, especially towards the end of autumn, ought to continue the use of the Peruvian bark for some time after he is well. He should likewise abstain from all trashy fruits, new liquors, and every kind of flatulent aliment.
This disease, which in some parts of Britain is called the rose, attacks persons at any period of life, but is most common between the age of thirty and forty. Persons of a sanguine or plethoric habit are most liable to it. It often attacks young people, and pregnant women; and such as have once been afflicted with it are very liable to have it again. Sometimes it is a primary disease, and at other times only a symptom of some other malady. Every part of the body is liable to be attacked by an erysipelas, but it most frequently seizes the legs or face, especially the latter. It is most common in autumn, or when hot weather is succeeded by cold and wet.
CAUSES.——The erysipelas may be occasioned by violent passions or affections of the mind; as fear, anger, &c. When the body has been heated to a great degree, and is immediately exposed to the cold air, so that the perspiration is suddenly checked, an erysipelas will often ensue[103]. It may also be occasioned by drinking to excess, by continuing too long in a warm bath, or by any thing that overheats the blood. If any of the natural evacuations be obstructed, or in too small quantity, it may cause an erysipelas. The same effect will follow from the stoppage of artificial evacuations; as issues, setons, or the like.
SYMPTOMS.——The erysipelas attacks with shivering, thirst, loss of strength, pain in the head and back, heat, restlessness, and a quick pulse; to which may be added vomiting, and sometimes a delirium. On the second, third, or fourth day, the part swells, becomes red, and small pustules appear at which time the fever generally abates.
When the erysipelas seizes the foot, the parts contiguous swell, the skin shines; and, if the pain be violent, it will ascend to the leg, and will not bear to be touched.
When it attacks the face, it swells, appears red, and the skin is covered with small pustules filled with clear water. One or both eyes are generally closed with the swelling; and there is a difficulty of breathing. If the mouth and nostrils be very dry, and the patient drowsy, there is reason to suspect an inflammation of the brain.
If the erysipelas affects the breast, it swells and becomes exceedingly hard, with great pain, and is apt to suppurate. There is a violent pain in the arm-pit on the side affected, where an abscess is often formed.
If in a day or two the swelling subsides, the heat and pain abate, the colour of the part turns yellow, and the cuticle breaks and falls off in scales, the danger is over.
When the erysipelas is large, deep, and affects a very sensible part of the body, the danger is great. If the red colour changes into a livid or black, it will end in a mortification. Sometimes the inflammation cannot be discussed, but comes to a suppuration; in which case fistulas, a gangrene, or mortification, often ensue.
Such as die of this disease are commonly carried off by the fever, which is attended with difficulty of breathing, and sometimes with a delirium and great drowsiness. They generally die about the seventh or eighth day.
REGIMEN.——In the erysipelas the patient must neither be kept too hot nor too cold, as either of these extremes will tend to make it retreat, which is always to be guarded against. When the disease is mild, it will be sufficient to keep the patient within doors, without confining him to his bed, and to promote the perspiration by diluting liquors, &c.
The diet ought to be slender, and of a moderately cooling and moistening quality, as groat-gruel, panado, chicken or barley-broth, with cooling herbs and fruits, &c. avoiding flesh, fish, strong drink, spices, pickles, and all other things that may heat and inflame the blood; the drink may be barley-water, an infusion of elder-flowers, common whey, and such like.
But if the pulse be low, and the spirits sunk, the patient must be supported with negus, and other things of a cordial nature. His food may be sago-gruel with a little wine, and nourishing broths taken in small quantities, and often repeated. Great care however must be taken not to overheat him.
MEDICINE.——In this disease much mischief is often done by medicine, especially by external applications. People, when they see an inflammation, immediately think that something ought to be applied to it. This indeed is necessary in large phlegmons; but in an erysipelas the safer course is to apply nothing. Almost all ointments, salves, and plasters, being of a greasy nature, tend rather to obstruct and repel, than promote any discharge from the part. At the beginning of this disease it is neither safe to promote a suppuration, nor to repel the matter too quickly. The erysipelas in many respects resembles the gout, and is to be treated with the greatest caution. Fine wool, or very soft flannel, are the safest applications to the part. These not only defend it from the external air, but likewise promote the perspiration, which has a great tendency to carry off the disease. In Scotland the common people generally apply a mealy cloth to the parts affected, which is far from being improper.
It is common to bleed in the erysipelas; but this likewise requires caution. If however the fever be high, the pulse hard and strong, and the patient vigorous, it will be proper to bleed; but the quantity must be regulated by these circumstances, and the operation repeated as the symptoms may require. If the patient has been accustomed to strong liquors, and the disease attacks his head, bleeding is absolutely necessary.
Bathing the feet and legs frequently in lukewarm water, when the disease attacks the face or brain, has an excellent effect. It tends to make a derivation from the head, and seldom fails to relieve the patient. When bathing proves ineffectual, poultices, or sharp sinapisms, may be applied to the soles of the feet, for the same purpose.
In cases where bleeding is requisite, it is likewise necessary to keep the body open. This may be effected by emollient clysters, or small doses of nitre and rhubarb. Some indeed recommend very large doses of nitre in the erysipelas; but nitre seldom sits easy on the stomach when taken in large doses. It is however one of the best medicines when the fever and inflammation run high. Half a drachm of it, with four or five grains of rhubarb, may be taken in the patient’s ordinary drink, four times a day.
When the erysipelas leaves the extremities, and seizes the head so as to occasion a delirium or stupor, it is absolutely necessary to open the body. If clysters and mild purgatives fail to have this effect, stronger ones must be given. Blistering plasters must likewise be applied to the neck, or behind the ears, and sharp cataplasms laid to the soles of the feet.
When the inflammation cannot be discussed, and the part has a tendency to ulcerate, it will then be proper to promote suppuration, which may be done by the application of ripening poultices with saffron, warm fomentations, and such like.
When the black, livid, or blue colour of the part shews a tendency to mortification, the Peruvian bark must be administered. It may be taken along with acids, as recommended in the small-pox, or in any other form more agreeable to the patient. It must not however be trifled with, as the patient’s life is at stake. A drachm may be given every two hours, if the symptoms be threatening, and cloths dipped in warm camphorated spirits of wine, or the tincture of myrrh and aloes, may be applied to the part, and frequently renewed. It may likewise be proper in this case to apply poultices of the bark, or to foment the part affected with a strong decoction of it.
In what is commonly called the scorbutic erysipelas, which continues for a considerable time, it will only be necessary to give gentle laxatives, and such things as purify the blood and promote the perspiration. Thus, after the inflammation has been checked by opening medicines, the decoction of woods[104] may be drank, after which a course of bitters will be proper.
Such as are liable to frequent attacks of the erysipelas ought carefully to guard against all violent passions; to abstain from strong liquors, and all fat, viscid, and highly nourishing food. They should likewise take sufficient exercise, carefully avoiding the extremes of heat or cold. Their food should consist chiefly of milk, and such fruits, herbs, and roots, as are of a cooling quality; and their drink ought to be small-beer, whey, butter-milk, and such like. They should never suffer themselves to be long costive. If that cannot be prevented by suitable diet, it will be proper to take frequently a gentle dose of rhubarb, cream of tartar, the lenitive electuary, or some other mild purgative.
This is sometimes a primary disease, but oftener only a symptom of some other malady; as the inflammatory, eruptive, or spotted fever, &c. It is very common however as a primary disease in warm climates, and is most incident to persons about the prime or vigour of life. The passionate, the studious, and those whose nervous system is irritable in a high degree, are most liable to it.
CAUSES.——This disease is often occasioned by night-watching, especially when joined with hard study: it may likewise proceed from hard drinking, anger, grief, or anxiety. It is often occasioned by the stoppage of usual evacuations; as the bleeding piles in men, the customary discharges of women, &c. Such as imprudently expose themselves to the heat of the sun, especially by sleeping without doors in a hot season with their heads uncovered, are often suddenly seized with an inflammation of the brain, so as to awake quite delirious. When repellents are imprudently used in an erysipelas, an inflammation of the brain is sometimes the consequence. It may likewise be occasioned by external injuries, as blows or bruises upon the head, &c.
SYMPTOMS.——The symptoms which usually precede a true inflammation of the brain are pain of the head, redness of the eyes, a violent flushing of the face, disturbed sleep, or a total want of it, great dryness of the skin, costiveness, a retention of urine, a small dropping of blood from the nose, singing of the ears, and extreme sensibility of the nervous system.
When the inflammation is formed, the symptoms in general are similar to those of the inflammatory fever. The pulse indeed is often weak, irregular, and trembling; but sometimes it is hard and contracted. When the brain itself is inflamed, the pulse is always soft and low; but when the inflammation only affects the integuments of the brain, viz. the dura and pia mater, it is hard. A remarkable quickness of hearing is a common symptom of this disease; but that seldom continues long. Another usual symptom is a great throbbing or pulsation in the arteries of the neck and temples. Though the tongue is often black and dry, yet the patient seldom complains of thirst, and even refuses drink. The mind chiefly runs upon such objects as have before made a deep impression on it; and sometimes, from a sullen silence, the patient becomes all of a sudden quite outrageous.
A constant trembling and starting of the tendons is an unfavourable symptom, as are also a suppression of urine; a total want of sleep; a constant spitting; a grinding of the teeth, which last may be considered as a kind of convulsion. When a phrenitis succeeds an inflammation of the lungs, of the intestines, or of the throat, &c. it is owing to a translation of the disease from these parts to the brain, and generally proves fatal. This shews the necessity of proper evacuations, and the danger of repellents in all inflammatory diseases.
The favourable symptoms are, a free perspiration, a copious discharge of blood from the nose, the bleeding piles, a plentiful discharge of urine, which lets fall a copious sediment. Sometimes the disease is carried off by a looseness, and in women by an excessive flow of the menses.
As this disease often proves fatal in a few days, it requires the most speedy applications. When it is prolonged, or improperly treated, it sometimes ends in madness, or a kind of stupidity which continues for life.
In the cure, two things are chiefly to be attended to, viz. to lessen the quantity of blood in the brain, and to retard the circulation towards the head.
REGIMEN.——The patient ought to be kept very quiet. Company, noise, and every thing that affects the senses, or disturbs the imagination, increases the disease. Even too much light is hurtful: for which reason the patient’s chamber ought to be a little darkened, and he should neither be kept too hot nor cold. It is not however necessary to exclude the company of an agreeable friend, as this has a tendency to sooth and quiet the mind. Neither ought the patient to be kept too much in the dark, lest it should occasion a gloomy melancholy, which is too often the consequence of this disease.
The patient must, as far as possible, be soothed and humoured in every thing. Contradiction will ruffle his mind, and increase his malady. Even when he calls for things which are not to be obtained, or which might prove hurtful, he is not to be positively denied them, but rather put off with the promise of having them as soon as they can be obtained, or by some other excuse. A little of any thing that the mind is set upon, though not quite proper, will hurt the patient less than a positive refusal. In a word, whatever he was fond of, or used to be delighted with when in health, may here be tried, as pleasing stories, soft music, or whatever has a tendency to sooth the passions and compose the mind. Boerhaave proposes several mechanical experiments for this purpose; as the soft noise of water distilling by drops into a bason, and the patient trying to reckon them, &c. Any uniform sound, if low and continued, has a tendency to procure sleep, and consequently may be of service.
The aliment ought to be light, consisting chiefly of farinaceous substances; as panado, and water-gruel sharpened with jelly of currants, or juice of lemons, ripe fruits roasted or boiled, jellies, preserves, &c. The drink small, diluting, and cooling; as whey, barley-water, or decoctions of barley and tamarinds, which latter not only render the liquor more palatable, but likewise more beneficial, as they are of an opening nature.
MEDICINE.——In an inflammation of the brain, nothing more certainly relieves the patient than a free discharge of blood from the nose. When this comes of its own accord, it is by no means to be stopped, but rather promoted, by applying cloths dipped in warm water to the part. When bleeding at the nose does not happen spontaneously, it may be provoked, by putting a straw, or any other sharp body, up the nostril.
Bleeding in the temporal arteries greatly relieves the head: but as this operation cannot always be performed, we would recommend in its stead bleeding in the jugular veins. When the patient’s pulse and spirits are so low, that he cannot bear bleeding with the lancet, leeches may be applied to the temples. These not only draw off the blood more gradually, but by being applied nearer to the part affected, generally give more immediate relief.
A discharge of blood from the hæmorrhoidal veins is likewise of great service, and ought by all means to be promoted. If the patient has been subject to the bleeding piles, and that discharge has been stopped, every method must be tried to restore it; as the application of leeches to the parts, sitting over the steams of warm water, sharp clysters, or suppositories made of honey, aloes, and rock-salt.
If the inflammation of the brain be occasioned by the stoppage of evacuations either natural or artificial, as the menses, issues, setons, or such like, all means must be used to restore them as soon as possible, or to substitute others in their stead.
The patient’s body must be kept open by stimulating clysters or smart purges; and small quantities of nitre ought frequently to be mixed with his drink. Two or three drachms, or more, if the case be dangerous, may be used in the space of twenty-four hours.
The head should be shaved and frequently rubbed with vinegar and rose-water. Cloths dipped in this mixture may likewise be applied to the temples. The feet ought frequently to be bathed in lukewarm water, and soft poultices of bread and milk may be kept constantly applied to them.
If the disease proves obstinate, and does not yield to these medicines, it will be necessary to apply a blistering-plaster to the whole head.
This disease may be occasioned by external injuries; as blows, burns, bruises, and the like. It may likewise proceed from dust, quicklime, or other substances, getting into the eyes. It is often caused by the stoppage of customary evacuations; as the healing of old sores, drying up of issues, the suppressing of gentle morning sweats, or of the sweating of the feet, &c. Long exposure to the night air, especially in cold northerly winds, or whatever suddenly checks the perspiration, especially after the body has been much heated, is very apt to cause an inflammation of the eyes. Viewing snow or other white bodies for a long time, or looking stedfastly at the sun, a clear fire, or any bright object, will likewise occasion this malady. A sudden transition from darkness to very bright light will often have the same effect.
Nothing more certainly occasions an inflammation of the eyes than night-watching, especially reading or writing by candle-light. Drinking spirituous liquors, and excess of venery, are likewise very hurtful to the eyes. The acrid fumes of metals, and of several kinds of fuel, are also pernicious. Sometimes an inflammation of the eyes proceeds from a venereal taint, and often from a scrophulous or gouty habit. It may likewise be occasioned by hairs in the eye-lids turning inwards, and hurting the eyes. Sometimes the disease is epidemic, especially after wet seasons; and I have frequently known it prove infectious, particularly to those who lived in the same house with the patient. It may be occasioned by moist air, or living in low damp houses, especially in persons who are not accustomed to such situations. In children it often proceeds from imprudently drying up of scabbed heads, a running behind the ears, or any other discharge of that kind. Inflammations of the eyes often succeed the small-pox or measles, especially in children of a scrophulous habit.
SYMPTOMS.——An inflammation of the eyes is attended with acute pain, heat, redness, and swelling. The patient is not able to bear the light, and sometimes he feels a pricking pain, as if his eyes were pierced with a thorn. Sometimes he imagines his eyes are full of motes, or thinks he sees flies dancing before him. The eyes are filled with a scalding rheum, which rushes forth in great quantities, whenever the patient attempts to look up. The pulse is generally quick and hard, with some degree of fever. When the disease is violent, the neighbouring parts swell, and there is a throbbing or pulsation in the temporal arteries, &c.
A slight inflammation of the eyes, especially from an external cause, is easily cured; but when the disease is violent, and continues long, it often leaves specks upon the eyes, or dimness of sight, and sometimes total blindness.
If the patient be seized with a looseness, it has a good effect; and when the inflammation passes from one eye to another, as it were by infection, it is no unfavourable symptom. But when the disease is accompanied with a violent pain of the head, and continues long, the patient is in danger of losing his sight.
REGIMEN.——The diet, unless in scrophulous cases, can hardly be too spare, especially at the beginning. The patient must abstain from every thing of a heating nature. His food should consist chiefly of mild vegetables, weak broths, and gruels. His drink may be barley-water, balm-tea, common whey, and such like.
The patient’s chamber must be darkened, or his eyes shaded by a cover, so as to exclude the light, but not to press upon the eyes. He should not look at a candle, the fire, or any luminous object, and ought to avoid all smoke, as the fumes of tobacco, or any thing that may cause coughing, sneezing, or vomiting. He should be kept quiet, avoiding all violent efforts, either of body or mind, and encouraging sleep as much as possible.
MEDICINE.——This is one of those diseases wherein great hurt is often done by external applications. Almost every person pretends to be possessed of a remedy for the cure of sore eyes. These remedies generally consist of eye-waters and ointments, with other external applications, which do mischief twenty times for once they do good. People ought therefore to be very cautious how they use such things, as even the pressure upon the eyes often increases the malady.
Bleeding, in a violent inflammation of the eyes, is always necessary. This should be performed as near the part affected as possible. An adult may lose ten or twelve ounces of blood from the jugular vein, and the operation may be repeated according to the urgency of the symptoms. If it should not be convenient to bleed in the neck, the same quantity may be let from the arm, or any other part of the body.
Leeches are often applied to the temples, or under the eyes, with good effect. The wounds must be suffered to bleed for some hours, and if the bleeding stop soon, it may be promoted by the application of cloths dipt in warm water. In obstinate cases, it will be necessary to repeat this operation several times.
Opening and diluting medicines are by no means to be neglected. The patient may take a small dose of Glauber’s salts, and cream of tartar, every second or third day, or a decoction of tamarinds with senna. If these be not agreeable, gentle doses of rhubarb and nitre, a little of the lenitive electuary, or any other mild purgative, will answer the same end. The patient at the same time must drink freely of water-gruel, tea, whey, or any other weak diluting liquor. He ought likewise to take, at bed-time, a large draught of very weak wine-whey, in order to promote perspiration. His feet and legs must frequently be bathed in lukewarm water, and his head shaved twice or thrice a-week, and afterwards washed in cold water. This has often a remarkably good effect.
If the inflammation does not yield to these evacuations, blistering-plasters must be applied to the temples, behind the ears, or upon the neck, and kept open for some time by the mild blistering ointment. I have seldom known these, if long enough kept open, fail to remove the most obstinate inflammation of the eyes; but for this purpose it is often necessary to continue the discharge for several weeks.
When the disease has been of long standing, I have seen very extraordinary effects from a seton in the neck, or between the shoulders, especially the latter. It should be put upwards and downwards, or in the direction of the spine, and in the middle between the shoulder-blades. It may be dressed twice a-day with yellow basilicon. I have known patients, who had been blind for a considerable time, recover sight by means of a seton placed as above. When the seton is put across the neck, it soon wears out, and is both more painful and troublesome than between the shoulders; besides, it leaves a disagreeable mark, and does not discharge so freely.
When the heat and pain of the eyes are very great, a poultice of bread and milk, softened with sweet oil or fresh butter, may be applied to them, at least all night; and they may be bathed with lukewarm milk and water in the morning.
If the patient cannot sleep, which is sometimes the case, he may take twenty or thirty drops of laudanum, or two spoonfuls of the syrup of poppies, over night, more or less according to his age, or the violence of the symptoms.
After the inflammation is gone off, if the eyes still remain weak and tender, they may be bathed every night and morning with cold water and a little brandy, six parts of the former to one of the latter. A method should be contrived by which the eye can be quite immersed in the brandy and water, where it should be kept for some time. I have generally found this, or cold water and vinegar, as good a strengthener of the eyes as any of the most celebrated collyriums.
When an inflammation of the eyes proceeds from a scrophulous habit, it generally proves very obstinate. In this case the patient’s diet must not be too low, and he may be allowed to drink small negus, or now and then a glass of wine, The most proper medicine is the Peruvian bark, which may either be given in substance, or prepared in the following manner:
Take an ounce of the bark in powder, with two drachms of Winter’s bark, and boil them in an English quart of water to a pint; when it has boiled nearly long enough, add half an ounce of liquorice-root sliced. Let the liquor be strained. Two, three, or four table-spoonfuls, according to the age of the patient, may be taken three or four times a-day, It is impossible to say how long this medicine should be continued, as the cure is sooner performed in some than in others; but in general it requires a considerable time to produce any lasting effects.
Dr. Cheyne says, ‘That Æthiops mineral never fails in obstinate inflammations of the eyes, even scrophulous ones, if given in a sufficient dose, and duly persisted in.’ There is no doubt but this and other preparations of mercury may be of singular service in ophthalmias of long continuance, but they ought always to be administered with the greatest caution, or by persons of skill in physic.
It will be proper frequently to look into the eyes, to see if any hairs be turned inwards, or pressing upon them[105]. These ought to be removed by plucking them out with a pair of small pincers.
Those who are liable to frequent returns of this disease, ought constantly to have an issue in one or both arms. Bleeding or purging in the spring and autumn, will be very beneficial to such persons. They ought likewise to live with the greatest regularity, avoiding strong liquor, and every thing of a heating quality. Above all, let them avoid the night-air and late studies[106].
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 part 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 clothes, 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 suffocation; 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 sometimes starved at last, merely from an inability to swallow any kind of food.
When the breathing is laborious, with straitnesss 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 among the peasants of Scotland. 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 wrapped 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 black currant-bush; but where the jelly 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 acute 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 recommended in this disease, as a swallow’s nest, poultices made of the fungus called Jew’s ears, album Græcum, &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[107].
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 tunnel, 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 his 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 riband, 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 which 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 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 disappears, 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 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 a 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 strangury, 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.